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Jun 2015

Health Insurance Coverage For Surrogates

Is your patient a surrogate? To increase your chances of successfully obtaining reimbursement for the medical services provided to the surrogate and the baby, here are a few things a hospital should keep in mind:

  1. Make sure the surrogate has her own health insurance coverage! In most cases, the parents’ health insurance will not cover their surrogate’s hospital bill. So, it is important for the hospital to ensure that the surrogate – the woman carrying the baby – has her own health insurance. Here are a few questions that the hospital can ask to ensure it has proper documentation to obtain payment: Does the hospital have a copy of the surrogate’s insurance card that clearly states the surrogate is the person holding the policy and that the insurance company identified on the card is the insurer? Does the hospital have anything in writing from the insurance company verifying that the surrogate’s insurance coverage is valid, and she is eligible for benefits? Did the hospital obtain authorization for the surrogate’s stay and the baby’s post-delivery stay?
  2. Determine whether the surrogate’s health insurance has a surrogacy exclusion clause. Patients are protected by state laws and regulations with regard to their identity and medical information. As such, it is tempting to say that a surrogate mother’s health insurance will be obligated to pay for her health care needs because it is none of her health insurance company’s business whose child she is really carrying. However, the hospital may be stuck with an unpaid hospital bill if the surrogate’s health insurance plan has a “surrogacy exclusion clause,” which means the insurance company will not cover any costs associated with her pregnancy if she is acting as a surrogate. The best way to find out whether there is a surrogacy exclusion clause in the surrogate’s health plan is to call the insurance company to confirm that the surrogate’s health plan covers her and her baby in the hospital when she is acting as a surrogate, and also request a copy of the health policy from the insurance company or the surrogate.
  3. Double check whether the surrogate has health coverage specifically for her surrogacy, in addition to her regular health insurance. The surrogate may have specific coverage designed for her surrogacy, such as coverage from New Life Agency, in addition to her normal day-to-day health insurance. If this is the case, the hospital will have to look into coordination of benefits to insure that the correct payor is being billed for the services.


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