Episode Transcript
[00:00:00] Speaker A: Insurance probably isn't the first thing people think about when they're planning a surrogacy.
[00:00:04] Speaker B: Or egg donation journey.
[00:00:06] Speaker A: But it's one of the most important. Whether you're growing your family or helping someone else grow theirs, the reality is that third party reproduction comes with risks, medical, financial and legal. And no matter how carefully you plan, things don't always go as expected.
That's why having the right protection in place matters. Insurance is what makes it possible for everyone involved to move forward with with clarity, confidence and security.
It's not just a formality. It's part of the foundation.
Welcome back to Fertility Cafe. I'm your host, Eloise Drain. Today we're digging into a part of the family building process that affects everyone involved. Intended parents, surrogates, egg donors and professionals. And that's insurance.
When you're part of a third party reproduction journey, there are so many moving parts. The focus is often on the medical steps, the legal contracts, or the emotional preparation. But behind all of it, insurance plays a key role in making sure everyone is protected. This isn't the kind of coverage you get from a typical health plan. It's layered, it's specific. And honestly, it can be hard to understand, especially when you're already navigating a process that's emotional and complex. That's why today's conversation matters. Whether you're a parent to be trying to make sure your surrogate is covered, or a surrogate yourself wanting to understand how your medical care and recovery are protected, this episode is for you. I'm joined by Virginia Hart, founder and executive chair of Art Risk Financial and Insurance Solutions.
For over two decades, she specialized in building insurance products that support the assisted reproduction community. From pregnancy coverage to donor risk management, to financial safeguards for the entire journey, she brings a deep understanding of the risks involved and the protections that can make all the difference.
Let's get into it.
Well, Virginia, thank you for joining me. I appreciate it.
[00:02:10] Speaker C: Thank you for having me. I'm excited to be here.
[00:02:13] Speaker B: First, let's get into the world of insurance. And how did you first get into insurance?
[00:02:20] Speaker C: Oh, gosh. So I was a director of human resources for many years and the company that I was working for was doing some downsizing or right sizing, whatever you want to call it. They combined three jobs into two. I had the lease seniority, so they said, good for you, you get to leave. So I did. And the insurance broker who was doing the insurance for, for that company called me and said, I think you would be really, really good at this. And I said, I think you're crazy at sales and no thank you. And she said, no, I think you should give it a whirl. I was a single mom and the thought that I could basically form my own destiny, my earnings were based on what I produced was kind of intriguing. So that's, I said yes and I worked with her for a year and then I started my own company.
Wow.
[00:03:11] Speaker B: So you went from no and okay, I'm going to start my own company.
[00:03:16] Speaker C: Yeah, it seemed like a good idea at the time. In my bedroom.
[00:03:19] Speaker B: Yes, yes, absolutely.
[00:03:21] Speaker C: The original remote worker, right?
[00:03:23] Speaker B: That's right. That's right. What types of insurance were people most confused about when you started? And those still areas where people struggle with today. As far as insurance, I don't think.
[00:03:34] Speaker C: Anyone understands health insurance. I think it's a complete mystery to them. Life insurance is easy. You die, you get paid. That health insurance is so confusing as far as what's a copay, what's a deductible, what's an out of pocket maximum? But I paid this much, why do I need to pay more? What's a network, what's out of network? My doctor said they would take it. Yeah, they'll take anything. The insurance company just won't pay it. All of those things. I think health insurance is probably the most things that people just don't understand.
[00:04:03] Speaker B: Yes. Oh, 100%. So for someone hearing about art risk for the first time, can you talk about what kind of coverage or protection do you guys actually provide?
[00:04:15] Speaker C: That's a great question. So our goal is to make sure that all parties involved in a third party arrangement, either donor or surrogate, are financially protected.
So we offer products that, that will protect all of that interest.
