Anyone in insurance?? Kind of in a bind...

bradysmama29 · July 2010

My husband recently switched companies, so obviously our coverage changed as well. I just came to find out that the maternity benefits through this new plan are slim to none. Only $500 is covered per calendar year, and I have already hit that with my first two prenatal appointments (which included bloodwork, ultrasounds, etc.)

Obviously, pregnancy is considered a pre existing condition, so finding coverage while pregnant is really tough. I am looking for either a new plan, to upgrade the current one...or find some solution, so I am not stuck with thousands in medical bills.

Anyone have any insight or advice on this?

agibson175 · July 2010

Most insurance companies SUCK when it comes to pregnancy as a pre-existing!

the only thing I can offer is speaking with your doc office.... sometimes they give discount pricing if you pay "cash", or you can negotiate a price for the entire pregnancy and labor and delivery.

state721 · July 2010

Not in insurance but I am pretty sure a law was passed in the 90s that made it so pregnancy was not a pre-exsisting condition. When I switched insurances, all the new company required was that I did not have a lapse in coverage (which I did not). The only differences may be, as you found out, is the different level of coverage which luckily my new company was exactly the same as the old which is wonderful.

Good luck finding a new company!

odear · July 2010

state721:

Not in insurance but I am pretty sure a law was passed in the 90s that made it so pregnancy was not a pre-exsisting condition. When I switched insurances, all the new company required was that I did not have a lapse in coverage (which I did not). The only differences may be, as you found out, is the different level of coverage which luckily my new company was exactly the same as the old which is wonderful.

Good luck finding a new company!

This applies to group plan, not individual plans. You can not go out and get an individual plan that covers maternity benefits while already pregnant. Most individual plans that do have maternity coverage require you to be on the plan for 1-2 years before it covers anything.

I am not sure if there is anything you can do to "upgrade" your plan unless your DH's company has different tiers of coverage. Even if that is the case, you likely can only make this type of change during open enrollment.

jteneback · July 2010

state721:

Not in insurance but I am pretty sure a law was passed in the 90s that made it so pregnancy was not a pre-exsisting condition. When I switched insurances, all the new company required was that I did not have a lapse in coverage (which I did not).

Yes, but she would be looking for private coverage, where maternity is usually very expensive. Do you have a job with benefits where you could switch to your plan? Unless your DH wants to switch jobs again your only other option may be Medicaid.

bradysmama29 · July 2010

jteneback:
state721:

Not in insurance but I am pretty sure a law was passed in the 90s that made it so pregnancy was not a pre-exsisting condition. When I switched insurances, all the new company required was that I did not have a lapse in coverage (which I did not).
Yes, but she would be looking for private coverage, where maternity is usually very expensive. Do you have a job with benefits where you could switch to your plan? Unless your DH wants to switch jobs again your only other option may be Medicaid.

unfortunately, no, i am a SAHM.

Piad1 · July 2010

I would go with the pp's recommendation to negotiate with the doctor's office. When I had my son, I wanted to use a practice that didn't take my insurance. I spoke with them and since they didn't want to lose a patient, they allowed me to stay with them and accepted a reduced rate as full payment. Not all offices will do that, especially if you haven't been a patient of theirs, but it is worth a try. Ask them how much they charge for "global obstetrical care", which should inlcude all prenatal check ups, delivery, and the post partum visit.

Stina4242 · July 2010

agibson175:

Most insurance companies SUCK when it comes to pregnancy as a pre-existing!

the only thing I can offer is speaking with your doc office.... sometimes they give discount pricing if you pay "cash", or you can negotiate a price for the entire pregnancy and labor and delivery.

It was really important to my dr that I do a initial US and my insurance company will only pay for any besides the 20 week one if it is medically necessary and the Dr gives a reason why. So when I spoke with billing (before my US) the women was like we consider this routine and thats how we bill it. I will note you account that they should look really hard to find something on it as to why we had to do it but she stressed to me not to worry. She said they would work with us on the amount and a payment plan if insurance didn't cover it.

I am having twins, and will need to go to a high risk and my OB so now its like I am sticking it to the insurance company because this requires a lot of US (from what I am being told)!

Good Luck, I hope yours has a good ending, just try to work with your Dr!!!

Stina4242 · July 2010

agibson175:

Most insurance companies SUCK when it comes to pregnancy as a pre-existing!

the only thing I can offer is speaking with your doc office.... sometimes they give discount pricing if you pay "cash", or you can negotiate a price for the entire pregnancy and labor and delivery.

It was really important to my dr that I do a initial US and my insurance company will only pay for any besides the 20 week one if it is medically necessary and the Dr gives a reason why. So when I spoke with billing (before my US) the women was like we consider this routine and thats how we bill it. I will note you account that they should look really hard to find something on it as to why we had to do it but she stressed to me not to worry. She said they would work with us on the amount and a payment plan if insurance didn't cover it.

I am having twins, and will need to go to a high risk and my OB so now its like I am sticking it to the insurance company because this requires a lot of US (from what I am being told)!

Good Luck, I hope yours has a good ending, just try to work with your Dr!!!

andrea922 · July 2010

Maternity coverage on an individual plan is not an option, as many companies don't offer it and the ones that do have a waiting period of usually a year or more. We have a maternity rider on an individual plan and we started paying it last August and I was not allowed to deliver before this August.

Pregnancy is not a pre-existing condition when you switch from group plan to group plan, per federal law.

Won't you reach your deductible and then have everything covered?

MelCfromMN · July 2010

I would call the insurance company just to make sure that is right. Under my insurance the prenatal care is seperate from Labor and Delivery. Is this the same for you? If they only cover the $500 for just appointments and routine things, it might not be so bad, but if that includes L&D that could get expensive. If you are out of luck, I guess start saving and like others have said, see if you can work something out with the hospital.