Uninsured and Out of Luck

TheLadyBrooke

My husband and I are in the first month of trying to conceive after stopping my birth control and I'm already nearly fed up with the medical system. Before I stopped my birth control I called my GP's office, where I have been a patient for the last 12 years, and tried to make an appointment for a pre-pregnancy check up. You know, make sure everything was a green light, not that I'm anticipating there being any issues. Right off the bat there were problems because the nurse I spoke with acted like I was a lunatic. She said there was no reason to see a doctor until I was already pregnant and no, my doctor would not prescribe me a prenatal to get started on. (I work as a pharmacy technician, I know there is a difference in ingredients vital to the first month of pregnancy that isn't in OTC prenates.)

So after a fight with my GP's office she tells me that my doctor doesn't "deal with pregnancy" anyway and I'd have to find another doctor to follow up with once I'm pregnant. This began my search. I am uninsured. We are more than willing and able to pay for any pregnancy related expenses and we have money in savings that we've been stashing away for this very reason. I have contacted all of the local OB's I can find and NOT ONE of them will accept an uninsured patient on a payment plan or cash upfront. I'm getting really frustrated with this.

Does anyone have any insight into this issue for me? Do I have to have an OB? I was just so floored when my family doctor who I've seen forever refused me for something that I feel is so important. Ugh.

-vent-

JCWhitey

Because of the AHCA doctors can't do cash payments anymore. It makes it very difficult for them. As a pharmacy tech you should probably have known all about this. At my pharmacy AHCA stuff was drilled into us constantly. Also do you really have $150,000+ saved up for this? Because that is what my sister's medical bill was for the birth of my nephew when she had to spend 3 weeks in the hospital due to pregnancy inducedkidney failure, the c-section to delivery him, and the 4 days he spent in the NICU. None of which could have been anticipated before she got pregnant as a perfectly healthy 19 year old. Luckily she only had to pay about $7,000 OOP thanks to insurance. If you don't have that much saved get insurance, it'll make your life easier and it's pretty affordable and even free if you are make under a certain amount. And if you do have that much saved why not just get insurance and have a nice savings? It makes no sense to spend that much money when you don't have to.

normandyn7

Please please please get insurance before getting knocked up. I will tell you from experience, it is freaking expensive to pay out of pocket for a pregnancy. My son is a year old and I didn't have insurance when I got pregnant. I have no idea how we are going to pay off all the medical bills we racked up from my pregnancy. You never know how your pregnancy will be and if you will need more medical care than normal (like me). Just get insurance. It's really idiotic to not have insurance and purposely try to get pregnant. I was an idiot and now I'm paying for it.

EDIT: I didn't purposely get pregnant. My son was an whoopsie and I was in the middle of getting insurance. Once I was pregnant it was a pre-existing condition so no insurance company would insure me.

ChristyM87

If you live in an urban area there may be free or low cost women's health centers available to you. I have also found nurse-midwives more likely to be flexible with taking cash payment or having a sliding scale fee.

That being said if there is anyway you can get health insurance prior to conceiving that would be ideal. Working in a pharmacy, I should not have to tell you that healthcare is expensive. Who knows if what starts out as a routine low risk pregnancy will end that way for you. Or what if your baby needs to be in the NICU or you need a C-section. I have read that the average NICU stay is $1500/day.

Please, look into self pay plans or see if you qualify for Medicaid. Even if a plan has a high deductible it could still give you some assistance and piece of mind if complications arise.

jennypolkadots

You are expecting to rack up some $12K + in medical bills within the next year, but don't want to just get insured? Depending on your income, you can get decent insurance for less than $400 a month and really reduce your liability for costs of birth. Honestly, I've never met anyone in my life that can afford a sudden catastrophic illness ($100K easy in a few weeks of ICU for example, a heart surgery, etc.) and these things really happen to everyone. If you're good with money, you should realize what a high risk you are running by not at least carrying basic insurance.

Get insured. Get pregnant. Then see an OB. 

