Insurance Q and stressed out! [long]

Nmooney1

This pregnancy was not planed (don't get me wrong, we are happy!!!). We were done and I was scheduled for a tubal (9/17). Last December we even dropped our then current insurance (to drop maternity) and took on a cheaper plan (my husband owns his own company, and it saved him money all around with him and his employees). I had an IUD at the time and wasn’t too concerned (not to mention I have PCOS and needed clomid for my other pregnancies).
Sooooo – fast forward to my BFP. I immediately call our insurance rep and tell him we are pregnant and that we need to change our insurance. He told me he would get it going with a 10/1 start date. I asked if it was going to make the cost sky rocket. He told me he didn’t know because Obamacare is so new. He said he needed to see if it would be better to change our family policy or take me off and give me my own policy. He asked me to give him until that Wed or Fri and get back a hold of him. I gave him until Monday just to make sure he had time to get it all done. I emailed him. Nothing. Emailed the next day. Nothing. Called and left a voicemail. Nothing. Emailed. Nothing. Called. Nothing….and it continued for over two weeks. Fast forward to today. I am starting to get pissed. I have another u/s on 10/1 and would like to get this figured out. Called him again and got his voicemail. I left a pretty stern message saying I needed to hear back form him even it if was just an email saying “I am working on it.” I decided to call his companies headquarters (he is the manager for his location). They said no one has ever complained of this issue with him. She put me on hold to call him. Guess what!? He didn’t answer. She asked what was going on and I explained. She then proceeds to tell me that, unless something has changed that she doesn’t know about yet, with the new healthcare reform, if you get pregnant with out maternity coverage, you get dropped completely as does the spouse on the plan. How in the world does that even make sense?!?!?!
I am trying to read stuff online, but I am finding a lot of mixed info. Does any have any insight to this? Why would they drop an expecting mother (and the spouse for that matter!)? Don’t they want proper care to be given? Now, of course, we will obviously pay for this out of pocket if we have to – but I know there are people out there that can’t afford it – therefore I would think they wouldn’t get all of the care they truly need bc they don’t want to pay for it.

ShannonSky

That doesn't really make sense to me that they would drop you, but I could see them not covering anything maternity. I'm sorry, all my HR experience is pre-Obamacare...it's a brave new world. Just keep calling, and maybe try emailing as well? I know I seem to get more clarity in answers to my questions when I email my insurance provider vs. calling.

sparklingdiamond

Did you have a private policy?  I know here, none of the private policies cover maternity and they will drop you if you get pregnant.  But if you have a group policy through an employer, it does cover maternity and they can't drop you.  I am currently without insurance because my husband's work didn't want to cover spouses anymore.  So I am just going to sign up for Obamacare in Jan and just have to be out of pocket until then.

jennifers1979

We have individual insurance as well, and I was told that if we didn't have the maternity rider and I got pregnant (or got pregnant before the maternity rider kicked in a year after we started paying for it), that all pregnancy-related expenses would be OOP.  They wouldn't drop us, but they wouldn't pay for anything remotely related to maternity (i.e. my PPD with DD #1 was not covered, because it was diagnosed after we got onto individual insurance but before we'd paid the rider for a year).

If I'd gotten pregnant w/o mat insurance, my OB's office would have worked with us on a self-pay plan (they would have reduced costs and made them similar to what the ins. company pays in terms of global fees for a pregnancy).  You may want to check into this with both your provider and hospital.

singing_lyn

My husband and I both don't have insurance, because he's temp, and I'm technically self-employed and don't get insurance through where I work. We assumed that he would be hired on before we got pregnant and then we would have insurance, but that didn't quite work out. So I called around to get quotes and called and spoke to one agent that one of my sisters and my parents have as an agent and I told him I was pregnant and looking for a policy. As soon as I said pregnant he was like nope, no one will insure you, and it you don't tell them you're pregnant and you go in for an appointment and they find that you were when you signed up for the policy they will drop you. If you're pregnant within 3 months or them insuring you. So then he goes you can definitely get medicaid you'll be approved no problem, and then in January when Obamacare comes in to effect you can apply then. So basically it sounds to me like your insurance company is probably freaking out and going to drop you, but as of January you'll be able to get insured again. Sorry that I can't be more helpful. But with how your agent is acting I would be preparing yourself for that.

IBackBevo

Well, as of January 1st they have to provide you maternity AND they cannot deny you for a pre-existing condition (i.e. pregnancy).  If they do drop you, it will only be for the next few months.

dragossoul84

I had to go on medicaid when I was pregnant for my ds because we had a private policy that did not have maternity coverage because I didnt think I could carry to term. The insurance company said they could not add maternity coverage after you find out you're pregnant. I had ds in 2012 so things may have changed but this was my experiance.

IBackBevo

What I said above is the law under the Affordable Care Act!  So you can think the dems.  I am not even a Dem (nor am I republican) but this is one thing they did that was good!  In my state (Texas) maternity was not even available if you are on a private plan...at all!!!!!!!!!!!!!

FYI, my DH and I have a private plan, too.  My husband is a physician with his own practice (so self- employed) and my employer does not offer insurance. 

IBackBevo

Also, you can begin applying for new policies on October 1st.  They won't come into effect until January 1, but you will be fine before the big ticket items.  Between now and then I would only do what is necessary if you are concerned about money.

For me, my RE will pretty much cover all 1st trimester bloodwork, ultrasounds, visits, etc. for $1500.  Or, I can pay per visit.  It is $300 for a doctor's visit plus ultrasound plus bloodwork. Not a bad deal.

Nmooney1

Thanks for all of the info ladies.

This may sound dumb -  but I don't know if our insurance is considered private or group. I would  think group bc I know my husband pays for one of his employees (no one else in the office needs it). Also, we don't pay out of our personal money for insurnace - he writes a check from the company to pay for it - which makes me think it is written up as a group plan.

I called my husband to ask him some questions about it, but he was too busy at the time.

sparklingdiamond

If he is covering all three of you, it might be considered a group plan.  But then group plans shouldn't have dropped you.  I hope you get it all worked out!