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Family Forum / Pregnancy / Pregnancy / May 2004Health Insurance
We're in the process of changing health insurance at work. In our group, we have my parents, me, Allyson, and Caterpillar. Neither my parents nor Allyson ever go to the doctor, and have probably had less than $1,000 in medical expenses combined over the last 10 years. Caterpillar and I need health insurance - I because I'm not done having kids, and she because I want more treatment than we can afford if she were to become seriously ill or be in a bad accident. We currently have a small group policy, which is hideously expensive and gets more so every 3 months. The advantage is that if we switch, there's no pre-existing condition wait. If I go to an individual policy, and we ever need to switch, there's a 12-24 month wait before anything we'd had treatment for in the prior year was covered. We also can't find an individual policy with maternity coverage, and complications of pregnancy are the most likely expenses our family will have. For Caterpillar, we had a homebirth with a midwife, and none of it was covered by insurance. That's the plan for #2, but I'm unwilling to risk having complications that run up a huge bill. The insurance agent I'm talking to has faxed me a page from the individual policy that says: "Limited coverage for specific conditions of pregnancy includes only spontaneous miscarriage, ectopic pregnancy, Medically Necessary caesarean section, gestational diabetes mellitus, and medical conditions whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy." Insurance agent says that means everything except routine prenatal care and normal vaginal delivery are actually covered by a policy that has no maternity coverage. Has anyone been in the situation where they had insurance with no maternity coverage, got pregnant, and had complications? Did you have a good experience? Any other things I should consider? Phoebe :) > For Caterpillar, we had a homebirth with a midwife, and none of it was > covered by insurance. That's the plan for #2, but I'm unwilling to risk [quoted text clipped - 10 lines] > and normal vaginal delivery are actually covered by a policy that has no > maternity coverage. I wouldn't interpret the quoted policy as saying that at all. What if you had complications during the homebirth that ended in a hospital transfer, an epidural, and an instrumental birth? Doesn't sound like that would be covered to me, but it would likely be pretty pricey to pay out of pocket, especially since you'd likely be paying your midwife on top of it. Best wishes, Ericka > What if you had complications during the homebirth > that ended in a hospital transfer, an epidural, and an > instrumental birth? Doesn't sound like that would be > covered to me, but it would likely be pretty pricey to pay > out of pocket, especially since you'd likely be paying > your midwife on top of it. A $10,000 hospital bill doesn't worry me. A $50,000 hospital bill worries me, and it's fear of a $50,000 hospital bill that is leading me to want insurance at all. We have a high-deductible plan, so the first $5,000 of expenses are out of pocket regardless. I'll get $5,000 into a savings account from my employer every year for 2004, 2005, and 2006, and we aren't anticipating that #2 would be born before 2006. We'll probably use some of that $15,000 for routine stuff, and some for TTC#2, but we've also got savings that could be dipped into. So $10,000 for a complicated vaginal birth and $5,000 in deductible doesn't worry me so much. Plus we're saving $500 a month in premiums (and getting slightly better coverage), which for 24 months is $12,000 that could be used to defray any birth expenses. Phoebe :) -- yahoo address is unread; substitute mailbolt > A $10,000 hospital bill doesn't worry me. A $50,000 hospital bill worries > me, and it's fear of a $50,000 hospital bill that is leading me to want > insurance at all. I should think so. I think going without insurance is terribly risky, even if you're quite healthy. My SIL went without insurance for a single month when switching between her employer's insurance and insurance through her husband. She figure no problem, she'd pay for the baby's six month well baby visit out of pocket since it wasn't that expensive. Wouldn't you know that was the visit her baby was discovered to have cancer. The financial implications for them were staggering. I'll keep thinking in case I can come up with a vaginal birth situation that might get out of hand financially. I assume that something strange like serious complications from an epidural would be covered. If there were complications from a vaginal delivery that required you to stay in the hospital for quite a few days, would that be covered? Best wishes, Ericka > I think going without insurance > is terribly risky, even if you're quite healthy. I agree if you've got kids involved, but if you've got no one dependent on you and no one responsible for you, there's always bankruptcy, or payment plans. Since I've been uninsured most of my adult life (and I suspect for most of my childhood), the vague possibility of catastrophic illness or injury weighs less heavily on me than the tremendous cost of health insurance. Your SIL's situation is covered by HIPPA now; you can have a 63-day break in group coverage without getting hit with a pre-existing condition period. But childhood cancer is really the only reason I care about insurance for Caterpillar. (For #2, I'd want insurance from birth, in case there were any birth-related issues, but we're past that point with #1.) > If there were complications from a vaginal > delivery that required you to stay in the hospital for quite > a few days, would that be covered? Heck if I know. Part of my problem is that even with the policy in front of me, I don't know enough about how any pregnancy-related complications would be coded to tell whether they'd count as a distinct diagnosis complicated by pregnancy, or a subset of pregnancy. Phoebe :) -- yahoo address is unread; substitute mailbolt >>If there were complications from a vaginal >>delivery that required you to stay in the hospital for quite [quoted text clipped - 4 lines] > be coded to tell whether they'd count as a distinct diagnosis complicated by > pregnancy, or a subset of pregnancy. Yeah, that's the