So for example, on the donor side we have a complication insurance that will pay from the start date of medication up to four or six months after the transfer. And any complication that would occur, it has no deductible and no copay. So 100% of a complication's medical bills would be covered. So that really protects the donor from getting late notices and you know, ding her credit. And it protects the intended parent. For surrogates, we take a look at two things. What does the surrogate bring to the table? What insurance does she already have in place? Because you don't need two. What does their contract say? Because we want to make sure that if the intended parents have a financial liability in that contract that they're covered. So from the very beginning of the process we have a complications insurance that would Cover any complication due to the retrieval, including an ectopic pregnancy. We want to make sure that medically she's covered with medical insurance that would cover the prenatal, the postnatal, the delivery and any complications that would occur. We want to make sure that she has life insurance so that should she perish in this process, her family is taken care of. And then we want to take a look at kind of ancillary coverages. Are the intended parents responsible for loss of reproductive organs? If so, we can add that to a policy.
Are they responsible for her bed rest if she's not able to work? We have policies that can cover that as well. And then there's an optional coverage that would reimburse the parents for a miscarriage or fetal demise so that they have money to do this process again.
[00:06:15] Speaker B: And we're going to go into depth with all of those, but high level. Obviously I wanted you to kind of share all of the various things that you guys are involved in over the years.
[00:06:26] Speaker A: Have you seen the needs of intended parents and surrogate shift when it comes to insurance?
[00:06:31] Speaker C: Yes, absolutely. Art Risk is actually formed in 2010 and before that I was doing it under the name of another company that I, the Resource Group. And we were still doing surrogate insurance. And then it was just like, well, we're not going to tell the insurance company this is a surrogacy life insurance. Why? Very low dollar life insurance amount. And now everyone is very in tune to the insurance and what they need, what they should have coverage. No one really suggests that you don't say it's a surrogate pregnancy because the insurance companies will find out.
So don't hide anything. And I think the whole awareness around insurance has shifted dramatically.
[00:07:12] Speaker B: Yes.
[00:07:12] Speaker C: Which is 100%.
[00:07:14] Speaker B: Yeah. So when people come into the process and they usually don't realize how many different types of insurances are involved. And I know even for us, and when we say about, well, she needs this and this and this, and they're just like, well, what is that? And how, what is, how does that play into it? And what are the core areas of coverage that need to be addressed, like.
[00:07:34] Speaker A: Right from the start, like before she.
[00:07:36] Speaker B: Even gets into, you know, the fertility medication and all of that, where should they be looking as far as like core coverage that's absolutely needed.
[00:07:47] Speaker C: So the products that they actually have to have, number one, is that she has to have something to cover her medical insurance. So before you even get into the process, what does she have? Does she have anything? If not, what can we put into place.
Right. So you have to take a look at that. You also need to make sure that she's got some form of life insurance or accidental death that will cover that death. And then we start expanding out from there and going into the other types of coverage. In an ideal world, we talk to the intended parent at Match.
So they know financially really what they're looking at. They know, does she have insurance that will cover if so that's far less expensive than having to buy a new policy.
How much is the life insurance going to be the complications insurance to cover her in case she were to have a complication due to the retrieval? How much would it cost to have the miscarriage insurance so then they can start thinking about what they want and what they have to have and what the costs are.
[00:08:44] Speaker B: Can you break down why each of them matter, whether surrogacy or even in donation journey, like why these additional policies besides medical insurance are just as important to have?
Because I know everybody is, you know, you're looking at the cost, but it's just like, yeah, there's a cost up front, but it's going to save you a whole lot of heartache if something happens in the end.
[00:09:07] Speaker C: Absolutely. So the complications insurance, either on the donor or the recipient side, very important to have because those complications can be horribly expensive on the donor side. Ohss if you end up ovarian hyperstimulation syndrome, if you end up in the hospital, first of all, the emergency room visit alone, by the time they do all their tests and everything can be anywhere between six and $10,000, $15,000 depending upon the hospital.
And who wants to pay that?
I mean, that's expensive if she's hospitalized and we've seen some, you know, 50, 60, $70,000. So that's very important to have that coverage because her health insurance technically doesn't have to cover it if it excludes infertility. So you want to make sure she's got that added layer. Same thing on the surrogate. If her health insurance has not yet been effective because you want to make it effective at pregnancy or whatever, or she lives in a state where pregnancy is a qualifying event, so you're waiting for that. You need to make sure that if she has an ectopic pregnancy or she has an allergic reaction to the medication, she is covered. And we all know there was a tragic case last year where it was an allergic reaction to the medication and she was in the ICU for many days and that policy would have covered. So that's why that's important.