Prenatal vitamins are just a fail safe. There is nothing in a vitamin that isn't better supplied through a healthy diet. Focus on your diet and just take the OTC vitamins practically everyone else takes. I took off brand gummies (OH! the horror!) and am currently 6 months pregnant with a perfectly healthy baby. In fact, at the 20 week U/S the doctor commented on how perfect the spinal cord looked. But maybe he is just getting paid to say that by Target's vitamin department, who knows 

:-?

jennypolkadots

PP brought up a great point about infant insurance. If something goes wrong at your birth, it is YOUR insurance (or lack there of) that covers the baby for the first 30 days. You can't get insurance for a baby until after they have been born, and any issues that arise would be pre-existing conditions at that point. You can't be denied coverage for PEC but you can pay out the ass for it. I'm sure there is even more to this, but this is my limited understanding from looking into my insurance and what our baby will have.

Even if you are just insanely rich ($1M in savings), you should know that limiting your monetary risks by carrying insurance is the sane thing to do. You don't want to lose everything you have worked hard for. This just sounds insane honestly. 

I'm not using my insurance for my birth because we are using midwives and an out of hospital birth. We will pay out of pocket and can afford it (there is no award for this btw)... but boy am I glad my insurance is excellent in case we have an emergency at any point during pregnancy, delivery, or postpartum. And having my baby covered until we can get their own insurance plan. Please consider this and get insured before getting knocked up. 

Helenahhandbasket

So, why do you not have insurance? 

pippacricket

TheLadyBrooke said:

I work as a pharmacy technician, I know there is a difference in ingredients vital to the first month of pregnancy that isn't in OTC prenates.

Pharmacist here telling you to get over yourself. They're vitamins. The only difference between OTC and RX prenatal is the amount of folic acid in SOME (not all) of the prescription formulations. 

TheLadyBrooke

Thank you everyone who has replied. I will continue to try to find insurance, I'm not refusing it trust me. I'm just not offered it through my job. I'm in the process of trying to get put on my husband's insurance but that's just a mess of a discussion I'd rather not get in to.

As for why get pregnant without insurance? There are circumstances we're in and my husband and I had to make a decision about what we want in our lives and this was it. None pertaining to any health issues, but still they are concerns. I'd rather not discuss them on a public forum but I appreciate those of you who asked.

I would like to point out that this was my first time posting as a member of this forum and I had a genuine question and some of the responses I received were rather rude. I had hoped that this being a forum for mature, adult discussions and questions I wouldn't be met with that but I guess you can't avoid bad behavior on the internet. It's a shame.

Thanks again everyone for your input.

DebateThis

jennypolkadots said:

You are expecting to rack up some $12K + in medical bills within the next year, but don't want to just get insured? Depending on your income, you can get decent insurance for less than $400 a month and really reduce your liability for costs of birth. Honestly, I've never met anyone in my life that can afford a sudden catastrophic illness ($100K easy in a few weeks of ICU for example, a heart surgery, etc.) and these things really happen to everyone. If you're good with money, you should realize what a high risk you are running by not at least carrying basic insurance.

Get insured. Get pregnant. Then see an OB. 

Prenatal vitamins are just a fail safe. There is nothing in a vitamin that isn't better supplied through a healthy diet. Focus on your diet and just take the OTC vitamins practically everyone else takes. I took off brand gummies (OH! the horror!) and am currently 6 months pregnant with a perfectly healthy baby. In fact, at the 20 week U/S the doctor commented on how perfect the spinal cord looked. But maybe he is just getting paid to say that by Target's vitamin department, who knows 

:-?

Ditto this.

BUT just one addendum. My ultrasounds alone were $400 each. I had them weekly from 18-38 weeks due to cervix issues. $8k, just in ultrasounds. That's not including the $500/month in Crinone I was on to try to delay labor as long as possible, the weekly MW visits, an overnight stay for preterm labor ($7,500)... the list goes on and on.

