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Insurance group reverses course, will now cover same-sex Madison couple’s baby’s delivery

The couple was previously denied coverage since their gestational carrier lives out of network.
Published: Oct. 7, 2021 at 8:03 PM CDT|Updated: Oct. 7, 2021 at 10:30 PM CDT
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MADISON, Wis. (WMTV) - After a long fought battle with a local insurance company, a Madison couple expecting a baby says they’re in shock. After sharing their story publicly, they’ll now get the coverage they say they need.

Matt and David Clark-Sally shared their story with NBC15 Investigates at the end of July. Back then, they were told their future baby’s delivery and hospital bills would not be covered by their insurance company, Group Health Cooperative of South Central Wisconsin or GHC, since the couple’s gestational carrier lives out of network. The couple appealed the decision three times. Each time they were denied. But since then, GHC has reversed its decision.

“We just had another ultrasound yesterday, everything looks great,” says expectant parent Matt Clark-Sally.

Before she even enters the world, baby Clark-Sally, along with her two dads, has already sparked change.

“It’s brought awareness that I feel is bigger than just us. It’s not just about us,” says Matt.

Back in July, Matt and David say under their insurance plan from GHC, they knew they would have to pay out of pocket for infertility treatments, an egg donor and a gestational carrier, a process that costed the couple more than $110,000 out of pocket. But, they also wanted GHC to pick up the baby’s hospital bill after birth, which costs anywhere from $3,000 to $5,000.

“We were informed by our insurance company that they would not be covering the delivery and birth of our baby girl and her time in the hospital,” said David back in July.

Fast forward two months, these dads received a letter from GHC on September 1, 2021, reversing their decision, saying in part, “After extensive review, GHC-SCW believes it is in the best interest of both parties to resolve this matter and GHC-SCW is agreeing to provide coverage for the planned out-of-network birth of your child.”

“When they told us they were going to reverse their decision, I was really shocked, honestly,” says David.

The official reason for the denial reversal GHC gave to Matt and David in the letter is that “As the insurance certificate did not clearly state how newborns are covered in your specific situation, you were initially provided information that was not relevant to the costs associated with the birth of your child.”

The statement goes on to say they will address concerns in future certificate revisions.

That’s not the only change at GHC. The company also hired Chief Equity and Engagement Officer Kingsley Gobourne to review current policies.

Gobourne saw the couple’s story after it aired on NBC15.

“When I saw the story, it was difficult to watch to be completely honest,” Gobourne said. “It was hard to see the experience they were experiencing and just trying to understand, it was hard to portray how difficult that journey might be. But it was great for us to have some conversations on how we can better improve.”

Gobourne says before he was hired, work was already being done within the company to ensure equal coverage for all families, but that hearing the couple’s story highlighted work that still needed to be done.

“The work is large and ongoing,” Gobourne said. “And although we can feel good about some things we’ve done in the past, it’s very evident the opportunities are greater in the future for us to continue on this journey and not only to address not only the issues of these members as it pertains to family planning, but also the larger community we serve. Where else do we have the opportunities to continue to learn and to grow and to better inform ourselves so we can provide the right products and services to the communities we serve.”

Matt and David say they are grateful for the insurance coverage change-up and the hiring of a new diversity officer. But they want the change to affect more families in the future.

“Is this just a thing you’re doing to make us be quiet and go away? Or are you really understanding? Matt mentioned they were listening. They did listen to us in that we didn’t like their decision. But were they really listening? And that still remains to be seen,” says David.

It’s change these dads hope is bigger than them.

“Real change is more than a few words in a letter that they sent us. Let’s put some action behind that and move forward,” says Matt.

It’s change they will proudly tell their daughter about when she enters this world. She is due any day now.

“You know, going from a family of four to a family of five and a baby, and away we go,” says Matt.

Seventeen states in the U.S. have laws that require insurance companies to cover a portion of the costs of infertility treatments. Wisconsin is not one of those states. NBC15 Investigates went to the Wisconsin State Capitol to talk to lawmakers to see if any sort of bill is in the works. We sat down with Democratic State Representative Lisa Subeck who represents the 78th district including Madison. She says there is a bill in the works.

“There is a group of us here in the legislature who have been talking about this issue who have been working with advocates and medical experts to determine how to best address it, and I do expect us to come forward with legislation again to insure people have access to infertility treatments,” says Representative Subeck.

Back in 2015, Representative Subeck sponsored a bill that would have required insurance coverage for infertility treatment in Wisconsin. No Republicans signed on in support, so it did not pass.

Subeck says a bill of that nature is still important today.

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