Her medical insurance is important because just saying, well, I'm going to pay cash because she's had three great pregnancies in the past, so this is going to be great too. That is a really good thought and I certainly hope she does. There's just no guarantee. Every pregnancy is a unique venture. Everyone is different. And because it's worked in the past unfortunately does not mean it's going to work in the future.
So you don't know if she's going to be on bed rest for whatever reason, the membrane is separating or anything is happening really. Our bodies are complex and so we can't predict that. And so you never know. And so not to have insurance and leave yourself as well as your surrogate exposed because ultimately the bills are in her name is just not the right thing to do. You know, if you had to buy an ACA compliant plan to cover her medical insurances, honestly you're looking at maybe $15,000 for a year, which, including her medical costs, I realize that's not inexpensive, but it's a lot less expensive than $100,000. And so that's really how you have to look at it. As far as the life insurance goes, every contract is going to require that maternal deaths don't happen often. When they do happen, they're devastating.
And it's very nice to know that the family at least is taken care of, that her kids will be able to play football and do cheer and go to college because there are funds available or if she's a single mom, there's somebody to help whoever is taking those children in with their expenses. So I think that's just critical.
The other insurance is really protect the intended parent more. They really, for example the loss of reproductive organ or, or the miscarriage that really reimburses the intended parent so that money isn't out of their pocket because contractually sometimes that is required.
[00:12:20] Speaker B: And unfortunately too, I mean we're sitting here talking about all these insurance policies but you and both and I know firsthand of actual people that this has happened to. So this is just an, is not just hyper generalized conversations that we're having.
[00:12:35] Speaker C: No, unfortunately these are all real life examples. Yeah, I wish they weren't, but they are.
[00:12:41] Speaker B: Yeah, you had alluded to if surrogate hasn't a plan or she doesn't have a plan or whatever. So what happens when a surrogate doesn't have a health insurance plan or she has a medical insurance plan. But there's, when you guys have reviewed her records, it says that there's an exclusion. How does art risk step in to help create like a workable plan for this particular person?
[00:13:06] Speaker C: Excellent question. So a lot of it depends on the time of year.
If it's late in the fall, then we can put into place with the Affordable Care act plan. So that's normal health insurance that does not have a surrogate exclusion that she can use. You can only apply for those plans between November 1 and January 15. So very near a window.
And it also depends on whether or not she lives in a state where pregnancy is a qualifying event.
If pregnancy is a qualifying event, then once she's pregnant, we can put an Affordable Care act plan into place.
Those plans are the most affordable way to obtain health insurance for a surrogate. They're also the most comprehensive.
There are ways that we can bridge that gap. Let's say it's June and they want to do a transfer in July.
So some states have what's called short term insurance.
The short term insurance does not cover pregnancy, but would cover a complication of pregnancy.
So the intended parents would pay out of pocket for any office visits or lab work. But if she had a miscarriage or an ectopic pregnancy or developed gestational diabetes or anything such had to go on bed rest because of a complication, then that policy would pay for those medical expenses, expenses that would get them through to the time of January 1, when the ACA plan would put into place. She would have insurance that she could then deliver the baby on and have coverage. There is also a plan through Voice of London that's called the interim plan that's designed to do the same thing. Because the short term plans are only available in 38 states.
And this, the, the Lloyd's plan is available in all states. So that's another way that we can bridge that gap. Or sometimes intended parents should say, well, I'll wait and I'll transfer in November. And so they do the complications insurance and then the ACA plan is effective in January 1st. There are plans through Lloyd's of London that can be purchased 12 months out of the year that are primary insurance plans. So they will cover prenatal, postnatal delivery complications, C sections, emergency C sections, things like that.
They are not medical insurance and therefore they're a little bit more limited. They might limit the number of ultrasounds a gestational carrier could have, or they might limit the number of fetal non stress tests that they can do.
So they're broader as far as there's no networks. They can go to any doctor, any hospital, but then there's also some limitations of coverage.
[00:15:48] Speaker A: Are there parts of coverage that tend.
