Episode 50 Transcript

Ep 50 | Fertility Insurance with Jason Smith

Jason Smith
For lack of a better way of saying it that IVF is an elective procedure—I don’t necessarily agree with that. I think that there are certainly people that have a need for IVF. And maybe personally, I think it could be treated differently.

Intro
Whoever thought making a baby could be so hard? Luckily, the fertility journey isn’t meant to be traveled alone. Eloise Drane has helped hundreds of people build and grow their families over the last 15 years, and she’s ready to share insider knowledge and expertise with you. So grab a seat and let’s talk fertility and alternative family building in the Fertility Café.

Eloise Drane
Hello, and welcome to Fertility Café. I’m your host Eloise Drane. Health insurance is an important aspect of every surrogacy journey, but for many, it’s a topic that inspires confusion. Oftentimes, any one person starting the journey and third party are often taken aback by all of the many insurance options and considerations. Luckily, you don’t have to go it alone. There are trusted professionals who have dedicated themselves to offering guidance and specialized policies specifically for surrogacy and egg donation. Today, I have the pleasure of speaking with Jason Smith, the Founder and President of International Fertility Insurance. He and his team now provide hopeful parents as well as agencies with the solutions required with unparalleled service. They are passionate about playing whatever role they can and helping with the creation of new families. Jason Smith is the Founder and President of International fertility insurance IFI, a leading provider of insurance and services to cover surrogacy and egg donation. He is a frequent speaker to the surrogacy industry on the insurance options for a surrogacy journey.

Jason’s passion for insurance for third-party reproduction in surrogacy started with his own personal struggle with fertility. He experienced firsthand fertility treatment, early labor, medically ordered bed rest, and the NICU. Prior to launching IFI, Jason had been providing insurance and financial solutions since 2008. Matching insurance to the surrogacy journey since 2014. He was the leading writer of life insurance death benefits among over 18,000 agents for several years in a row at State Farm Insurance, where his area of focus was life and disability insurance for surrogates. International fertility insurance specializes in surrogate pregnancy and egg donation insurance needs, including IVF complication insurance, surrogate life, and disability insurance, surrogate maternity plans, and newborn insurance—as well as a variety of consulting practices, including medical billing, management, and local or outside monitoring management. Jason’s top focal points are high-touch customer service and providing an abundance of education for intended parents, agencies, attorneys, and fertility clinics. Welcome, Jason, thank you for joining me, although I shared a bit about your bio, I would like to start off by having you share a bit about yourself first.

Jason Smith
Sure. Well, as relates to his business, I’ve been doing insurance since 2008. And right around 2014, I had a good friend of mine that was struggling with fertility, and actually even predating that, I had some challenges in fertility back in 2004. But in 2014, a good friend of mine was about to start his sixth round of IVF. And he and his wife were just really struggling with this and just having a glass of wine with him one night and I just started chatting about it. And he said, well, gosh, what would be next? And he said, probably surrogacy, and I knew what that was, but I wasn’t really that familiar with it. My dad was an obstetrician and gynecologist so I had sort of baby-making in my blood, but I sort of had this baby-making part of me. And also, I was a big life insurance producer with a large insurance company. So I had life insurance radar on I guess, and as my friend said, this, I said, I wonder if surrogates might need life insurance. And the next day, I just started calling certain agencies and over time built a number of good relationships.

That’s what brought me into it and then a few years back, decided it was really my passion and I left the company that I was at and started this company. And it’s just I just really enjoy what I do every day. On a personal side, I’ve got three kids of my own. The first troubling bout with fertility is them leading to twins. So thankfully, they’re now 16, driving and all that so I’ve seen it from the beginning to the end. And I have all girls so I’ve got 16-year-old twin girls. But in that process, we went from not even being able to achieve pregnancy to realizing what the issues were with getting on fertility medication, and then winding up the twins. And that was becoming a very complicated pregnancy that involved several months of bed rest and the NICU and all these things. And so while I didn’t have a baby through surrogacy, I certainly understand some of the dynamics of pregnancy challenges. So I think that helps a little bit in my day-to-day as well. I’m pleased to do this, really have a passion for it. And it’s full circle to now be at a place to be on a podcast with you.

