US Appeals Court Denies Health Insurance Benefits to Surrogate Mother

by Lakshmi Gopal on  September 12, 2011 at 11:21 PM Health Insurance News
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A western Michigan woman who gave birth to triplets for another couple is stuck with $42,000 in medical bills. This happened after an appeals court said last week that insurance benefits could be denied.
 US Appeals Court Denies Health Insurance Benefits to Surrogate Mother
US Appeals Court Denies Health Insurance Benefits to Surrogate Mother

NGS American, a benefits administrator, had approved Stephanie Lehr's bills until the final trimester when she developed problems and a doctor noted in her chart that she was carrying the babies as a surrogate. NGS learned about it and said surrogacy was not covered under the Richland woman's insurance plan.

"This is a classic example of no good deed goes unpunished," attorney Eric Phelps said in an interview.

Lehr, 35, was carrying the babies as a selfless act for Angela and Scott Sarver of Jenison, who created the embryos and became the legal parents after the triplets' birth in 2007 at Spectrum Health Butterworth Hospital in Grand Rapids, Phelps said. Surrogates cannot be paid under Michigan law.

Phelps argued that Lehr was a "surrogate carrier," not a "surrogate mother," because her eggs were not used. He said it's an important distinction that should have qualified her for insurance benefits. The appeals court, however, disagreed.

"NGS's decision to deny benefits was not arbitrary and capricious," judges Elizabeth Gleicher, Joel Hoekstra and Cynthia Diane Stephens wrote. "Lehr became pregnant after she was implanted with embryos created by the Sarvers. Lehr was a 'surrogate mother' under NGS's reasonable interpretation of the plan."

A message seeking comment was left with NGS attorney Jeff Muth. "I'm shocked. ... It's a slap in the face of reproductive health," said Lehr, a nurse who has three daughters of her own.

She said Angela Sarver was a co-worker at the time who couldn't complete a pregnancy.

"I knew of her trials and tribulations," Lehr said in explaining why she became a surrogate. "I did the right thing for the right reasons."

NGS administered Lehr's benefits on behalf of her employer, St. Mary's Health Care Trinity Health Corp., which is self-insured. Phelps said Lehr appealed directly to her employer for help but was turned down.

Before the case went to court, an evaluation panel of three attorneys had ruled unanimously in Lehr's favor in a non-binding recommendation, Phelps said. NGS rejected the recommendation, however, and the case proceeded.

Lehr is "stuck with debt that she doesn't have the money to pay," Phelps said.

Source: Medindia

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