[00:15:50] Speaker B: To fall through the cracks if people don't have the proper guidance early on to say, this is what I need, this is what I'm looking for, or so on.
[00:15:59] Speaker C: One thing that falls to the crack more than anything is the accidental death or the life insurance.
That is the one thing where whatever reason people seem to just neglect sometimes I think it's because the contracts often are written that when she gets pregnant she should then get it. And so everyone's so excited that they just forget that. Also some of the contracts are written at the gestational carrier is responsible for obtaining that. And she just doesn't, she doesn't know where to start, she doesn't know what to do, she doesn't know where to go. And then all of a sudden she's five months pregnant, somebody's asking for a documentation and she doesn't have any. So then that one, I think falls through the cracks more than anything. Health insurance people are always on top of. They realize they have to have it. The optional insurances, the miscarriage, the loss of reproductive organs, those, you know, they're optional. So if they don't have it, they don't have it. It just means it's coming out of their pocket.
[00:16:53] Speaker B: So for intended parents, obviously they're financially responsible, whether it's for the donor or the surrogate. That doesn't necessarily mean they're always prepared. What do they need to budget for when it comes to, you know, unexpected complications?
[00:17:10] Speaker C: If she has insurance through her employer, her, her partner's employer, her spouse's employer, that will cover a surrogate pregnancy, then the most they need to budget for is the out of pocket max.
Right, because that plan is going to cover all of her prenatal, all the postnatal. Any complication that occurs is going to be covered. It's very comprehensive coverage.
It's a plan written through Lloyd's of London with some of those exclusions. Great example. There is a doctor that believes in ultrasounds. So for a normal pregnancy, this One surrogate had 24 ultrasounds. Oh my God. Well, the plan was limited to eight.
And every ultrasound was like $150. So the intended parents had to pay for it. That was that. I mean, the doctor definitely did not need to do that, but he was making money, so I think that's why he did it. Not to be cynical, those kinds of things are unexpected. I think with the Lloyd's plans. Some of them, they actually don't Even spend all their deductible, they get the money back. Some of them, I would say the average if they go over services which doesn't happen often is maybe 2 to $3,000. If they don't purchase things like loss of reproductive organ, et cetera, then they need to budget whatever their contract says. If their contract says if she loses an ovary, you pay her $5,000, then that's what they need to budget for.
Same thing with bedrest. If they there's no short term disability plan in place, which if a surrogate is employed, go to her employer and see if she can get it because that's the cheapest best way, then what they're going to have to do is budget for that amount and that's going to be based on her wages. I mean that could be 10, 15, $20,000.
Again, you always have to plan for the worst case scenario when you're doing this budgeting because you just don't know what's going to happen.
[00:18:54] Speaker A: But if you have these policies in.
[00:18:55] Speaker B: Place, then whether she needs bed rest, hospitalization, emergency C section has a major complication, you can pretty be confident that, okay, I know I'm going to have to pay out of pocket, max. I don't have to worry, you know, getting a bill later on for $100,000.
[00:19:15] Speaker C: Correct. You have financially protected yourself and your limit truly is whatever that policy, either the deductible or the deductible in the out of pocket, maximum, whatever that might be. Correct.
[00:19:26] Speaker B: I'm going to switch over to donors real quick. And you mentioned OHSS or ovarian hyperstimulation Syndrome. What typically for the policies, the complication policies that a donor would receive, what typical complication or surgical coverage is covered during with this complication policy? Did she have to go back to her doctor, the fertility clinic, or is it the hospital or does it matter? Like how does that work?
[00:19:54] Speaker C: It really doesn't matter.
Ideally she's called her IVF physician. She said she is having complications of some sort. Then you know, the IVF physician, some of them say, well come on in and let's triage you and see if we can help you out here. Sometimes they can give them IV fluids and, or drain any excess fluid in their abdomen, whatever it may be. Other times at 2 in the morning they're going to say go to the emergency room. No matter what they do, it is covered. So that's the good news. There's no deductible, so there's no money out of the intended parent's pocket.