Eloise Drane
Awesome. Well, thank you, I appreciate it. So I’m gonna jump into really my first question because I know that unfortunately, insurance can be intimidating for many people. And I, for one, know way more about insurance than I ever thought that I would possibly know in my lifetime. And I do want to say that, of course, the good news is that when you work with a reputable agency that will take care of the insurance considerations, you hope that that agency owner or the people that are in there do have some kind of understanding when it comes to insurance. But we are definitely not the end all be all. And it’s more of we know who to go to ask for the information and what we’re seeking. So with that, first, let’s kind of talk about intended parents and their insurance. Because unfortunately, I know that 19 states now have mandated insurances, but it is not common for intended parents insurance to pay for surrogacy or to pay for egg donation. This typically then turns out to be where a lot of the intended parents want the surrogates to use their insurance for surrogacy. So can we talk about the surrogate using her plan to cover the pregnancy for obviously, a surrogacy pregnancy?

Jason Smith
Sure. So as I think it out, the two most expensive pieces are the maternity coverage as well as the newborn coverage. And newborn coverage is usually at least only relevant to international intended parents. Usually, at least we can chat about the word usually, when we’re talking about someone that’s in the United States, usually, they can put the baby on their plan. There is an importance in checking in with their insurer and making sure that there’s proper coverage in-network, out of network, and so forth. But the most expensive part of this is the maternity coverage, it applies to every single case. And I think that it’s maybe 50% of the time, the surrogate’s insurance will cover the surrogate pregnancy, and maybe 50% of the time, it doesn’t. And that’s just what we see. Right? So we may actually not see all the cases there might be. Agencies that know this plan works because we’ve used it earlier in this year or early in this open enrollment period. And so we already know, so we may not even get that case sent to us to evaluate. But of all the ones that we evaluate, we do have a team that does insurance reviews, where we’re looking for exclusions and liens, and so forth, probably 50% of them cover it. And when they do, it’s important to distinguish that it covers basically from let’s call it, the confirmation of pregnancy, it doesn’t typically cover anything related to IVF. It’s, for lack of a better way of saying it IVF is an elective procedure. I don’t necessarily agree with that. I think that there are certainly people that have a need for IVF. And maybe personally, I think it could be treated differently, but from the insurance company’s perspective, it’s not the surrogate, that’s, that’s, that’s got fertility challenges. It’s intended parents, be it naturally or be it that they’re two gay men or two gay women, for example, that obviously can’t naturally conceive a baby just with their own sperm or eggs. So the IVF itself is not generally ever covered by the surrogate’s insurance but when from the point that she if her plan does not have exclusions or does not have exclusions, let’s leave it at that. Then it will typically cover from the start of pregnancy until the delivery and beyond. So, six weeks postpartum, so forth is typically also covered by her plan.

Eloise Drane
And let me jump back in and talk about laying out the types of insurance which might be involved in specifically a surrogacy journey. So we already talked about newborn insurance. What other policies again, specifically to a surrogacy journey are out there?

Jason Smith
Sort of looking at a timeline from start to finish, it starts with the IVF process, we have coverage for the donor for complications of IVF. We also have coverage for the surrogate for complications throughout the IVF process. And then those are not to pay for the IVF but they’re for the complications that could result. Then moving on, you’ve got life insurance for the surrogate, which can either be through a term life insurance policy, or there’s also a very specialized surrogate life policy that we offer, which also has some optional coverages, like loss of reproductive organs, permanent disability, or coverage for the intended parents for their financial loss. Moving on, you’ve got surrogate disability coverage, we’ve got a cover a policy that can cover hospitalization due to complications, as well as a policy that’s more specific to surrogate bed rest, whether she’s in or out of the hospital, then we may have mentioned it previously, but not in this much depth. There’s maternity insurance. So probably the most expensive and complicated piece of the puzzle, it starts with, there are the various ways of doing that would be an ACA policy, Affordable Care Act, that is policy, or if that’s not an option, sometimes her employer-based insurance can cover that. If that’s also not an option, we have a choice of either waiting for a specific open enrollment period for an ACA type of plan, or we have a couple of different ways to cover her through what I would just say are alternative surrogate maternity plans. We have our own IFI surrogacy maternity plan, which is backed by Lloyds of London, the world’s biggest, strongest specialized insurer. W have a legacy Lloyds of London program for that as well. So a couple of different routes that are both backed by the same provider. And then there’s the newborn insurance that we already mentioned.

Eloise Drane
Yep. Now, how was the coverage of the surrogates policy assessed?

