Tuesday, May 06, 2008

Figuring out the finances

Nothing much has changed in our day-to-day lives since we've made our decision to look for a gestational surrogate. Honestly, for my husband, nothing has changed. I'm, perhaps, a bit more hopeful...most of the time.

If a friend or family member would volunteer, this might be a lot easier. Unfortunately, that hasn't happened yet. Several people have said that they would if they could...which is extremely nice of them. Of course the fact remains that for various reasons, I don't think any of them will be able to help us out. Some of them live in states where it would be too difficult. Some have had pregnancy or other medical issues that would preclude them. (For example, my friend with the autistic son has said that she would do it if she could...however since her child's autism is probably the result of in utero exposure to the epilepsy medication that she takes, not so much)

Mr. W still really wants it to work out this way, and if I'm being honest, so do I. I don't want to have to seek someone out. Not really. I have trust issues in general and I would just find it so much more comforting to not have to establish that level of trust with someone that I don't already know. As a mother of a 2 year old who has never left her child with a babysitter or in the church nursery...well, I just don't know how to make myself alright with letting someone in on something so very delicate.

I'm trying to be a realist. It likely isn't going to work out that way. If we are going to do this, we are going to have to seek someone out. I've looked at agencies, I've looked at ads on surrogate websites. I've read through countless threads on message boards. Mr. W and I understand that this is going to be an expensive undertaking (even if we were to work with a friend we would be paying all of the medical expenses in addition to financial compensation for our friend). I do, however, have some problems with what I'm finding.

First, I'm being turned off to a lot of people rather quickly. Call me a snob, say what you will -- I simply cannot handle reading ads that begin "Thank you for reading my add." It is an ad, not an add. Incorrect spelling is a big deal for me, apparently. (Compleat? Seriously? NO!) I don't know why I'm so disturbed by ads and message board posts with bad spelling and grammar, but I am. I find myself not taking these women seriously.

I know that's not the way to look at things. Knowing the correct spelling of a word or how to use it properly has nothing to do with the ability to gestate a human being. It says nothing about the love and caring that a person could have in their heart. And yet I have such a hard time getting past it.

My next big problem is the expense. I found a woman who is looking to be a first time GS who had posted several times and I just liked the way her posts read. She had linked to her web site in one post and I read her blog. I still liked her. Then I read her list of what she expects in compensation.

I'm completely fine with a lot of it. Perhaps most of it. But then I just hit a mental roadblock. I'm not naming names or posting links, and from what I'm reading she isn't asking for more than what others are asking for, so I feel alright listing her fees and where I'm at in my thinking.

As her base compensation she wants $20,000 paid out over 10 months. If a multiple pregnancy occurs, that becomes $25,000. So far I'm completely ok with this. It's a lot of money, but it's well within the norm as I'm reading things. Quite honestly, it's much less than what I would be paying if I went through an agency. I don't like that there is an additional fee for multiples and hadn't really planned to offer that to a friend -- maybe because I'm looking at the compensation as a number that would be agreed upon with the understanding that a resulting pregnancy could be a singleton or twins. Further, I think that if you're saying you would not undergo a selective reduction, you shouldn't really say "but I will want more money from you for carrying more babies." I'm not saying that I would want to reduce from twins to a single baby -- I absolutely wouldn't. I'm just saying that if a carrier is saying that they would not reduce that it's a bit unfair to say that the intended parents should then pay them more for something they may not want to have happen in the first place. (I know, I know...if that's a problem for an intended parent, find another carrier). Honestly, this isn't even a problem for me, it's just the general feeling of it being unfair that I find unsettling. I can't help it. I'm one of those people -- I get all fired up over perceived injustices that have nothing to do with me. I can't help it. It's just who I am.

Ok. So I don't like that the compensation changes, but I get that it has to -- seriously, you can't expect to gestate higher order multiples and have the same easy pregnancy as with a singleton. Maybe my problem is that the extra money kicks in with twins which is not on the same scale of issues as triplets or quads or *my head just exploded thinking of larger numbers of newborns than that*.

