A Rocky Path to Parenthood: One Family’s Experience with Insurance Discrimination

By Matt & David Clark-Sally

Read more of Matt & David’s story here.

Having a baby is one of the most joyous times in life. And, even though the family-building journey for gay men is tedious and challenging, it’s no different for our family. We couldn’t be more excited to welcome a new baby girl to our family this fall!

Still, we’ve faced many ups and downs along the way. We’ve experienced the highest of highs: finding out we’re pregnant, hearing a heartbeat, and seeing the baby at the 20-week ultrasound. We’ve also navigated the challenges that come with being an LGBTQ+ family: selecting an egg donor, finding a gestational carrier, navigating IVF, working with lawyers, and (of course) lots of added bills and expenses.

As it says in the book The Path to Parenthood: LGBTQ+ Edition, the LGBTQ+ path to parenthood will “send you in a tizzy.” This is no joke. At times, the process for us has been outrageous!

And while we predicted some of the tribulations that come with expanding a family as an LGBTQ+ couple, we weren’t expecting all the difficulty we encountered when trying to access newborn health insurance coverage for our baby.

The way our insurance company, Group Health Cooperative (GHC) of Southcentral Wisconsin (a local co-op in the Madison, Wisconsin area), treated us and the discriminatory decisions they made could jeopardize the health of our child and carrier. And I’m sure we’re not the only couple with this story to share.

Navigating insurance companies

Exclusionary policies

We expanded our family through in vitro fertilization, using an anonymous egg donor and a gestational carrier. A lot of insurance companies don’t cover much when it comes to infertility as a whole, and when they do cover it, you have to “prove” your infertility—which is often impossible for LGBTQ+ couples. That was hurdle number one: Paying out of pocket for our infertility treatment.

But we assumed that once a baby entered the world, our insurance coverage would kick in. Right?

Because of the way that surrogacy and gestational carrier arrangements work, our baby will be “born out of network.” So, when we found out we were pregnant, we reached out to our insurance company to get prior authorization of our baby’s newborn coverage. The company met us with resistance and offensive statements. Over the course of many conversations with them, we were told:

  • That the mother’s insurance should cover the baby, which is both untrue and problematic. We’re a two-dad family!
  • Coverage for non-biological children doesn’t start until legal paperwork is complete. This is also untrue—she is our biological child!
  • Coverage differs when the child is “born outside of marriage.” Another untrue statement, as we have been happily married for 2.5 years.

Not only are these policies offensive and exclusionary (why should non-biological children or children born outside of a marriage receive different healthcare coverage?), but they don’t apply to us. Our baby is biologically related to us. Our baby is being born within a marriage.

Putting Our Baby’s Health at Risk

In addition, our company denied our request for coverage of the baby’s newborn services. Apparently, the baby’s birth wasn’t “urgent” or “emergent,” so it wasn’t medically necessary. This means that GHC didn’t have any obligation to cover the baby’s newborn care out of network. Instead, they suggested our carrier move to Madison, Wisconsin so she could deliver within their network.

First, we cannot fathom a situation where any healthcare provider would suggest that it isn’t medically necessary for a newborn to receive medical care and attention immediately upon their birth. Most hospitals and pediatricians require a stay of at least 24-48 hours for observation.

Second, requiring our carrier to move went against her OBGYN’s medical advice and would put her health and continuity of care at risk—in addition to risking the health of our baby.

Third, it would be unsafe for our carrier to attempt to get to Madison once she goes into labor.

After our denial, we went through the appeal process. Three times.

This involved providing in-depth documentation and resources about what was in the best interest of our carrier and unborn child. Yet again, they treated us poorly. In our appeal hearing, they rushed us off the phone after just 13 minutes. Not a single person asked any questions. And then, after only 3 days, GHC denied our appeal.

This entire situation is baffling, disregarding medically-recommended practices in the best interest of our newborn baby. To this day, we can’t believe the way they treated us and their failure to uphold standard healthcare practices. That’s why we’re writing this blog post today. We want to share our journey to make change for families of all kinds for years to come.

Inequity and inequality for LGBTQ+ Families

As gay men, the overt discriminatory actions taken by our insurance company is perhaps most disturbing. GHC prides itself on being inclusive and LGBTQ+ friendly. They exhibit at LGBTQ+ festivals in Madison, raise the rainbow flag for Pride Month, and wear LGBTQ+ pride GHC gear. Their website emphasizes their commitment to the gay community. But their policies, their lack of knowledge of how LGBTQ+ families are formed, and their disrespect towards us demonstrated completely opposite ideals.

The path to parenthood for many LGBTQ+ families involves adoption or gestational carriers/surrogates. These are extraordinarily expensive processes, and we need to work together to ensure that every state has laws that require insurance companies to cover a portion of the costs of infertility treatments regardless of family make-up.

We also need to ensure that families like ours have access to crucial newborn hospital care—otherwise, insurance companies are creating another financial burden for LGBTQ+ people looking to expand their families.

We’ve tried to respectfully ask GHC to come to a different conclusion. We’ve shared our concerns about our child’s medical well-being and their discriminatory actions. They ignored these requests, making no effort to be inclusive or to review their policies.

GHC has the opportunity in this situation and in the future to take actions that support equality. But by standing by their inequitable policies for LGBTQ+ people, they’re coming down on the wrong side of history.

Making a change

Of course, with a newborn on the way, we are so excited for what’s to come. Our daughters are thrilled to be big sisters. But our story shows that for LGBTQ+ families, becoming a family is anything but easy.

Like Family Equality, we believe that it doesn’t have to be this way. Together, we can speak out and demand real change. We can hold insurance companies like GHC accountable on social media, via email, or via phone to let them know their discrimination is unacceptable.

And we can support organizations like Family Equality, which offer inclusivity training programs to companies like GHC so they can learn how to appropriately support families like ours. Family Equality is also working on the state and national level to advocate for legislation that would require insurance companies to expand coverage for all families.

Unless we stand up and demand more inclusive policies and practices, change will not happen. We believe in the power of pride and in our community speaking out. So, let’s get started!