A lot of times when they end up going to the emergency room, the good news is they really don't have a complicated medication. They were just experiencing discomfort from the procedure, which can happen because it's not comfortable. Right. It's not a walk in the park. One thing is I don't think that the donors are really prepared for that. I think they all think it's going to be a walk in the park. They're young, they're healthy, they're vibrant and oh my gosh, this hurts. Right. The good news is sometimes they go to the emergency room and there's no complication.
And it's a very interesting struggle with the insurance companies because they're like, but there was nothing wrong. But on the other hand, if she didn't go, how would you know?
[00:21:07] Speaker A: Right, Correct.
[00:21:08] Speaker C: Right. So they have to go get treatment. And we've never seen the insurance companies not pay. It's like, yes, it's a complication or she didn't know it was a complication, but she was presenting with reasonable symptoms. And therefore then we, the insurance companies are paying for that, which is great.
So really we have paid for laparoscopic surgery because sometimes there's torsion, you've got to go in and remove an ovary, which is, you know, for a 22 year old, dramatic and traumatic to say the least. You know, whatever that may happen. We had anaphylactic shock from the medication and the donor was in the ICU for about just a couple days. They're all paid, which is great. I mean the coverage is really good coverage and it's super cheap. It's like you know, 300, $350. Yeah. So a lot of coverage for not a lot of money.
[00:21:58] Speaker B: Yeah, no, for sure. I know we've talked about the surrogates and the donors and all of that, but obviously they're, we're doing all of this for a baby to be born, obviously. And then a lot, I think people get misunderstanding about how the coverage for the baby's birth and post delivery care is handled as far as billing, which can, I know, gets tricky fast. What's the right way to make sure hospital bills don't accidentally get routed through the surrogate's insurance?
[00:22:29] Speaker C: Probably the best way is to meet with the financial department of the hospital pre birth and be very clear on whose baby this is.
So when the surrogate goes in to pre register, a best practice is to have her insurance ready to go. Right. So they all know what her insurance is as well as bring a Letter, you know, if the pre birth order is done, bring the pre birth order because that very says this is not her baby. This is a baby of, you know, Joni and John.
And then bring Joanie and John's insurance and bring a letter that says that the baby's insurance should be on plan abcd.
This is the insurance company. Here's a copy of the card. The baby will be added upon birth and just clearly spell it out for that hospital because otherwise they're going to do the easy thing. The mother that gives birth is presumed to be the mother and therefore they're going to bill her insurance. It can be unwound. It just takes time and a pain, quite frankly.
[00:23:31] Speaker B: Yeah. So how can the parents plan for.
[00:23:33] Speaker A: The baby's medical coverage even, especially if.
[00:23:36] Speaker B: After the baby is born and needs extra care after birth?
[00:23:39] Speaker C: So the best thing the parents can do is find out what their insurance will cover and how they will cover cover. So for example, if the baby is not being born in the state where the parents live, which is very common, will their insurance cross state lines? If they live in Oklahoma and the baby is being born, say in Kansas, how is that going to work? Will their insurance cross that state line? Will their insurance cover that baby? Whether it be a well baby or whether it be a, you know, meeting time in the nicu, Is it considered a life threatening emergency? Because most coverages will cover out of state if it is a life threatening emergency.
Our argument always is, any baby that's in a NICU is a life threatening emergency. We had one insurance company say, but they didn't go in through the emergency room. Oh, seriously, let's think about this for a minute. Right, we won that argument. But it's just, you know, the things they come up with. Sometimes you just shake your head and go, really? So if the baby's born healthy, you know, oftentimes you can negotiate a cash rate. If the insurance company says no, it's a healthy baby, it was a planned event, you have an hmo, we're not paying for it. Sometimes depending upon the state, you can get the baby its own plan and it is a PPO plan and it does cross state lines. So sometimes that's available.
But the best way to prevent a tragedy is to find out way ahead of time what you have and what works. There's also plans through Lloyd's of London that will cover that newborn. Not inexpensive, but a catastrophic stop loss. More of a plan. You know what your expenses are going to be. Anything above that would be paid. There's also a contingent plan that you can purchase that says if our insurance won't cover this, insurance will. And so that's another thing that they can do to protect themselves. But getting informed early on and making a plan is the best thing. Don't wait till the baby is born. That never works as well.