I expect to give a couple hundred dollars for maternity clothes. In my ideal world, I'd go skipping through the maternity section hand in hand with my surrogate trying on clothes and just buy them for her. So the fact that she's asking for a $500 clothing allowance is no big deal to me. Not at all. She needs to wear clothing. I get it. In a perfect world, it wouldn't be a dollar amount. In my perfect world, we'd just go shopping together and we would buy the clothes that she needs. It might be more, it might be less. It really wouldn't matter. Since that wouldn't be likely to happen, a set amount of money for her to use on clothing is fine. (I would, however, have a problem with paying that money if I found out that she used it for anything other than maternity clothing. Perhaps I'd be more comfortable with giving her a gift card to a maternity store in that amount.)

Now come the expenses that I'm really not sure that I agree with. A $250 mock cycle fee. A $750 transfer fee. $250 for any dropped or cancelled cycles. $750 for "invasive procedures." $225 monthly expenses allowance (which is supposed to include insurance premiums). $3,000 c-section fee.

I don't understand those extras. I just don't. I don't see how you can agree to carry a child for someone else, knowing that IVF is required to do so...and still expect they will give you extra money for the actual transfer? Isn't that part of what you were agreeing to do in the outset? Why is that an "extra"??? It's kind of the most important part and the reason I'm willing to compensate so much for carrying my child is that it is my child being transferred! And while I haven't personally undergone an IVF cycle, I do understand that a mock cycle is pretty common, so again -- why the extra money there?

Can someone explain to me why those extras are extras? I'm fully aware that I'm going to be paying all of the medical expenses. I don't know that I should be responsible for paying her monthly insurance payments (why am I responsible for keeping her insured -- I understand I'm responsible for the expenses incurred as a result of the pregnancy, but she would be paying to have insurance whether she was carrying my baby or not!).

What are your thoughts on all of this?

[ posted @ 10:59 AM ] [ Post a Comment ] [ View Comments (8) ]
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Comments about my post, "Figuring out the finances":

Does she work? Are the amounts for the extras intended to compensate for lost time there? While I have never done IVF, nor investigated surrogacy, it does seem that some things are standard and those are included. On top of the HUGE $20k fee (OMG I had no idea it was that much to use a surrogate on top of the medical costs), it seems like she is itemizing random things. Will there be charges for ultrasounds or routine prenatal testing? Why those and not something like standard dr appts? Are those fees in case the transfer does not result in a pregnancy to ensure she has some compensation for her time?

[ Permalink ] posted by Unknown : 12:57 PM

Wow. I had NO idea that people charge over $20,000 for being a gestational surrogate. I guess I'm pretty naive, huh?

I think that the "extras" seem a bit...well, greedy. There. I said it. I totally agree with you about the extra $5,000 if she carried multiples - wth?

I have a good friend who is considering being a surrogate, but I can't imagine she'd insist on all those extras. Maternity clothes? Really? Hmm. It seems to me that you could get some maternity clothes with a tiny little bit of that original $20-25,000.

[ Permalink ] posted by Kier : 1:00 PM

I didn't fully understand the extras until we started the whole process and it does seem a little ... weird. I initially thought the transfer fee was for the clinic and only just realised it's for the surrogate.

For now I am just thinking that it's money for inconvenience for her, I guess the whole fee can be summed up as that, but when I look at the whole figure, 20,000 over 9 months is not that much for a pregnancy. The monthly salary is not that high. That's how I am seeing it but the money side is difficult to accept. I forget it for a while and then it sneaks up and reminds me that this is a business arrangement.

I hope you manage to find someone who wants to help you two and with whom you feel very comfortable. Mabye if you have a little time you will be able to find someone this way. (And I know what you mean about the spelling, I felt everything you said).

[ Permalink ] posted by Unknown : 3:20 PM

I am a GSx1 and am currently cycling for another surrogacy. Though I've never been on the IP side of the fence, I can understand the relative sticker shock that comes from learning about the compensation and fees associated with surrogacy. Perhaps seeing things from a GS point of view might make things a bit clearer.

