When health insurance won’t cover your pregnancy

A few weeks after my first prenatal exam, I got a letter from my health-insurance company. It informed me that my pregnancy would not be covered because I wasn’t insured at the time of conception. The fact that I did not know that I was pregnant at the time of conception was irrelevant. I had a complicated pregnancy with preeclampsia, which raised my blood pressure and caused my kidneys to function poorly. Because I required a month of hospitalization and numerous tests, the costs were exorbitant. But I was fortunate. My baby was healthy and my previous insurance company paid the initial bills through the waiting period.

For Tina (right), in Pittsburgh, the solution was not so easy. She, too, developed preeclampsia, as well as gestational diabetes, another high-risk condition. About five months into her pregnancy, she began receiving doctors’ bills and was informed that her individual insurance policy did not cover maternity care. In addition to the mounting financial stress, her mother was diagnosed with cancer, and she had a death in the family. The emotional toll did not help her medical condition. But a newspaper reporter took on her story, and, in the end, the insurance company agreed to cover her bills.

But what about all the women who are not as lucky as Tina and I am?

According to the 2007 report out of the Henry J. Kaiser Family Foundation, the cost of having a baby—even with a routine pregnancy—comes to about $10,000, and a pregnancy like Tina’s can cost as much as $300,000. Amanda from Weiser, Idaho, discovered this firsthand. It would have cost almost $800 a month to add her and her son to her husband’s health policy (he’s a teacher), so she purchased an individual policy instead. But with the insurance’s premium and childbirth deductible and the upcoming birth of their second child, they’ll end up spending 50 percent of the family’s net annual income on healthcare.

In 1978 the Pregnancy Discrimination Act mandated that employers of 15 or more workers provide health insurance with maternity coverage. Unfortunately, that doesn’t include individual policies such as Tina’s and Amanda’s, and it doesn’t cover smaller businesses. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits discriminating against pre-existing conditions, so that women like me, who switch health plans while pregnant, have it easier. But HIPAA mainly applies to those who have had prior group health coverage. If you move from an individual to a group plan, you may be subject to a pre-existing condition waiting period. Or if you move from one individual health plan to another, you may not get pregnancy coverage at all.

We try hard to promote the value of prenatal health care in this country, but when pregnancy costs can wipe out savings, women will invariably be placed in the position of once again making impossible choices.

—Orly Avitzur, M.D., medical adviser to Consumers Union

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Comments

[Paul]

In the past 2 or 3 years, insurance costs and medical costs for my family have grown substantially. And it's not that any of my family members have become sick.
My wife became pregnant and we just gave birth. This caused us to pay out our $2500 deductible rather quickly. Now, we have a new infant to insure, which will be no less than an additional $200/month (on top of the nearly $400/month I pay for my spouse).
A substantial percentage of my sole-provider income is going to medical and it's frustrating.

[Elaine]

This article hits home. Just having my second child, we are faced with the same situation. Insurance companies seem to be less and less affordable, and the list of things they don't cover seems to grow longer and longer. There are many faith-based programs that collect money into a pool and disperse on a as-needed basis. These seem to be more popular and I've heard amazing stories from members. My pastor's daughter had over $1 million in medical bills and it was paid entirely by Medishare. I'm not sure how frequent this type of generosity is, but to me, it is worth looking into.

[tim thomas]

Hi there, thanks for taking the time to respond to my question. I am a teacher for for the blind and visually impaired in Orange County , Ca. Our company was enrolled in Pacificare at the beginning of this year, however effective June 1st we were informed that United health care took over our insurance, which was fine by me. My question is, I met my calender year mental health deductible in March of this year. Do I have to meet a 2nd calender year deductible now that UNH took over for Pacificare? Thanks for any input, sincerely tim

[Affordable Health Insurance Quotes]

When is comes to complication of pregnancy, it is viewed differently than what the maternity benefit covers. Maternity benefit is for regular vaginal birth. As in this case, this was a complication of pregnancy which insurance companies are required to cover even if the policy doesn't cover maternity.

