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Jen,
In our situation, our health insurance started paying after the TPR. We took our son directly home from the hospital at legal risk. It was 8 weeks before the TPR occurred (in WI it takes place in court). So, our agency said we were to tell our clinic that Medical Assistance should be billed for his appointments that occurred between the time we brought him home and the TPR. Though, the agency couldn't actually apply for Medical Assistance for him until after the TPR. Billing always takes so long, so by the time those bills were sent, Medical Assistance could cover them.
If you agree to pay a portion of the medical bills for the actual birth, that would probably be out of pocket for you. There was a possibility that we were going to be asked to pay for the deductable of our son's birthmom's insurance. If an emom did not have insurance we were told our agency would help to get them on some kind of assistance/insurance to reduce the cost.
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Me - 31 PCOS
DH - 30 low motility, morphology, and count
TTC - for 3 years prior to bringing our son home
Golden Retriever (8 yrs old) 
10/06, 11/06, 12/06 - clomid, metformin, HCG, and timing (developed vision problems from clomid)
1/07, 2/07 - IUIs (letrozole, metformin, and HCG)
IVF #1 - 6/07 - IVF/ICSI ( fresh transfer cancelled due to OHSS, retrieved 21 eggs - 16 mature)
8/16/07 - FET 
Starting adoption process...but will keep trying
9/18/07 - FET
10/21/07 - FET w/AH
IVF/ICSI #2
12/31/07 - Fresh blasts w/AH
Will become parents via domestic adoption
1/08 Adoption education classes and homestudy
1/29/08 - wait begins
7/2/08 - Matched! Boy due July 25th!
7/22/08 - Our precious boy was born!
7/24/08 - he's home!
9/16/08 - TPR - Jaxon is our son forever!
2/3/09 - Finalized the adoption! Our son, forever and always!
Saving for child #2 - embryo adoption or domestic adoption
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