XP Who knows health insurance?? pregnancy a pre-existing condition :(

katemennenga

Ok this is gonna be long, sorry in advance!..

We have found out we're expecting baby #2 (yay!)... but the timing is a little challenging due to health insurance.

We currently have a group policy that is in effect until 4/10. Our family is moving and my DH is taking a new job. Our new health insurance policy is a private plan which will be in effect 4/5. At the time we applied for the private health insurance policy, AND at the time we accepted the policy, we did not know I was pregnant. Private health insurance policies can deem pregnancies a pre-existing condition and NOT cover them. (Group health insurance policies cannot). Soooooo because I was technically pregnant before the start date of 4/5, I'm scared they're not going to cover this pregnancy. Anyone had experience with this before? Is there anything I can do to appeal it?

A close friend is our insurance agent, so I explained the situation to her and she said to call the company and explain and that they would most likely not cover anything. But when I called they said they haven't even processed our acceptance yet, but it should be processed tomorrow (4/4). So I didn't explain anything yet because I want them to have the papers we signed and dated accepting the plan. So now what do I do. I was thinking calling back tomorrow and making sure they have received our acceptance and processed it...THEN telling them I found out I was pregnant.

My OB was nice enough to code my first prenatal appt (today 4/3) as routine annual gyno instead of OB, so there's no documentation proving I was pregnant before 4/5, other than the pregnancy test they ran today.

AHHHHHHH so stressed. If anyone has any thoughts on how to proceed, let me know...

tortuga47

I have private health care and you are right, they are VERY adamant that any pregnancies before the start date are considered pre-existing even if you did not know. I'm not sure where you live, but you can probably apply for PCIP which DOES cover pre existing pregnancies. It'd be a different plan and you may not get your pick of doctors but may be better than nothing. You can also talk to your doctor. A lot of doctors are willing to negotiate their rates down to what the insurance companies have (very reduced) so even though you may be paying out of pocket, it'd be a fraction of what they typically charge. GL

 https://www.pcip.gov/

Edit: Sorry, but I just re-read their 'exclusions' on Pcip's site and if you've been covered in the past 6 months by any policy, you are ineligible for PCIP. I would talk to your doctor though, you may be surprised how much they are willing to work with you and it'll be a heckuva tax deduction.  

family310

That's a tough one.  I have private insurance because my husband and I are both self-employed and with our policy, I had to add a maternity endorsement to my regualr health insurance plan, which we pay an additional premium for each month.  The maternity endorsement had to be in effect for 30 days before we conceived and covers all pre-natal care and delivery.  My regular private health plan does not cover maternity care. 

I hope it all works out for you, insurance can be a real headache!   

Ladylec

I just got something in the mail about this since I got laid off and I keep getting info on insurance practices from my old job.

It stated that if you have a gap of being uninsured for 30 days or more than it is not considered a pre-existing medical condition and will not be covered when you go to the new insurance company.

So because of this, I would check with the new company your DH is going to, if you do need to make sure you don't have any gaps in coverage there is always COBRA or other types of companies like that where you can pay out of pocket yourself until his insurance kicks in. GL!

katemennenga

Thanks Tortuga47! My OB mentioned the negotiated rates thing too. It might be the route we go.

jennypasadena

Have you thought about using COBRA to remain on your existing group insurance?  It will be expensive, but probably still cheaper than having to pay out of pocket for OB care.

katemennenga

I'll look into COBRA, but the way it was explained to me (a long time ago) is that it's so expensive it might not be worth it. But I'll definitely look into it. Thanks!

Mrs.S-S

katemennenga:

I'll look into COBRA, but the way it was explained to me (a long time ago) is that it's so expensive it might not be worth it. But I'll definitely look into it. Thanks!

It's expensive, but you can elect ist just for you and not the rest of your family and it won't be as expensive. Likely it will be WAY less expensive than paying for pregnancy, labor and delivery out of pocket. However, I would look into it ASAP before you are covered by another insurance plan.

Here's the deal - they are not going to cover you since you got pregnant before you were covered. Get ready for it - it doesn't matter when you call - you are pregnant before your coverage date and they are not going to cover you unless I am missing something from your story. If I were you I would: 1) Look into COBRA if I didnt previously reject it ASAP; 2) If that is not an option, look into state/county programs that may cover you; 3) Do not lie to your new insurance company about your dates or having your OB code things wrong.  They will find out when you got pregnant and if you lie, and they find out, they can cancel your policy. Work with them on a payment plan or a sliding fee scale if it comes to this.

Good luck.

DragonflyBelle

The Health Insurance Portability and Accountability Act of 1996 (AKA: HIPAA) prohibits employers from discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information; this includes pregnancy....even if the woman had no prior coverage before enrolling in her current employer's plan.

Mrs.S-S

DragonflyBelle:

The Health Insurance Portability and Accountability Act of 1996 (AKA: HIPAA) prohibits employers from discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information; this includes pregnancy....even if the woman had no prior coverage before enrolling in her current employer's plan.

THIS IS FOR GROUP PLANS ONLY. She has an indiviudual plan and this law does not apply.

Can people please stop posting legal information about which they have no clue? TIA.