Jason Smith
So we have it reviewed by attorneys and as well as our staff. What we’re doing there is we’re looking through her policies, usually about a 125-page document. And we’re looking for key phrases related to surrogacy throughout that document. And so we’re looking for exclusions, where it can be very cloudy, sometimes it will, it might look like it’s an exclusion, but it’s really saying just that, sometimes it’ll be very confusing like that, that it will the difference between covering her being the surrogate versus hiring a surrogate if that makes sense. So that’s a real key piece to really understand well, within the documents. We’re also looking for liens and a lien for anyone that’s knowledgeable and that is not the same thing as a lien on your home. For lack of a better term, it’s like an extra deductible, where if a surrogate is being compensated, it can be up to her full compensation in some states. And in California, where I am, there’s a statute that says it’s usually a third or a half of her compensation, but nonetheless, we’re looking for these lead for lien language as well, which allows an insurer perhaps in a state where they’re maybe not allowed to exclude surrogacy that they can impose this lien. Which basically says we’ll cover the claim, but only after we recovered whatever she was being paid for this process. So we’re looking for that.

We’re also looking, if it’s an employer plan, if it’s self-funded And where this comes into play is self-funded employer plans are basically where the employer is taking on some of the risk and the employer plans in general, have looser language than an ACA plan. The great part about an employer plan is that they’re usually subsidized in part by the employer. So they can be very cost-effective. This works, but they also have fewer rules and regulations than the sort of federally run program. That is the ACA. And so they don’t have to play it as clearly say whether it covers or doesn’t. In fact, it may not even say anything about surrogacy at all. And so then it becomes a question of, do you want to trust it or not? And I think I didn’t actually mention it. But it’s sort of another variation of the maternity plan is we have what’s called a secondary or backup contingency plan, which is something that can sit behind these types of situations just in case the plan changes, or she moves or she loses her job or any of these things. And all of a sudden, she’s left without coverage there, then you’d have some sort of backup plan to sit behind it.

Eloise Drane
So is it more common than not for insurance policies to be found exclusionary? I mean, I know just, maybe even five years ago, it was very common for us to be able to find a surrogate with insurance through her employer, spouse’s employer that didn’t have any exclusions, and more times than not, we could use her plan. But now, it’s not necessarily the case. So what are your thoughts on that?

Jason Smith
I actually surveyed my team ahead of this call. I don’t know, we probably have the data. But I don’t know. We definitely have the data. And we have every one of our reviews, but I don’t know that we’ve actually tracked it. But a general feeling that was pretty much a consensus amongst multiple people on my team is that it’s about 50/50. It’s, and I would agree with you, it used to be probably more like 80/20, or 75/25 that it would cover, and now it seems like it’s waning. And I think that it’s a lot of the intended parents I talked to about this are very confused because many of them are from other countries where they just get health insurance. And it’s just, it’s just, it just happens and everything’s covered. And, so they’re so confused by this, like, why wouldn’t it be covered? And I, for anyone listening to this that has that kind of a question, I would just say from the insurance, it is quite different when you’re talking about surrogacy. And this is not to say that surrogacy is an inappropriate thing. I think it’s wonderful. It’s obvious I’m in this industry. But I think from the like, I have health insurance, and I am not planning to have another child. And so I’ll probably have the same health insurance for 10 years.

If I need some sort of minor medical procedure, they’ll have received my premium year after year after year. But in the case of surrogacy, I am aggressively trying to get pregnant within months, yeah, and I’m creating one of the most expensive things that an insurance company will ever see. There are worse things, maybe cancer or something like that. But aside from that, I mean, this is one of the riskiest situations for an insurer in terms of the cost, and so where they might get $1,000 of insurance premium, they’re bound to be paying out far more than that on a pregnancy. So it’s their goal to not have to cover this, and some states allow it, and some states don’t allow it. And it’s just, it’s, it’s very confusing for people that aren’t from America as to why this would be this case.

Eloise Drane
You know, it’s confusing for people in America too. So I don’t think it’s just International. And to be clears has talked real quickly about what is not covered by the surrogate’s health insurance. So we know that the preconception portion is not covered by the surrogate’s medical insurance, IVF, and so forth. But what other things are not typically covered, through her insurance?

Jason Smith
So it’s to be clear on what is covered, I would say in general, presuming that there is no exclusion would be her maternity care, and then delivery and the postpartum recovery. What maybe is and maybe isn’t, or things like midwives and birthing centers. I think that in many cases they are but it’s important to be aware of that. And even in specialty plans, some of them will allow it as long as there is a doctor and hospital in the background, just in case. So there has to be fast to be that’s an important thing to point out. What’s also not generally covered would be genetic testing, the newborn care. So with the exception, perhaps of post-birth order states, which basically means this is just to distinguish who’s the legal parent as well or parent of the baby that has just been born. Some many states have had a pre-birth order where the intended parents really truly are the parents at birth. In other states, it’s more of the paperwork that has to be filed after the fact, and in theory, in those states, it might be possible that the surrogate’s insurance might, in theory, cover the baby. Now some not to take a standpoint of that, some believe that’s a great idea, others don’t. And even if it is the case, they don’t want to try to use her insurance. But, yeah, I would say genetic testing, IVF itself, anything sort of experimental in nature, and then the newborn care.