The fees for your prospective surrogate are common and are within the normal ranges. A surrogacy journey, from start to finish, brings with it different physical tolls and levels of sacrifices. The base compensation is just that - it is the base for the pregnancy. A GS goes through a lot before pregnancy is even acheived, and the additional fees compensate for those things.

The transfer fee compensates for the time, effort, and discomfort that goes into cycling. Hormones can wreak havoc on a woman's system. Most GSs have to take Lupron, which is known to cause horrible headaches and sometimes other side effects, not to mention the discomfort from several shots, especially PIO. The GS also has to go through a period of abstinance from the start of cycling through the first u/s or beyond.

One thing that is tricky about fees is the wording and what the fee actually covers. This can vary from surroagte to surrogate. For example, I have a Cycling Fee of $400 payable at the start of meds other than BCPs and a Transfer Fee of $350 due at the time of transfer. This equals what your PGS (prospective GS) asks for with her Transfer fee. It looks like she would want her Transfer fee paid at the time of transfer and not want anything paid for the actual cycling. If the transfer was to be cancelled after start of meds, then she would want the $250 for what part of the meds she did have to endure. I think this is reasonable. I would want clarification and would ask when she wants to be paid the Transfer fee. If it's at the time of transfer, I think that's acceptable but I would not feel comfortable paying that any earlier.

I also think that the mock cycle fee of $250 is acceptable; mine is counted the same as the Cycling Fee, because technically that's cycling without going all the way to transfer.

$750 for invasives is common, and is actually closer to the lower end. Invasive procedures are usually painful, both physically and emotionally: cerclage, D&C, amnio, CVS.

Carrying multiples is MUCH harder than carrying a singleton. Both the surrogate and her family make greater sacrifices for carrying more than one.

As far as the selective reduction is concerned, that is stated upfront not to "trap" the IPs into paying more for babies that the IPs might not want to have, but it is because the stance on S/R is one that must be clear on. It is stated in effort to match with IPs who feel the same way. Some of the worst situations have arisen in the case of multiples where one party felt differently than another where S/R was concerned. The opinion on S/R is stated in the sense of "just in case". The general rule for surrogates is to not transfer any more than you're willing to carry. For a surrogate who does not wish to reduce, it's important that she makes that known upfront to avoid matching with IPs who want to transfer three knowing ahead of time that they'll reduce to two or one if they stick. Having a multiples fee in conjunction with a no S/R stance is presented in advance so that the expectation is known in case something like that does happen.

$3,000 c-section fee is also on the lower end (average is around $5K), especially if a woman has never had a c-section before. There is added discomfort during recovery that would not be present in a regular vaginal delivery. I don't have a c-section fee because those are the only deliveries I've had and they are normal for me.

Most surrogates have a non-accountable monthly allowance and $200-$250 is common. This generally covers things like gas to regular appts, childcare for those appointments, prescriptions, parking, tolls, and little incidentals that the surrogate would not have if not for either being pregnant or trying to get pregnant, etc. What the monthly allowance covers varies from surrogate to surrogate so I would want this part to be very clear. For example, if the monthly allowance is supposed to cover gas and childcare to regular appointments, then you should not have to pay *extra* for those things from month to month.

To answer Erin's question above, fees are not given for things of routine nature like OB appts and routine testing.

Some surrogates are with their IPs for months, even a year or two going through transfer after transfer, and sometimes even miscarriages before acheiving a healthy pregnancy. It is fair that they, and any other surrogate is compensated for the time, effort, and physical demands that they are putting on their bodies in the months leading up to just the transfer.

Being a surrogate takes lots of time, effort, and dedication not only of the surrogate but also of her family. It is not about the money, but it is about the dedication that goes into helping someone build their families.

