When international billing won't bill

Many people come to Canada from elsewhere for surrogacy. Sometimes they can't pay their hospital costs even if they want to.

As readers of HeyReprotech may already know, Canada is a popular destination for international surrogacy. There are a few good reasons. For one thing, there is no discrimination against people who are gay or single. As well, the process for recognizing parentage is, in most provinces, fairly straightforward and relatively quick. Add to that, any child born here automatically gets citizenship. 

Then there is the matter of our universal health care. That means that a Canadian surrogate's care during pregnancy and childbirth is paid for through provincial health insurance. It also means that a newborn's care is often paid for—even when it isn't supposed to be. 

In the province of Ontario, for instance, the ministry of health says that a child born here is only eligible for health care if a parent considers this province their primary place of residence. Some Ontario hospitals do bill for surrogacies. An uncomplicated birth might only cost a few thousand dollars. But when a baby ends up staying in the neonatal intensive care unit (NICU), the cost can be a lot higher. According to the Canadian Institute for Health Information, care for a baby born at 29 weeks weighing less than a kilogram will ring in at about $90,000. There have been instances where uninsured intended parents (IPs) have decided to abscond rather than pay up. 

But what if you're an international IP who wants to pay? Below I share the account of someone who recently came to Canada from the US for surrogacy, had a child who spent a week in the NICU here, and tried to pay for the full cost. 

“I couldn’t get anybody to bill me”

Our son was in the NICU for a week. Every attending physician who looked at him during that week gave me an invoice, which I fully expected, and I paid them. I was expecting to have to pay them. It was not a problem.

We were told by many different people at different times along the way that healthcare coverage in Canada is by residency. So our son is not eligible.

At one point, I said I really hope the hospital bill isn't going to be crazy expensive. I will be able to claim it on my private insurance that I have in the US, but there are co-pays and everything else, so I just didn't know how much it would be.

My surrogate told me all these horror stories that she'd heard from other surrogates, about other international couples who hadn't gotten insurance and just skipped town when the baby was born and they had their passport in hand. And all of these hospital bills were just left behind. She said it's the biggest dirty secret out there.

So half the time, hospitals won't even track it, she said. They won't even try to pursue international couples whose babies are born through surrogacy. I couldn't believe that. But she said it happens all the time.

So when we got back home, and I hadn't heard from the hospital, I actually called. I said I would like to arrange for payment, that I could put them in contact with my insurer. I never heard back. 

I was fully prepared—fully prepared—to pay. I have good private health insurance here in the US. I knew a good portion of the cost was going to be covered by my insurance. I just didn't know how much I would have to pay out of pocket. But I couldn't get anybody to bill me.

It's not like I just left general messages on the general lines of the hospital—I looked through the directory, I found the international billing department, I found the voicemail of the person, I left voicemails, and I gave my son's patient number. They never returned my calls. I'm trying to pay these people, and they won't take my money.

Canadian taxpayers are paying through the nose for all these international couples! I would be outraged! Clearly, that's just wrong.

This interview has been edited and condensed.

Contact me at alison.motluk@gmail.com.

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