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December 2012 Moms
Who knows health insurance?? pregnancy a pre-existing condition :(
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...
This discussion has been closed.
Re: Who knows health insurance?? pregnancy a pre-existing condition :(
What a stressful situation! I don't know too much about this, but could you purchase COBRA coverage so that your group coverage would stay in effect until after the baby is born? Also, you might try posting this on the Money Matters board on The Nest... I've always found those ladies to be pretty smart!
I would assume that your private insurance is going to go by your LMP and if that's prior to your date of coverage, you are SOL.
Regardless, no one on any board can tell you what your insurance is going to do since every company and every policy is different, so just call your insurance.
If there is no proof/paper trail that you knew you were pregnant before that date, then you should be covered. Your OB is awesome for doing that little white lie for you!
I wouldn't tell them you are pregnant for awhile, it might be suspicious if you tell them too soon. When is your next appt w/your OB?
Why do you have to tell them you are pregnant? Do they require pre authorization of OB services?
(I am in medical insurance billing, so if you have Q's, you can PM me too!)
Also - check into state assistance in the state you are in, usually called Medicaid...just in case, you never know. Your income might be within the guidelines if you end up with no health care, which would be complete BS, but it's never wrong to prepare for the worst...
"Your truth is different from my truth, and we're both right."
TTC since March 2013. BFP 4/13/13, blighted ovum discovered 6/6/13, m/c 6/8/13.
BFP 11/10/13, EDD 7/25/13 - stick little owlet!
Teal Owl- THANK YOU.
I guess I'm struggling with the whole "dishonesty/disclosure" thing... We do not need pre-auth for OB, so I think she just wanted us to fully disclose to the insurance company before the effective date of 4/5. She's a close friend of ours so we trusted her with confidentiality. But part of me wants to just wait until our next appt (in 4 weeks) to see what would happen when we submitted the OB claim to the private insurance. I mean worst case scenario- they don't cover it, right? But if we notify them now- then we're almost guaranteeing them not covering it, right? (because we're admitting a pre-existing condition before the start date).
Someone threw the words "insurance fraud" at me (by not disclosing that I know I'm pregnant now and then filing a claim)- so that scared me because I don't want to end up with NO health insurance because of this whole situation. But I also don't want to call them today and tell them that I'm pregnant and then be told that they are going to put a delay or cancel the policy that should start 4/5.
I'll look into Medicaid, but I think that we could swing paying a negotiated cash rate to our OB.
Well there are LOTS of women that don't know they are pregnant as early as you know. So that can be your leverage if they try to deny it as pre existing. You can just say you didn't know you were. They can't argue that. Well, they CAN, they'll do anything to not pay for coverage.
Your OB office should be the ones filing the claim/bill to them. You'll receive an EOB from your insurance when they pay/deny the bill. Keep all of those, I always do until I get a bill from my office and match them up to see if they are accurate. People make errors allll the time, I'm guilty of it!
You should talk the billing department for your OB, they should have some good insight, and they might be familiar with your insurance company.
And check into financial assistance where your delivery would be if that's an option. I had a huge hospital bill last year because of my high deductible and I applied for assistance thinking we would be over income, but we still got 20% off the bill!
"Your truth is different from my truth, and we're both right."
TTC since March 2013. BFP 4/13/13, blighted ovum discovered 6/6/13, m/c 6/8/13.
BFP 11/10/13, EDD 7/25/13 - stick little owlet!
HIPAA prohibits pregnancy from being considered a pre-existing condition if the new plan already offers maternity coverage. There are problems if you're on the individual market but you are through your husband's employer, yes?
https://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
That link explains it.
DS Nathan 12/4/12
BFP: 3/31/15 EDD: 12/4/15
MC: 7/2011, 12/2011
Unfortunately that only applies to group policies offered through the employer. We had to take out a private policy (my husband will be joining the family farm business- self employed which does not offer a group policy) so they can consider pregnancy a pre-existing condition.
Agh, I'm sorry I just skipped right over that part in your post. Is it too early to blame pregnancy brain?
I hope you work out a solution soon!
DS Nathan 12/4/12
BFP: 3/31/15 EDD: 12/4/15
MC: 7/2011, 12/2011