Feel free to ask me any questions you might have about fees or the rationales behind them.
Kym

BTW - poor grammar and spelling is almost an instant deal-breaker to me, as well. My FIM (former intended mother) has very weak written grammar and spelling and it was VERY hard for me to initially get around that when we first started communicating in email. But I was able to get through that to read deeply in to the content of what she had to say in those initial emails and I could tell that she was of good character and had all the makings of what I was looking for in IPs. She even said that she knew she was weak when it came to writing and that she was an "open book" in person and on the phone. I gave her the chance and agreed to speak with her on the phone and I could tell that my instincts were right. She was great, and had I passed on her initial email because of the grammar and spelling I would have missed out on her.

That being said, there were many other replies to my ad that I instantly sent a polite "thanks, but no thanks" response to. The spelling and grammar were poor, but the content was just as vapid.

[ Permalink ] posted by JW Moxie : 7:38 PM

I'm a 2x gestational surrogate mother, and also the author of a book on surrogacy.

I had to smile when I read your comments about "adds". It drives me nuts too. No, you are not being unreasonable to be turned off by that. Grammar is one of the only things that separates us online. Everything else can be done behind closed doors.

As far as the fees, the reason your surrogate is charging all of those fees is because they are "standard". When my husband and I decided to enter the world of surrogacy, we examined fees from all angles, and finally decided to do an "almost inclusive" schedule. We did not charge for all the little extras, including twins. (which I did have)

I do, however, go through all those itemized expenses in my book. Why? Because 95% of all surrogates choose this route.

As far as the transfer fee, I actually agree with having one, and I did have a transfer fee which was taken out of my base compensation.

The reason I chose to do it this way was because of all the medication, injections, testing, travel, baby sitting of my children, etc that had to be done just to get to the transfer. If it failed, and we had to start all over again, I'd still have to do it all again. To me, the preparation for and the actual transfer were the hardest part of the journey.

As far as the insurance goes, you are right. Her calling her monthly expenses "insurance payments" is a little ridiculous. She would be paying those whether she was your surrogate or not. Sounds like she is just a little inexperienced and getting some lousy advice.

This journey is hard. It is an emotional roller coaster. Take the time finding a match, its ok if it doesn't happen overnight. Its like dating. You'll just know.

Best of luck to you.

[ Permalink ] posted by Anonymous : 8:16 PM

I re-read the part about the insurance and realized I forgot to answer about that part. Some surrogates have insurance, but their policy might have a surrogacy exclusion. These surrogates usually find a policy that will cover the pregnancy after they are matched and the IPs will pay the premiums. Of course, the insurance is used only for the pregnancy and not for the surrogate's other health needs or those of her family. I definitely do not agree with a surrogate asking for IPs to pay the premiums on an insurance policy that she already has in place. Usually, finding a surrogate with an existing insurance policy that does not exclude surrogacy is key for IPs.

[ Permalink ] posted by JW Moxie : 10:28 PM

To Kymberli, in most cases, carrying twins is NOT much harder than carrying one. Actually, from personal experience, my twin pregnancy resulted in far fewer issues than most women who carried just one child. It depends on the person and situation.

I know nothing about anything when it comes to being a surrogate, except that it breaks my heart you're having such a hard time finding one. It also shocks me that it resembles more of a corporate takeover rather than a surrogacy, but in this day and age, I suppose that shouldn't surprise.

I have no words of advice, since I have no yardstick or experience with the subject, just know that we here are thinking of you constantly and throwing the best karma out for you, in hopes it comes back ten fold. :)

[ Permalink ] posted by Anonymous : 3:08 PM

I'm very glad that Kymberli posted as she addressed a couple of things that I've been thinking about writing to you over the past few days.

Would it help at all when considering the costs of surrogacy to draw a parallel between paying a GS to care for your child and paying any other childcare provider? If you'll bear with my analogy, you're paying for 24/7 care for your child for nearly ten months. That is what the $20K fee is for. If you work it out, that equates to approximately $2.90/hour -- the minimum wage in 1978. Those who balk at the “huge” $20K fee must not be familiar with current child care costs that parents have no compunction paying once the baby is born.