[00:25:36] Speaker B: Yeah. So does art risk provide support with claims processing or billing issues or if something, you know, goes wrong with how the hospital files the insurance, can you guys step in and kind of help there?
[00:25:47] Speaker C: Absolutely. So we can do it two ways. We have a complete program where we'll manage the surrogate's bills as well as the newborn bills from beginning to end. Making sure every bill is paid, every bill was for the surrogate, truly surrogate related and the intended parent's responsibility.
And then making sure that at the end there's zero balance statement so nothing come back and bite the surrogate or the intended parent. No surprise billing in the end. So that's a comprehensive service. Or we can also do it on an hourly basis. If there's just a little problem here, a hiccup there, then we can do it on an hourly basis. So there's two ways that we operate and often that happens. We'll have someone say, I just can't get this. I'm done, I'm baked. And the last thing a new parent wants to do is mess with medical bills. Honestly, they want to be with their baby and they don't need the headache. So we definitely can do that. We're here to help every step of the way. We also have a service that if the gestational carrier has an ACA plan that we make sure that every month that premium is paid because once that plan is canceled for non payment of premium, it will not get reinstated. Legally it's not supposed to be, but we can get it done every once in a while. But you can't. No guarantee. But yeah, that's another very important service because you don't want to know that your surrogate loss or health insurance and halfway through the journey and some intended parents say, well it's okay, it's on my credit card. And then they forget that they canceled that credit card because it had fraud on it. And oh guess what, she lost her insurance. Lots of reasons why that's an important service to have.
[00:27:18] Speaker B: I know we keep talking about the intended parents and making assumptions, as my brain is doing anyway, that these are all US based intended parents, but what about international intended parents?
[00:27:29] Speaker C: Some international intended parents need exactly the same insurance for the surrogate or the donor as if they were in the US that would make zero difference. The big difference is with the baby because most international couples tend to or singles, doesn't matter, tend to have insurance through their country because they have nationalized health care and nationalized health care does not work outside of their country.
Travel insurance does not work because you cannot add a newborn through your travel insurance. They have to be at least 14 days old and healthy. So if it's a healthy baby, they can negotiate with the hospital, they can have somebody like us negotiate with the hospital and they can get a lower rate.
Everything's negotiable. But the issue becomes is what if the baby isn't born healthy? So there are several insurances out there that they can purchase that will cover that catastrophic NICU event.
And they are available. They need to be purchased, Some of them need to be purchased prior to the transfer and some of them after the transfer. So there's all options available. None of them are inexpensive. The intended parents are looking at probably 15, $16,000 anywhere really between 10 and let's say $15,000 to get insurance.
But at least they have coverage. They're not going to get stuck with a 100,200, $300,000 bill.
So it's very important that they get that.
[00:28:58] Speaker B: And this is in addition to getting the surrogate's medical insurance because again, as we stated earlier, the baby cannot be on the surrogate's insurance.
[00:29:07] Speaker C: Correct? That's absolutely true.
[00:29:10] Speaker B: You alluded to earlier about the insurance availability restrictions depending on geography, whether it's for the surrogate or the even the intended parents crossing over. But specifically for surrogates, what are some of the hardest states to kind of secure surrogacy coverage?
[00:29:29] Speaker C: Right now, Wyoming is a must. You cannot get surrogate friendly insurance. In Wyoming, a surrogate may have a plan that's surrogate friendly through an employer, but you can't buy one other than a lloyd's plan. So there's no ACA plan available.
California is very challenging right now with insurance because of the liens, which means that they will ask the surrogate to pay back what she was paid up to the amount of her medical bills, which means that expense is on the intended parents. There currently is a bill that is going through the California legislature that will not allow that practice anymore. We're all crossing fingers. We're in one more committee and then maybe it gets, we get lucky. So California is a tough state because of the liens. Other than that, those are the two hardest states, honestly. And Wyoming is a super large state for surrogacy. Anyway, Oregon is a little bit challenging because they also have liens. So Washington, not so hard, except that everything has to go through there. Washington and New York both work this way. Everything has to go through the state exchange.
So if the gestational carrier ever was on state aid, Medicaid, Apple Care, whatever you want to call it, depending upon the state, they have their own special name. That can be challenging. You can usually get it done. It's just a challenge.