ChristyM87

TheLadyBrooke said:

Thank you everyone who has replied. I will continue to try to find insurance, I'm not refusing it trust me. I'm just not offered it through my job. I'm in the process of trying to get put on my husband's insurance but that's just a mess of a discussion I'd rather not get in to.

As for why get pregnant without insurance? There are circumstances we're in and my husband and I had to make a decision about what we want in our lives and this was it. None pertaining to any health issues, but still they are concerns. I'd rather not discuss them on a public forum but I appreciate those of you who asked.

I would like to point out that this was my first time posting as a member of this forum and I had a genuine question and some of the responses I received were rather rude. I had hoped that this being a forum for mature, adult discussions and questions I wouldn't be met with that but I guess you can't avoid bad behavior on the internet. It's a shame.

Thanks again everyone for your input.

I am sorry you did not get the advice you wanted.

I would look into getting on your husband health insurance, even if it is a lot of work it would be worth it. If you are opposed to that then I recommend buying a plan on the exchange.

amelyse39

You have no health insurance? Besides the fact that you have to have health insurance because of the ACA even if it's a high deductible plan, not having insurance is a horrible, horrible idea, regardless of whether or not you're pregnant. Although some of the other posters on here may have come across rudely, I can't even fathom why you would be thinking of getting pregnant without having any health insurance. Talk about taking a huge, life changing, stressful event and compounding it a million times over. You can't just have money in the bank for something like a pregnancy- what if your child is born prematurely and is in the NICU for months? What if there's a major complication at birth? You could be in debt for the majority of your life due to this.

Sorry but you need to do a bit of growing up before you even think about having a baby. Take some of that savings & get some damn health insurance.

Carolinabuckeye

OTC prenatals are different, but you can get similar ones with some research. BUT prescribed prenatals are often the result of many pharmacy reps selling their product. Despite copious amount of research from the drug companies who manufacture them, it is in any best interest to research what you need and go from there. Perhaps get a CBC and check yor vitamin levels and try to find a prenatal with higher percentages of the vitamins you need that fall win your healthy range. As far as being uninsured, you can A) apply for gap coverage (aka obamacare) or offer to sign a contract with legally binding payments. You can also say that you are "in between insurances" and you can pay cash for now. I am surprised that you have been rejected for cash, and unless some of the other posters have had personal experience with it, most physicians can accept cash payments. If they don't, it might be because they are afraid if you pay up front, you might not pay for additional charges that could happen after an appointment. Many physicians offices tend to over charge a tad to a percentage health insurance, with cash they tend to make less money...but it's money right away. I would suggest calling a midwife or a dhoula if you cannot find a physician that will enlist you as a patient. Often times you can get 20% off services if you pay that day in cash. (Depending on your district) Keep calling and keep checking. Good luck!! Sources: I have a degree in medical admin, specializes in health insurance

jennypolkadots

TheLadyBrooke said:

but I guess you can't avoid bad behavior on the internet. It's a shame.

Haha this literally made me laugh out loud at my desk. I feel like OP is literally wagging her finger at every person who said it isn't a responsible idea to get pregnant without health insurance. [-X 

How do you "try" to get on your husband's insurance? Open enrollment should happen for most companies between now and the end of the year. It's a very simply process. You don't have to "work on" getting insurance, it is really an easy process. Call a few different providers and get quotes, you can be covered today. If you have money saved for the pregnancy the cost should be nothing in comparison to what you are expecting to pay. You want look specifically at maternity coverage - low deductible (because you will meet it!), ultrasounds covered, prenatal visits covered, and who is considered in network.You need to do this before you get pregnant or the amount you will pay for insurance will be much higher, or may exclude paying for your pregnancy if you didn't disclose it before signing up. You should also look into short term disability coverage before getting pregnant if you rely on your income. 

https://www.aetna.com/individuals-families.html

https://www.bcbs.com/

https://www.humana.com/individual-and-family/

https://www.unitedhealthgroup.com/

https://www.healthcare.gov/

MrsRustyGriswold

ZOMG, that is such a good plan.  You should totally go for it and rack up as much in medical costs as you can.

Did I answer correctly?