Eloise Drane
And I would also probably add IVF medications, typically.

Jason Smith
Anything related to the IVF. Yeah, yeah.

Eloise Drane
Or monitoring appointments, clinic procedures, even if she is deemed pregnant while she’s at the fertility clinic after the transfer, and they haven’t released her to the obstetrician. Most often her policy cannot be used there.

Jason Smith
Yeah, it’s a good way of it, while there are probably some exceptions, a good way of thinking of that is, as soon as she’s released to the OB.

Eloise Drane
Exactly. How often do you see IPS who surrogate is found to have a reliable policy purchase additional coverage?

Jason Smith
Yeah. So we’re pretty aggressive. So I say this over and over again. But we’re, we’re aggressive in educating, we’re never aggressive in pushing anything. So we don’t ever say, you really, really, really got to have this, you’re a bad person if you don’t take this plan. We just try to educate. It’s my goal that every single case we work on learns about what we call the secondary attorney plan, or some called the backup or contingency plan. I think it’s really important that people understand the risk and then make their own decision. So our goal would be that all the agencies we work with, and attorneys and independent cases, and all learn about this plan, whether they buy it or not, it’s up to them. I would say it’s probably like 65% do and maybe 35%, don’t but maybe a little higher. But there’s some waiting that we have some super large agencies that we work with that just buy it on every single case, it’s like it’s not, it’s like a rule that you have to have it. So that probably skews the numbers. But if you take them out of the fold, it might be 60/40 or 65/35 that buy this. I think we briefly touched on earlier, but there’s a lot, there’s a handful of risks, all of which are very unlikely to happen. But they all could happen.

Some of the risks I think are greater than others. Like if your plan is going to renew over the pregnancy, it is a big risk. Because all you’ve got is a plan that is guaranteed to work the same way it does until the renewal at that point, the employer could change the plan. If you plan on January 1, it’s up for change and it could go away completely. It could all of a sudden have exclusions. It could all of a sudden have a lien. We see insurance carriers every year, kind of go into certain markets and exit certain markets. So like even right now I can think of insurance companies that are expanding, as four more states, six more states that last year or this year at least have covered surrogacy. So my assumption is they’re going to cover it next year. But in so great, six more states, they’ll be there. But they might just be expanding their network, but all of a sudden putting an exclusion on surrogacy? We don’t know yet.

Eloise Drane
Well, let’s actually talk about so talking about the Affordable Care Act and being able to purchase a plan for the surrogates that either don’t have insurance or have a policy with an exclusion. And I mean, the good thing this year was that the ACA plan had open enrollment twice. Well, it had already had it once already, when it opened, what in March or whatever, and then it ended in August, and then it’s going to open back up again in November and God willing, that will happen again next year because it just made life so much easier. But let’s dive into the ACA plan because I think there is a lot of confusion for people like okay, I mean, it’s a plan that you can just purchase, why shouldn’t we get it all year long? Then there’s also this misunderstanding from a lot of people that not all of these plans that are offered will be able to be utilized for surrogacy because there are exclusions in those plans, too. And so why don’t you touch a bit on the Affordable Care Act and kind of how the pros and cons of purchasing that policy work.

Jason Smith
Yeah, so let’s just talk about the general timeline, and then we’ll talk about the pros and cons. So general timeline, typically, you can buy it, typically we start to see plans around the middle of October. And we can start to put people in them usually around the middle of November. There are some variations. Some states are open a bit longer than others. But usually, in November and December, we can put someone into a plan, but it will, it will have a January 1 start date. And there are some exceptions, some states will go until say, the end of January, or even into the middle of February, perhaps some states even longer under certain circumstances. But generally, that’s your window. And this year, as you said, was unusual. And with COVID concerns they kept it open and open and open. It was supposed to be until April, then it became until August, and some states, a few states are still open. But in general income in normal years, November, December for a January 1 start date. And again, we talked about it earlier, but people ask well, why can’t I get it in July or so forth.