I doubt that any childcare providers are ever accused of being in it only for the money, yet people have no problem casting such aspersions on surrogates when they make markedly less than any childcare provider I know…and *they* are not abstaining from sex & alcohol, monitoring their diets, and subjecting themselves to psychological examinations in order to do their jobs.

To take the analogy further, I pay my childcare provider to take care of my child(ren). There are certain things that the job encompasses, that are inherent as part of the job (i.e., dealing with spit-up, singing songs, changing diapers). Those would be equivalent to the things that are inherent in the standard discomforts of being pregnant (i.e., the heartburn, the difficulty sleeping, the need to pee every 4 minutes).

If I were to ask my childcare provider to do more than what is part of the job – some of the teachers at my kids’ school will expand their care to include bringing the child home from the center and babysitting until Mom or Dad gets home – I would expect to pay them for their additional efforts. Likewise, the surrogate’s fees for invasive procedures are compensation for enduring what is not typically considered part of the standard expectation for being pregnant. Amnios, c-sections – I’ve had both – they really are invasive and painful, and I’d hate to even speculate on the additional anguish of a D&C. Knowing how awful I felt when our first cycle didn’t work, I can only imagine how hard it would be to miscarry (and the accompanying feelings of failure) when all you want to do is help someone you care about have a baby.

I respectfully disagree with Sherry who claimed that a twin pregnancy is not much harder than that of a singleton. In addition to being exponentially more exhausted than I had been in either of my singleton pregnancies, the twin pregnancy came with gestational diabetes, pre-eclampsia, and much more missed time at work due to bed rest requirements. It all comes down to the fact that every woman is different and you can’t really know what a multiple pregnancy will do to you, your body, and your family (who must make accommodations as well) until you go through it.

I think that the additional fees being requested by this particular surrogate are a touch on the high side – though my perspective is altered by the fact that I haven’t had to look at the numbers part in over two years. As another commenter mentioned, the surrogate is making sacrifices even before she is pregnant. Some of these fees (the cycle fee, the transfer fee) ensure that she is compensated for going through the grueling injections and monitoring which occur whether or not the cycle is successful. I never had a monthly allowance (it felt weird) and simply submitted my expenses, itemized and with receipts.

The issue about insurance is odd, though. My pregnancy was covered under my own health insurance, once I was released from the care of the RE’s office. Figuring out the hospital bills – with the twins covered by one policy and me covered by another one – has been difficult and I continue to receive weird statements in the mail. I believe that our contract stated that the IPs would pay for a LIFE insurance policy for me for the course of the pregnancy, but I don’t think that they ever did in fact do that. Perhaps the “insurance” she’s alluding to is life insurance, not health insurance?

For those posters who balk at the idea of outlining everything in a contract, as though it were a “corporate takeover” – would you rather have all the parties involved in such a delicate, emotional process NOT be protected by ensuring that the relevant issues (especially SR) have been discussed and agreed upon? That doesn’t seem like a good idea to me.

Personally, I decided to become a surrogate well before I had any idea what the standard compensation was. I would bet that 99% of surrogates would agree that their primary motivation is to help people have the child(ren) they so desire. To go back to my analogy – does the fact that your childcare provider LOVES children mean that she should not be compensated? For some reason, no one has any qualms about paying the RE fees ($300 for a 3 minute dildocam exam – I saw the bill(!)), and yet the surrogate is accused of venality?

It took me a while to become comfortable with the financial aspects of the agreement that we made with our IPs. In retrospect, I feel as though the money wasn’t really for me anyway – it was the one thing I could bring back to my family for all of the things they had to sacrifice so that I could do what I felt I’d been called to do.

I apologize for being so long-winded, but I’ve been thinking about this a lot since you posted. I got a picture of the twins in the mail yesterday and finally got a better handle on some of the points I wanted to make. I truly hope you find the right person to help you expand your family. When you meet her, you’ll know it and it will all come together. In the meantime, please feel free to email me. I’d be happy to share the details of what worked for us if you think it might help.

[ Permalink ] posted by Anonymous : 2:37 PM