JCWhitey

econmama said:

Because of the AHCA doctors can't do cash payments anymore. It makes it very difficult for them. As a pharmacy tech you should probably have known all about this. At my pharmacy AHCA stuff was drilled into us constantly. Also do you really have $150,000+ saved up for this? Because that is what my sister's medical bill was for the birth of my nephew when she had to spend 3 weeks in the hospital due to pregnancy inducedkidney failure, the c-section to delivery him, and the 4 days he spent in the NICU. None of which could have been anticipated before she got pregnant as a perfectly healthy 19 year old. Luckily she only had to pay about $7,000 OOP thanks to insurance. If you don't have that much saved get insurance, it'll make your life easier and it's pretty affordable and even free if you are make under a certain amount. And if you do have that much saved why not just get insurance and have a nice savings? It makes no sense to spend that much money when you don't have to.

Umm. First, it's the ACA (or full name PPACA) and not AHCA. If you're going to inform someone of what the law says, I'd think you'd at least know the name. Second, all of this regarding cash payments is wrong. ACA did not change doctor payment methods. Signed, ACA implementation expert Regaring the OP: 1-You don't need a preconception appt. 2-OTC prenatals are fine. 3-I'd consider health insurance. 4- Docs don't take patients without insurance unless they pay something upfront so they can confirm their ability to pay. It's quite logical.

Sorry I didn't want to write out Affordable Health Care Act a dozen times. Anywho... if this is true then why did every single pediatrician in my town turn us down for out of pocket payment by saying that due to the changes they could no longer accept OOP patients?  We had insurance that they also wouldn't accept.  My son had to get his vaccines at the public health center until we moved and were able to get better insurance.  Maybe it's just California, but it definitely screwed a lot of cash payers over, including us.  So you may be an "expert", but this was my experience.

JCWhitey

MrsRustyGriswold said:

ZOMG, that is such a good plan.  You should totally go for it and rack up as much in medical costs as you can.

Did I answer correctly?

Well, she can always do what people did before health care was pretty much as affordable as it comes and easy to get in the US.  Rack them all up and then not pay them and dump them on someone else.  It's the American way, after all!!!

Seriously, OP, I was pregnant when I got PG with my son, another surprise baby.  A lot has changed in the two years since I got that news and insurance can be gotten even if you are pregnant, but your best bet is to get it BEFORE you get pregnant.  Just in case.  Because I can also tell you that nothing sucks worse than getting a $400 bill in the mail from the doctor who diagnosed your miscarriage.  That's a lovely slap in the face.  Which I hope doesn't happen to you or anyone ever, but it can, sadly.  And trust me, you don't want that.

sandrabrooke

For some reason I thought this was illegal to not carry insurance....

MrsRustyGriswold

sandrabrooke said:

For some reason I thought this was illegal to not carry insurance....

I don't think it's illegal, per say, but if comes with a hefty fee/fine.

stemi

Not adding anything new here, but just want to emphasize how completely irresponsible it would be to TRY to get KU while uninsured.... Especially now. You can enroll for new insurance in November. Start researching plans now and call around to Dr's offices to see if they participate.

Mysterious_wife

My failed pg was over $25k. I saw my OB at least 6 times. I think those a few hundred each time. I saw a MFM up to three times a week over a span of 8 weeks. I don't remember what she charged. Level II u/s costing about $600 a pop. (I think I had 4) the regular u/s was $250ish. I had a few of those. The CVS test was $2,500. Then there was the blood work every week. i had two echocardiograms too. And a heart holster. Then I lost the pg around 14 weeks. I had to have surgery. That was $10k alone. Due to the special circumstance I had a panel of RPL blood work. I think that was $800.


So yeah. You may not even bring home a baby and go bankrupt. There is no way I could have paid that OOP without causing a huge burden on my one income family.


Oh and I was on bed rest for a few days. I couldn't work or attend school. (I was a SAHM so work did not matter)



KOKO without insurance, but don't cry to anyone when you can't put food on the table or pay your bills.