The idea is that they give you these windows that you don’t go without coverage, then all of a sudden, once you realize you have cancer, buy a new plan, right? Or once you realize you’re pregnant buy a plan, or change your plan. They want you to lock in so the insurance providers can have a set amount of premium to match up with the risks that they’re taking. So then the pros and the cons. So the pros, the biggest, biggest pro of the ACA is it has an unlimited benefit. So when we compare it to the other options out there, typically there’s a $500,000 limit on the specialty plans, you can get that increased for an additional premium, if you want, I think a competitor of ours might have a $250,000 plan. But usually, most of them are 500,000, let’s say whereas the ACA plan, unlimited. And where that can come into play is if we’re looking at single 10 versus like a multiple embryo transfer, the specialty plans are even more expensive. Whereas an ACA plan, it really doesn’t matter if you have one or four babies, you just increase your complication of pregnancy risk, but you’re gonna have a maximum out of pocket. If you hit it, you hit it doesn’t matter whether you barely exceeded it, whether you have $2 million of claims, your risk is capped. And so that’s probably the biggest benefit of the ACA. The cons or the concerns are timing. You’ve got this, this, this short window, typically, which means if you want to get pregnant in or have a surrogate pregnancy in July, you’re kind of out of luck, you really just you’re gonna have to wait six months.

We talk with all sorts of parents with all sorts of intended parents, it is with all sorts of circumstances that they’re there, they’re wanting and ready to have a baby as soon as they can, and they don’t want to wait six months. And so timing is a concern. The other factor that relates to that is commonly a lot of the agencies will then try to map out the IVF, to start to, to achieve pregnancy right around New Year’s, and if you’re unsuccessful, then well, then you’re going to need a second transfer. And now the second transfer might be two or three months later. And hopefully, that works. If that works, you’re probably going to still get heavier delivery in that same year. If however, your second transfer doesn’t work, you’re unquestionable unless you are unfortunate to have a really early delivery, you’re going to deliver in the next year. And because of that, you don’t have a certainty that the plan that you just bought will even exist at the time of your delivery. Or it might be surrogate-friendly now but have exclusions that come on. So we’re shooting this in 2021 right now or recording that. But if somebody is planning on January 1, pregnancy, let’s just call it 2022, if a couple of transfers don’t work they’re going to deliver in 2023 and they don’t know that their plan will even be there for the delivery. So that’s where you’ve got to have that or in my opinion, it’s a good idea to look at that secondary plan.

The other thing is the networks. So number one when we’re looking for ACA plans where we’re not only looking for exclusions and liens we’re also looking at if her doctor is in-network with this plan? Is her hospital in-network with this plan? And those networks can change too. And so you might have a doctor and hospital that are really friendly on so and so plan and then the next year they’re not but you’re gonna deliver in March. And that’s something else you got to consider. That’s where again, a secondary plan is a good idea. So, the big ones are the timing, the renewal concern, will the plan still be there or not? And then the surrogate moving, sometimes I talk about this, people say, no, it’s in my contract, she’s not allowed to move. Life happens and you could have super ill parents or get married, get divorced, have your spouse’s or partner’s job changed. And all of a sudden, there’s just a really good reason why you need to move from Georgia to Louisiana, and maybe Georgia is a very friendly surrogacy stayed in maybe Louisiana is not and nobody planned on this move to Louisiana, but just happened then, and in perhaps now you’re without a plan that actually fits any longer. Again, all these are reasons to consider that backup plan, I think, but as long as, as long as you know your risks, ACA can be it’s definitely the most generous in terms of coverage.

Eloise Drane
And I would also add to what the ACA plans, it’s not that every insurance company out there also provides those ACA plans. So various states might actually have it a year or years ago, where many states really only had one or two plans to choose from, and then those one or two plans may have had exclusions. I mean, North Carolina was one of those states that none of the plans a couple of years ago, had was able to be utilized by a surrogate because every plan that there was in that state had an exclusion.

Jason Smith
Yeah, and even down like I’m in an enormous state, California, even down to the county level, it can be changing. I’m in San Diego, and last year or the year before, there were no plans in San Diego that covered surrogacy, but just, I don’t know, 30 minutes north of me in Orange County, they did. But it can be on the state level, it can be on the county level. We literally look at the surrogate’s zip code in terms of what’s available.

Eloise Drane
And then the other thing, too, that has happened to our surrogates in the middle of a plan, or in the middle of a policy, her providers became out of network. Yeah. And she had to, I mean, we literally had to scramble to find another delivery hospital, another OB, or all of those things. So that definitely is also something that could happen, not that it couldn’t happen even with a plan through an employer. But I saw that it was occurring more with the ACA plan, not that to happen often. But it did happen a few times through the ACA plan. So I think that’s another negative portion of having that plan. So I developed an online course for intended parents who wish to undertake an independent surrogacy journey called surrogacy roadmap. And I do believe that independent surrogacy is the most realistic option for some and the goal of my course was to provide important guide rails to those who wish to pursue such a journey. And we have an entire chapter on insurance. But I wanted to ask you, what words of wisdom do you have for intended parents who were working without the guidance of an agency? And what should they be especially aware of when it comes to insurance?