[00:30:48] Speaker B: So what if a surrogate has insurance but there's an exclusion on her policy? So she can't use her policy and we need to get an ACA plan for her, which is the Affordable Care act, or, you know, some people call it Obama plan, but it's Affordable Care Act. What if she has two policies? How does that work?
[00:31:10] Speaker C: So if she has two policies, there's a, what they call coordination of benefits. And every policy in it has rules. Do they coordinate benefits? Do they not coordinate benefits?
Which policy is primary, which policy is secondary? You need to know what the rule is on the policy. So for example, there's the older policy. Older policy will be primary. Sometimes it says any employee that you have through your employer will be primary. So what that means if you have a primary plan is not surrogate friendly. So there's an ACA plan purchased. All of the medical bills have to go through the primary plan, first be denied and then once denied, go through that ACA plan. It can get nightmarish because sometimes the plan that should have denied the bill didn't, but they have a right to deny it up to two years later. When somebody has two insurance plans, we highly recommend claims management from the very beginning because we'll make sure and go through that every bill was denied by that primary carrier and then submitted to the secondary and properly paid. It can get really confusing and everyone is like, well, they paid anyway.
Okay, well great. But that doesn't mean they're not going to come back and deny it later. We've heard like, well, just don't tell them you have that other insurance. There's some big computer insurance and insurance computer in this guy. And they know, don't worry, they know, right? So you can't fool them. So we say no every time you go to the doctor, a lab, an acupuncturist, wherever you go, give them both insurance parts so it's on record.
And if one denies, they'll automatically send it to the other.
[00:32:57] Speaker B: You talked earlier about lawmakers and changing and trying to Improve laws out of California, for instance. How are you guys approaching third party reproduction coverage? Or are things still stuck in the same place? I mean, I know that Nevada is one state in which they cannot deny a surrogate medical coverage with her insurance if she has one through an employer or whatever, but how does that. What are you seeing there?
[00:33:26] Speaker C: We're actually seeing progress being made, amazingly enough. New York also has a bill that says you cannot deny surrogate medical bills. They all exclude self funded plans though, which typically are the larger employers. Nevada does as well as New York. California will get rid of the liens. I'm convinced it's going to go through.
And pregnancy will be a qualifying event, which helps not only surrogates and gestational carriers, but really anybody that gets pregnant without health insurance. There are 14 states that do have pregnancy as a qualifying event. So that's nice. And we were laughing because so does Kentucky. And we're like, if Kentucky has it, why cannot California? Right. We're just like Kentucky of all cities. That was kind of interesting. Resolve has actually done a lot of work, not so much in the world of surrogacy, but in the world of infertility and has gotten some laws passed so that, number one, it's not so black and white. You know, the definition is much expanded, which is great. They've also done a lot of work in the area of employer benefits. So getting employer benefits to not only pay for some of the cost of third party reproduction, but also to include the cost for surrogacy every once in a while. Primarily in the tech space, we find an insurance policy that will cover the gestational carrier's medical bills under the intended parent.
Very rare, kind of a unicorn. But they do exist, which is amazing. And we're hoping I was one of those unicorns. Yeah. And so we're really hoping that as the dialogue continues about we need to offer more and better benefits and as the talent becomes rarer and harder to find for some of these tech companies, for the startups they're actually just starting to include more and more, which I think is great.
[00:35:18] Speaker B: Yeah, for sure. For Art Risk, there's obviously people that will ask, well, does any of these insurance policies, do they cover ivf? Is that something that we can purchase through you? Where I can purchase an insurance policy that will cover my IVF or cover my medications or what have you at.
[00:35:37] Speaker C: This particular time, we do not offer insurance that will cover ivf. We do have a program that will allow for discounting on an IVF procedure if the Doctor accepts it. Primarily it's through multi plan. So if your doctor is in the multiplan network, they would be able to access that at a discount. Huge discounts on labs and also some discounts on medication.
So there's no real IVF program.
A lot of employers are starting to offer them. A lot of insurance companies have expanded coverage now, which is great.