tough part :-( I wonder if you could take the policy statement to a medical professional in a childbirth-related field and ask them what they thought? Do you have an OB that you have any sort of relationship with that you could go to the office and talk to the person there who handles their insurance issues? Most offices have someone who specializes in insurance issues on staff these days. I suspect that person might know better than anyone else where the pitfalls might be. Best wishes, Ericka > Most offices have > someone who specializes in insurance issues on staff these > days. I suspect that person might know better than anyone > else where the pitfalls might be. I think you're right. I suspect if something did come up, I'd have a situation like Leslie's - whoever was doing the coding of the bill would need to find a diagnostic code that made it covered, then advocate for it to be covered. If we were planning a hospital birth (or risked out of homebirth before I went into labor), then I'd just find a sympathetic OB, and I think it would be fine. In a situation where we'd only need a sympathetic person if we needed to transport (and take whoever was on call), we're more likely to have problems. You don't happen to have any stats on likelihood of intrapartum and postpartum complications in subsequent pregnancies vs. initial pregnancies, do you? I know first babies are much more likely to transport, but I don't know what the odds are for complications that would cause a hospital stay after a homebirth, for instance. Phoebe :) > You don't happen to have any stats on likelihood of intrapartum and > postpartum complications in subsequent pregnancies vs. initial > pregnancies, do you? I know first babies are much more likely to > transport, but I don't know what the odds are for complications that > would cause a hospital stay after a homebirth, for instance. I know you'd be at a lesser risk for complications overall (because having a successful vaginal birth previously rules out some possible complications, but you haven't had so many babies that you're in the running for the sorts of complications that come with having had lots of babies). I don't know the actual numbers. If I run across something, I'll post it (don't have time to look right now). Best wishes, Ericka > >>If there were complications from a vaginal > >>delivery that required you to stay in the hospital for quite [quoted text clipped - 17 lines] > Best wishes, > Ericka I had possibly one of the worst insurance situations known to man in my first pregnancy-the company I was with changed on January 1st, having been bought out by another company. All subscribers under company A were immediately covered under company B, however, on January 1st, I ended up having an emergency C-section. Of course, all offices were closed on January 1. Officially, company B didn't even know I was pregnant. We ended up with all sorts of mess because I had ended up having a C-section w/o pre-approval or authorization. Luckily, both the women's hospital and the perinatologist were more than willing to argue with the company-and the medical records were clear that all the steps had been followed, just under the old insurance company. But you'd better believe I changed insurance ASAP after that! When I had a chance to change insurance, I spent quite awhile talking to the person who handles insurance for the perinatal practice, and went with the one that, according to her, had the best record of ACTUALLY covering high risk pregnancies and after care. We plan to keep my insurance on Cobra for the last few months of this pregnancy (I'm covered until Aug 1 because of the school district calendar, and will be covered at a reduced rate for the first 3 months of next school year for my normal "maternity leave", but after that I'm stuck for the full bill) just to avoid insurance hassles (my husband's company tends to change its insurance each fiscal year, so if I went with his, it would be switching mid-pregnancy again). Anyway, I second talking to the OB's billing office-they know quite a bit about which insurance companies are reasonable and which aren't, which are willing to pay for stays longer than the minimum if needed, will pay for extra pre-natal visits, etc. If you're considering a midwife instead of an OB, it would be good to check with that practice about whether or not they're covered, and for what. > If you're considering a midwife instead of an > OB, it would be good to check with that practice about whether or not > they're covered, and for what. Even if we had maternity coverage (which I currently do), they covered *nothing* for Caterpillar's pregnancy and delivery. They would have covered a birth center birth (I know because I read the policy and argued until they gave in), and prenatal care by a CNM. Our midwife is still finishing up her CNM work, so she won't have any real-world experience on dealing with insurance. The birth center near us closed down, so isn't an option. Phoebe :) > Anyway, I second talking to the OB's billing office-they know quite a bit > about which insurance companies are reasonable and which aren't, which are > willing to pay for stays longer than the minimum if needed, will pay for > extra pre-natal visits, etc. Actually, I would contact the insurance companies themselves, and request explanations of benefits (including answers to specific questions) in plain English, in writing. DH and I found ourselves in a situation where the clinic/hospital we went to for prenatal care assured us before I even got pregnant that we would be covered, only to find out after some complications early on that the insurance company did not cover prenatal care, a normal birth, or a healthy baby at all (granted, they have assured us if complications occur, they will cover that). Not good news for two students who make less than $10K a year put together. :( Get something from the insurance companies in writing -- then, if they claim different coverage later, you've got them on the hook. Good luck. -Carlye EDD 9/26/04 >Has anyone been in the situation where they had insurance with no >maternity coverage, got pregnant, and had complications? Did you have a >good experience? After William was was born, I had to be readmitted to the hospital because I had an awful headache, my chest hurt, and I just felt terrible. When I got