Jason Smith
Wow, great question. Yeah, so we work with a whole lot of agencies and attorneys that are helping independent cases. And then often we even talk to intended parents before they’ve even chosen an attorney. And I think that this is a very complicated web, the insurance piece of this, and I think that you either need to really have a great resource that maybe has gone through this before, or a good insurance broker, perhaps. But that you just really need to be educated. It’s the end even I would even argue in working with an agency, make sure that that agency seems confident about this. I think there are two types of agencies, there are the ones that really, really, really know what they’re doing. And then there are others that say, Oh, well, I’m going to release this to the insurance broker, and they’ll take care of it.

I think you want to have a feeling like your agency knows what they’re talking about, at least, but if you but there are lots of people out there that just can’t afford an agency perhaps and, and are going to go the independent route. And I think you just really need to understand your risks before you just go into this because you’re passionate about wanting to have a baby. So like we have, it’s great that you’ve built that course. We have an educational resource library, which is a bunch of videos of me talking about every single product we offer, and I try to update these about every four months or six months. And I think I just would say that you really need to know what you’re doing. I can’t tell you how many people blindly thought that, they read the plan themselves, and they didn’t see services specifically excluded. And so they just think it’s gonna work. And I think we really try to not have people pay money for they don’t need to, we know that something’s not needed, we’ll tell will. But like, it’s just to get a nice chance review, for example, it’s worth it to spend the time maybe it’s not even a cost, but just the time value, but talk to someone like myself or even our competitors, and ask these questions. Really, like, everything you just talked about in this podcast, everything’s relevant, and then some. And I just think that there’s a lot that, it’s not every time that we get, hey, how much will all these things cost? Can you give us a full cost of everything? But when you add it all up, even if you’re lucky enough that your surrogates insurance will cover it, it’s still expensive. And I think that some people just don’t really understand. You asked me that question about all the different types of insurance and there’s like, five, six categories. And they’re all relevant.

Eloise Drane
Yes, they’re all relevant. And I would also add to the fact that especially when people are doing independent surrogacy, they automatically assume oh, she has insurance, so I’m just going to go ahead and utilize her insurance. And what people don’t really understand is just because she has insurance and she’s been able to use her insurance for her own pregnancies, surrogacy pregnancy is different than your own pregnancy. So just because she was able to use her plan for her policy or is through her employer or whatever, doesn’t mean that it’s always going to be covered. And a lot of times too, people that are doing independent surrogacy may work with somebody who has Medicaid or Medicare. And I am one that I completely disagree with somebody using a government-provided policy to use that for surrogacy. And just to be clear, the ACA or the Affordable Care Act is a matter of fact, can you kind of break down the difference between Medicare, Medicaid, and the ACA plan? Because I think everybody kind of lumps them up and says, okay, they’re all government insurance.

Jason Smith
So I would also throw veterans insurance in there, as well as a similar but different category. Where it’s Medicare, or Medicaid or medical, or there’s a handful of different things that are basically the same thing. This is basically like it’s a low income, or no income option for people that are American citizens for whatever reason, are at a lower income level. And it is a way to provide health insurance for everyone. Similar to how many of our international clients may have but it’s not intended to, it’s not intended to be there for the benefit of someone else. It’s for the benefit of the insured, the low-income person. It’s not for her to then use that insurance for the benefit of others. Whereas so that that’s similarly, we have veterans plans that are for folks that have worked for the as Army, Navy, Marines, so forth, Air Force, and or other government branches perhaps and they also may get a benefit of an insurance plan that either is completely provided for them or at a substantial discount based on their years of service. And maybe they have been injured in that in their work capacity or something like that. These plans are intended to be a way for this person to have insurance. It’s not for this person to act on behalf of someone else and incur a large medical bill on behalf of someone else, which is what they’re doing in surrogacy.

Whereas the ACA, is also government-sponsored you might say it’s government regulated. But that’s the word government is the end of the difference of the similarity here. It’s just putting some structure behind health insurance for Americans trying to try to create a good environment for Americans to not be taken advantage of by the insurance companies perhaps. So that’s really the difference. And I guess you could argue that that’s not really intended to, to use for the benefit of others as well. But the difference is that generally speaking, the surrogate is, is paying an actual insurance premium to these providers, whereas on a Medicare, Medicaid, medical plan, or other similars different name, but the same idea around the country, it’s often free or being either completely or very close to completely provided by the government.