Laws are changing to the advantage of patients who need IVF coverage. So that's good. Keep your ears to the ground and look at your insurance policy every year, because they are changing. We also at Art Risk will evaluate insurance policies and say, you have this coverage. This is how you access it. So make sure that you're getting everything that's coming to you is my advice. Take a look at that policy and.
[00:36:33] Speaker B: Take a look at that policy. And if you clearly don't understand, because the majority of us do not when it comes to reading these policies, call someone at ART Risk because that is truly where you guys specialize in, correct?
[00:36:45] Speaker C: Yeah. Yeah, exactly.
[00:36:47] Speaker B: So what advice would you give to someone navigating this for the first time who might be overwhelmed by all the.
[00:36:54] Speaker C: Moving parts, baby steps, step by step by step by step by step. There are a lot of moving parts and it is overwhelming. And also this is a very emotional journey.
So not only are you dealing with your emotions, whether they be elation or sadness or desperation, whatever it may be, but you're also navigating a very complex process. So number one, baby steps. Number two, align yourself with experts who know what they are doing.
Do not go to the Yellow Pages. Do not look at pretty websites. Anyone can make a pretty website. I could not. But other people in this world can. Talk to people. Talk to your IVF doctor. Talk to attorneys. You know, for attorneys, there's quad A that they vet the attorneys. They have to go through a process to be allowed to be in there. There are professional organizations that will. Are they part of them? Are they part of resolve? Are they part of ASR? They following ESRM guidelines? What are they doing? Are they part of seeds, which some people argue is good? Some people say it doesn't matter. I'm not going to give a value on that. But at least somebody went through the effort to apply, right? They do actually vet their members. Get a good attorney. Not one who did real estate, but there are some excellent attorneys, as I said. So get a good IVF doctor. Look at their success rates. You can see what's going on.
Find a good agency.
You know, I think it's just so important to align yourself with professionals who've been in this field for more than a minute.
We laugh and say, there's a surrogate agency every day.
It's not quite that bad. But there are a lot. And I realize we all started, we were all beginners and we all learned. And honestly, I feel sorry for some of the intimate parents I learned on. But so, you know, find an agency that's been established and has a quality reputation. Just baby steps. And finally, good professionals.
[00:38:58] Speaker B: Yeah, for sure. If you could give everyone involved, parents, surrogates, donors, everyone, and to get them to ask one key question before signing anything, what would it be?
[00:39:11] Speaker C: Am I protected? And how?
Because both sides need to be protected. And so often, especially on the gestational carrier side, they're so excited. They so want to help this family and they want to do the right thing, but they don't stop to see where they might have gaps in coverage that could cost them money down the road.
So they need to know they're protected, and the intended parents need to know they're protected.
[00:39:40] Speaker B: Awesome.
[00:39:41] Speaker A: Virginia, thank you so much for your.
[00:39:43] Speaker B: Time and sharing all of this information because, I mean, I've told you millions of times, when it comes to insurance, it's just like, oh, my God, I'd rather just go somewhere else and do something else because I can't deal with dealing with insurance. And you are just like, yeah, no.
[00:39:58] Speaker C: This is, this is. This is a race.
There's some challenges, but for the most part, it shouldn't be overwhelming and it should not be intimidating. We can break it down to make it make sense and be logical. And thank you so much for having me. I loved being here.
[00:40:15] Speaker B: Awesome. So where can people find out information about Art Risk?
[00:40:19] Speaker C: Our website is a great resource at www.artrisksolutions.com and on there, there is tons of information. There's a little form you can fill out if you want more information, if you want us to contact you. All of our phone numbers are there as well.
So that is the best place to go. Webinars are there. You can sign up for webinars. We hold intended parent webinars once a month and we hold gestational carriers seminars once a month as well. Great. Way to go. Yes.
[00:40:48] Speaker B: Thanks so much for joining me. I appreciate it.
[00:40:51] Speaker C: Thank you. Eloise. It's been fun.
[00:40:53] Speaker A: Thanks so much for listening to Fertility Cafe. If you've enjoyed this episode, be sure to subscribe so you never miss an interview. Leave us a review and connect with us on socials. We're ertilitycafe you can also watch the full video version of today's conversation or over on our YouTube channel. Until next time, remember, love has no limits. Neither should parenthood.