there they began to run all sorts of tests on me, and because one explanation for the symptoms could have been post-partum cardiomyopathy, I had to have a lot of tests done includint, IIRC, an dkg, an electrocardiogram, a CAT scan, a VQ scan, and some kind of ultrasound, bloodwork, and God only knows what all else. Turns out that I had just bled a lot, lost half my blood, and needed two pints. My major medical, non-maternity insurance wanted to call this a maternity expense and stick us with the well over $10,000 bill (in addition to the money already owed to the doc, hospital, anesthesiologist, and neonatologist for the birth!). I was able to get my doctor to convince them that they should cover it--but it was 80-20 with a $2,500 deductible, so it was still pretty bad (and still mostly unpaid . . .). Anyway, I wouldn't count on insurance covering anything they don't explicitly say they will cover, not without a fight anyway. Leslie We had ours at my mom's, she brought her hot tub to body temp, it helped that she had birthed seven of her own and had been a nurse before that. We read all we could about home birthing at the library beforehand, and figured we could always call the paramedics in an emergency, though we never had to. Sure, get insurance if you can, but if you can't, do what women have been doing from the beginning of time, and a majority of the world's women do at the present day-have those kids yourself, at home. When we filed at the county for our first birth certificate, we found out from the clerk that it wasn't all that uncommon. You need medical attention if there are serious complications, but you don't need a doctor to catch the baby.-Jitney > We had ours at my mom's, she brought her hot tub to body temp, it > helped that she had birthed seven of her own and had been a nurse [quoted text clipped - 7 lines] > all that uncommon. You need medical attention if there are serious > complications, but you don't need a doctor to catch the baby.-Jitney Two other options: a midwife practice, with a birth in a birthing center or at home (much less expensive-I believe the one here charges about $2000 for pre-natal care, post-natal care, and a midwife-assisted home birth) or a pre-paid plan-One of the hospitals here has a package deal where you can pay your pre-natal care, all required tests, 1 u/s, an OB assisted delivery, and 2 days after-care for, I believe around $5000. This is done on a monthly basis, over something like 24 months. (I don't know what they do if you default-impound the baby??). Neither will help in the slightest if it turns out you or the baby need additional care, but in a vast majority of pregnancies, you won't. > Sure, get insurance if you can, but > if you can't, do what women have been doing from the beginning of > time, and a majority of the world's women do at the present day-have > those kids yourself, at home. I don't need insurance to cover a normal, uncomplicated birth, because the plan is to have a homebirth (which is what we did for #1). It's the case where something goes wrong that I worry about, and the difference between being stuck with a $10,000 hospital bill and a $50,000 hospital bill, when $20,000 in premiums would have saved $40,000 in expense. OTOH, I would *never* recommend that someone choose a homebirth (particularly UC) purely for financial reasons. I can't imagine being in labor, having a vague feeling that something was going wrong, and trying to balance the cost of going to the hospital against the risk of staying home. Phoebe :) "Phoebe & Allyson" <allyphoe@yahoo.com> wrote in message > Has anyone been in the situation where they had insurance with no > maternity coverage, got pregnant, and had complications? Did you have a > good experience? Any other things I should consider? <snip> I don't have any experience with what you are asking about, but we have a similar situation. Earlier this year, we opted to drop DH's employer's insurance plan and buy our own insurance policy. We opted for a plan with no maternity coverage, since to have maternity coverage (that was only up to $2500) was $56 per month extra and that would not cover a homebirth which is what we plan for #2. The policy has a statement just like yours that implies that pregnancy and birth related complications are covered (c-sections are specifically mentioned as covered, which was my main worry), but routine prenatal and delivery care are not. I probably should have asked if an NICU stay for the baby would be covered, since that can be horribly pricey, so you might want to ask about that. This option made tons of financial sense for us because dropping the employer plan gave DH an automatic $4 per hour raise (that is about $8000 a year!) and also took our monthly insurance premium from $320 per month to $120 per month. Both of those changes, mean the ability to create a larger emergency cushion to back up our minimal insurance coverage. -- Em mama to L-baby, 8 months old! > I probably should have asked if an NICU > stay for the baby would be covered, since that can be horribly > pricey, so you might want to ask about that. All of the baby's care is covered, because the baby is covered from the moment of birth. (That's almost certainly true of your policy as well.) If the baby were to get pregnant, that would be a whole 'nother story. ;) Phoebe :) -- yahoo address is unread; substitute mailbolt "Phoebe & Allyson" <allyphoe@yahoo.com> wrote in message > > I probably should have asked if an NICU > > stay for the baby would be covered, since that can be horribly [quoted text clipped - 3 lines] > moment of birth. (That's almost certainly true of your policy as well.) If > the baby were to get pregnant, that would be a whole 'nother story. ;) One of my main concerns with this policy was making *sure* that the baby would be automatically covered from the get go. (I was fairly sure it wasn't "allowed" for them to say that a newborn with a health problem couldn't be added to my policy, but I wanted to make absolute sure.) However, as I was reading this thread, I started to think that maybe they could wiggle out of NICU care somehow by saying that the baby was only there because of my homebirth or something like that. Doesn't make any sense when I write it out now though. -- Em mama to L-baby, 8 months old! |
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