Eloise Drane
Right. It’s definitely not subsidized. Where I know for all of the surrogates that we work with, they get the ACA plan, it’s a pretty penny premium that they’re paying, as well as the maximum out of pocket that they also have to cover. So it’s not like they’re getting the plan and it’s free. No, you’re paying a full premium, just like you would if you had an employer, and you had to contribute to your plan as well. So it’s unfortunate.

Jason Smith
It’s 1000s of dollars and these insurers have taken into consideration surrogacy, and they’ve either decided to include it or not, and they base their premiums probably around that. So whereas on a Medicare plan, it’s generally free. And it’s not really it’s not made for surrogacy.

Eloise Drane
Absolutely. I know. We’ve spoken mostly about surrogacy journeys, but let’s quickly speak about how insurance comes into play for egg donor journeys.

Jason Smith
Yeah, sure. So, again, if we go back to the egg donor, and we have a similar plan for surrogates as well, which is almost, I think, important to mention in this little part here, but the egg donor. So she’s acting on behalf of others, she’s not the one that is having fertility challenges to overcome. She’s just doing this for the benefit of others. So generally speaking, her insurance won’t cover her. There’s no insurance really, that will cover the cost of anything IVF-related. There are very few employer plans that might do something, or there are some employer-sponsored situations where you can hire somebody to do these things. But generally speaking, her insurance won’t cover it. And some of the potential risks are ovarian hyperstimulation or HSS. Varying torsion, allergic reaction to her medication, bleeding, cramping, nausea.

The way I like to put it, whenever I’m talking about this is right now as we talk, it’s 11:55 here in the middle of the day, if I was a donor, and I didn’t feel well right now and if my clinic was nearby, I might either go to the clinic or call the clinic and say, Hey, I’m not feeling well, what’s going on here. But if it was 12 hours later, and it’s almost midnight, clinics not open, and I’m going to and I don’t feel right, maybe this is my first time doing this and I have no idea why I’m feeling the way I am. So I’m going to go to the emergency room. And I may or may not be admitted and hospitalized and so forth. And these can be expensive bills. And so we have insurance coverage that’s called egg donor complications insurance, and it’s very, very inexpensive. And we have coverage anywhere from 100,000 to a million dollars most people choose 250. That doesn’t mean that that’s the right number, but most of it I think in general, these claims aren’t normally huge, but some of them can be. I know of one that was six figures not too long ago, but even a $20,000 bill is a huge bill and that’s what this egg donor coverage is for. And we have a similar coverage just to tie it all together in the same breath for the surrogate that would cover similar things like an allergic reaction to the medication, ectopic pregnancy, ectopic rupture, domino pain, cramping, so forth. So, one of these is both sorts of IVF-related, but your question was about egg donors but yeah, too passionate.

Eloise Drane
Yes. No, no, I know. I love it. Absolutely. So I’m curious, and I know every time I even think about it, I get irritated with myself about COVID. Because it has been the topic of everything these last couple of years and I’m so over it, but it is part of it is what it is and it’s part of life right now. How has the COVID pandemic affected the field of third-party reproductive insurance?

Jason Smith
Yeah, so really interesting question. It was like everything just came to a standstill, all of a sudden. And for a minute, I was like, wow, this is nice to have a little break. But then you realized, wait a minute, this whole industry is shaken up for a minute. And clinics shut down. Maybe on their own choice out of safety for their workers, maybe because they were forced to because it was just considered not to be an essential business like a supermarket. None of the supermarkets shut down because you got to go get your food, but the governments really didn’t have to go get fertility treatment. And so everything was shut down. Thankfully, it only seemed to me like, it was maybe a few months that where it was really just set to a standstill, and, and then it started to come back in. But where I think the bigger impact is that this is a global industry. A global wonderful thing that surrogacy is. Probably 50% or something of the business is international parents coming to have a baby in America through surrogacy, and it’s just recently, frankly, that the travel has opened up. I mean, it’s probably six months ago or nine months ago, but the clinics were closed for a bit. But then the ability to even be able to travel to come here really shut down for a while. I think we pray that we’ve gotten through it enough. You’ve got vaccination rates extremely high here, and in many other places, it’s similar. And it’ll just continue to hopefully get better and better in terms of the vaccination rate. And I think if this is not a statement on vaccinations, but I think if we can maintain that and increase that, then hopefully this shouldn’t be an issue. I mean, I’ve got a trip booked to Europe, two months from now, and I think it’s happening. And that just couldn’t happen 12 months ago.