[Carolyn Siler Washington]

I am astounded by all the things I have read here. With health insurance expected to rise again another 12.6% or more in 2009, you will pay more and get less coverage it's no wonder there's a health care coverage crisis in America. If you have a pre-existing condition, forget even trying for coverage. It's no wonder companies offering Benefits Plans are seeing a spike in consumer enrollment.

[George P.]

My wife and I will not be able to afford even maternity insurance. We may consider having the baby in Mexico to reduce costs, even though we are both white. We will also not be able to afford health insurance for our baby. Something's got to give, and it isn't going to be us.

[Dave]

Hi Folks,
Being an independent health insurance broker in Arizona I have run into this problem with quite a few clients. On individual policies even if you opt for the maternity option the additional premium will run you almost as much as they pay out. Usually only $2,000 to $4,000.

If you don't have insurance or maternity coverage, one way to reduce the cost is pre-negotiate a package price with your hospital and doctor. I've had clients say they saved up to half the cost. Getting the cost down from an average here of $8,000 to $4,000 sure can get baby a new pair of shoes. The only catch is you usually have to pay the bill in full by time you leave the hospital.

[CW]

Hello,
I currently have a group health insurance plan with PacificCare and I found out that I cannot add maternity coverage because my group will not cover it. Can anyone lead me to some sort of help? Should I switch from group to individual insurance or cancel my plan altogether and try for a completely new insurance plan? HELP!

[Dave]

As a retired agent, I would say a couple of things. One, if you are currently pregnant, don't drop your group plan..it may cover complications of pregnancy or other chronic illnesses that you may get concurrently. Two, if not pregnant yet, your best option may be to self insure with an HSA account and a High Deductible plan to cover catastrophic illnesses or accidents. Check Blue Cross/Blue Shield. Other considerations, check your chamber of commerce, or worst case check qualifications for public aid. Good luck.

[Janie]

I am 57 years old and realize at my age I am playing Russian roulette foregoing health coverage. But when you become unemployed and can only find sporadic work, it becomes impossible to afford the premiums for an individual policy. I get by with Rx samples my doctor provides when she has them. Otherwise, I would have to do without an expensive inhaler for my asthma. One of my other medications I have to purchase @ $125/mo. I take it every other day even though it should be taken daily. Never thought I would end up in these circumstances. I suspect there are many more out there like me. Too young for medicare but "too old" for the individual policy due to the higher premiums for people in my age bracket. Should I encounter any health emergency, I would have to file for bankruptcy as it would be an impossibility for me to pay those expenses.

[lawdoc]

re TIM THOMAS 8/31: usually, when a company purchases, or merges with another, they do not change the rules midstream, so only one deductible would be expected for the period of coverage (calendar year, or 12 months, etc.). PacifiCare (mental health administered by PacifiCare Behavioral Health [PBH] and UHC (United HealthCare [not "UNH"], mental health administered by United Behavioral Health [UBH], initially retained separate administrations for the different subscribers. Once they integrate their systems, they make whatever changes they feel are in their best interests -- usually financial. At some point, psychiatrists on UBH's network would be able to see patients who were seeing PaciCare Behavioral Health network patients, and, depending if UHC wanted to bring in the PBH psychiatrists into their network, they would either grandfather (grandmother?) then in, or invite them to apply to UBH and thus be able to continue seeing their previously PBH patients.

re CW 9/25: sounds like you are now on an employer's group plan. Check to see if the employer offers a choice of plans that you can switch to during 'open enrollment'. If the employer doesn't cover maternity benefits, contact your plan and see if they would offer you a maternity 'rider', or add on. It certainly makes sense from the insurance companies' perspective to NOT cover maternity when they know the person is asking because they DO INTEND to become pregnant. From the start, they know they are going to lose money on that one!!!! remember, they are NOT in business to provide health care unless it results in them paying out less money in claims than they take in in premiums!!