No maternity coverage?

raceyrae · July 2011

Turns out our nanny (who's pregnant) signed up for health insurance but didn't sign up for the maternity coverage (thought she did). She didn't find out that she filled it out wrong until her appointment last week (1st pg appt) when they told her she didn't have maternity coverage. Now her insurance company won't fix the error because it's a pre-existing condition.

For those that didn't have maternity coverage, are there any alternatives she can look into? Also, I thought Obama's healthcare plan got rid of the "pre-existing" condition exemption from insurance; has that not kicked in yet?

Mrs.LLG · July 2011

I don't know of other options, but just wanted to say that it will take a while for the pre existing condition thing to be in full effect even though it was passed back in March. I believe it starts with children this Sept. but doesn't have to apply to everyone until 2014.

NatPhoto09 · July 2011

man that sucks! I have no idea. I hope she figures something out.

mrsmikey · July 2011

I don't know the details of Obama's plan, but there are still pre-existing conditions. I think pp was right in that right now it only applies to children. At this point I'm afraid there's nothing she can do. No one is going to cover her now that she's pg. I'm sure her OB's office can get her on a payment plan, and probably offer her discounted, out of pocket pricing. And possibly the hospital too. If she doesn't qualify for any kind of assistance, I think she's just up the creek. Sad

lalabee0425 · July 2011

YGM

nark · July 2011

Is she under a private insurance plan? We do a BCBS private plan, and do not have the maternity rider. As it states on the BCBS website, the rider is really just a way of "pre-paying" for prenatal care & delivery, but generally doesn't save you any money. Plus, the regular insurance plan is required to kick in in the event of most complications. And of course, the maternity rider has nothing to do with infant care. The baby will be covered from birth. (Again, I'm talking about my own personal plan, so she should check hers to see if it works the same.)

In other words, she's probably not totally up a creek. In our case, the cost of prenatal care and delivery WITH the maternity rider (extra premiums, deductible, co-insurance) would have been at least equal to the amount we paid as self-pay patients for everything from the first appointment thru hospital charges. A few tips for her:

First off, if her household's gross income is within 200% of poverty, she may qualify for a sliding scale clinic - most cities have one or two of them. There is one in CLT that operates on government grants and I think patients pay like $50 tops for all prenatal care.

If not:

*Ask about the "global fee" at her OB's office. And then ask a few other offices to see if some are lower.

*Ask about any discounts on that global fee. All that I called here offered 20% I think. In Charlotte, the global fees are $3K-$4K for all prenatal appointments + delivery + postnatal appt. (Does not include charges for the hospital stay.)

*Ask if the fee includes the 20wk anatomy scan. In CLT, some do, some don't. Last time they accidentally billed me for it so I saw that it would have been an extra $500 at that office if it hadn't been included in my fee.

*Any optional testing will probably cost extra. That's a personal decision of course, but we tell every medical person we encounter at appointments that we are self-employed and don't have maternity coverage, so pls don't do anything that costs extra. And they always tell us to tell everyone we deal with every time. They are used to kind of just doing everything and billing insurance for it, but when they are aware they are more...careful with how they code things. Last time they even worked things so that insurance paid for some lab work that they probably wouldn't have otherwise.

*Do the same at the hospital, and bring advil etc from home. Just don't show it to them, and refuse theirs. They'll charge you like $35 a pill.

*Tell her to ask about "prompt payment discounts" when she gets the hospital bill. And tell her to ask for time extensions if she needs it. By being nice to the customer service rep, I got an extra 5 months to pay the bill, and still got the prompt payment discount.

*I highly recommend setting aside money every month now, to help save up for the costs later. She could pretend it's what she would have been paying for the maternity rider. (For us, the rider would be at least an extra $200 per month.)

I'm happy to answer any other questions about our experience. erinewalters at gmail dot com

raceyrae · July 2011

Thanks!

shoeaholic0403 · July 2011

Federal Pre-Existing Condition Coverage

starz080 · July 2011

My first inclination is that she won't get any maternity coverage from BCBS. We had the maternity rider and my understanding is that we had to pay for it for an entire year for it in order for it to kick in. So if your nanny wasn't already paying for it, then it could cover anything anyways. Just a guess though.

JennaNAaron · July 2011

Will she qualify for medicaid?

bre86ann · July 2011

JennaNAaron:
Will she qualify for medicaid?

This is something worth her looking into. There are income guidelines for her to qualify but if she's a single mom chances are she will qualify. There's a change she'll qualify even if she's married but the income guidelines are pretty rough and there's a limit to assets she's allowed to have in her name (which would include her spouse, if she's married)--I used to work for a company who did contract work with hospitals throughout the state. Any patient who went to the emergency room without insurance was referred to us and we helped them apply for medicaid....we had to go through pre-qualifying screenings before we would pass the case onto the state (to make sure they fell within or close to the guidelines) and then stayed on top of them and the case worker until everything was resolved and the hospital got their money (if they qualified).

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