Eloise Drane
What about surrogates and egg donors that get COVID for these policies and all these insurance plans that we’re talking about whether it’s the ACA or all these other plans? Will they cover them if they get sick?

Jason Smith
So great question. And it’s been a hot topic lately. And so ACA plans, yes. Term life insurance plans? Yes. Although, to my awareness, there hasn’t been a surrogate that died of COVID. And I sure, I sure hope that there never will be. Yes. But I know, there have been concerns, and there certainly have been cases where surrogates got COVID. I think that just from the health perspective, it might be a good idea in these times that the surrogate has a health plan, even if it’s got exclusions. So for example, there are situations where you’re allowed to have two health plans. There, the term that is important is called coordination of benefits. And it’s important that the surrogate or the agency, look into Plan A will plan a that she has right now allowed a Plan B as well. If so, then maybe she can keep her employer plan that doesn’t cover surrogacy, and then take out an ACA plan that does, and then maybe you’ve got the surrogate journey covered by Plan B. But you’ve got COVID for well, there’s a bad example because the ACA would have covered either way, but a different route. Let’s say there’s no ACA plan and you take a specialty insurance plan for the surrogate pregnancy, to round out the question.

A lot of the specialty plans will not cover COVID. And it’s something that I’m even yesterday, I sent a note asking again, even try to see if that could be something that’s resolved, maybe for a fee. Maybe for lower amounts, whatever the case is, I am certainly pushing to see if any reform can happen there. But historically, those plans have not been covered. They’re built for covering pregnancy and they’re built for things, on the life plans, for example, they’re built life insurance plans, they’re built for covering sudden events. They’re not built for covering slow-moving illnesses like cancer, for example. And all of a sudden, this COVID, that is coming out of nowhere, is most similarly related to something like it’s an illness. It’s not, it’s not like you just suddenly had a big event happen. So, it’s definitely, when your question about what should impact independent cases think about it a bit applies to people that are working with agencies as well, understanding what covers this, what covers that, but I think I think a safe safer bet is just in this even over this next year, or whatever it is, until we hopefully get rid of this thing, that she has some insurance. Which maybe doesn’t cover the pregnancy, but covers but will cover the COVID.

Eloise Drane
Any last words of wisdom for egg donors, surrogates, intended parents, or any other audiences regarding insurance?

Jason Smith
I think we touched on it, but I’ll reiterate it. We work with a lot of agencies. And I don’t think it’s important, whether they’re big or small, I think it’s important that they have a passion for this. That it’s not just a business to them, that it’s not about the numbers, and that they did 100 cases this year. I think that it’s just super clear to me that there are people in this business that really, really, really believe in it and work hard and get educated themselves and so forth. And then there are others that don’t. I don’t know that you need to talk to 10 different agencies or anything like that. But I think it’s important that you don’t stop until you find one that you really think knows what they’re talking about has experience. Because it matters.

We sit in the back and we try not to play any favorites or anything like that. But we definitely hear of agencies that people love, and you can just tell even in the interaction, you don’t have to hear it from the intended parent, you can hear it, you can just you can see how involved the agencies are. And I just think it matters. And so it’s the same thing, whether you’re independent or working with an agency, just do your homework. Really understand all the aspects of the insurance, If you don’t, feel free to ask me and like I said, we’ve got you don’t even have to work with us, you can get our videos and review them. And depending on where you’re at in your journey, they’ll either be ready and relevant now or irrelevant to at least paint the picture for you. But just get educated and work with someone that seems really passionate about this as well.

Eloise Drane
Awesome. It’s been a pleasure speaking with you and I’m certain our listeners have learned a great deal from you. And we’ll be sure to have all of your information in our show notes.

Jason Smith
Thanks for having me.

Eloise Drane
Thank you. I hope you found this discussion helpful. As you weigh your next steps. We will love for you to rate us. So if you haven’t yet, go to your listening platform of choice, and subscribe, rate, and review this podcast. You can follow Fertility Café on its Instagram and Facebook channel at family inceptions. We’d also love for you to share Fertility Café with friends and family members who would benefit from the information shared. Join us next week for another conversation on modern family building. Thank you so much for joining me today. Remember, love has no limits, neither should parenthood.

Outro
Thank you for joining us in the fertility cafe. Whether you’re an intended parent, a woman considering egg donation, thinking of becoming a surrogate yourself, or a friend or family member of someone dealing with infertility, we’re here to help. Visit our website thefertilitycafe.com for resources on fertility, alternative family building, and making this journey your own.

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