I'm in Insurance Hell

I know you said you don't qualify for the government programs, but I was just wondering if that included AIM (Access for Infants & Mothers. I was surprised at the income brackets. I think it went up to 5300/month (gross)for a family of 4 (baby & you count as 2) and from what I understand you just pay a flat 1.5% of your monthly income for the coverage. Just a thought and you probably already looked @ it but just in case.

Also I used to work up at a hospital in Butte county. And we often provided "cash discounts" for those who had no insurance. This usually was discounted down to the Medicare reimbursement rate, which is a drastic cut in the cost of delivery. For instance, a normal vaginal delivery billed amt to any insurance ranged from 10,000- 15,000 + $2,000- 4,000 for the baby. With the discount it came to $3400.00 up front for both the baby and mommy. Now for a c-section it all depends on how many days you end up staying in the hospital but I've given a discount of $7000.00 for both mommy & baby when the average charge for a c-section ranged btwn 25,000-34,000. Now mind you this is just for the facility fees all the doctors would be separate.

But there is negotiating when it comes to medical stuff. I don't know about the hospitals around here, but if you ask to speak directly with the financial departments head gooroo, and explain your story you might be surprised with how they will work with you. Especially with how the hospitals have been in the spot light these days about over charging.

Sorry for being long winded, but if you have any further questions just email me. I hope I could help.

1 mom found this helpful

Dear T.,
I'm so sorry to hear you're having a tough time with this when you least need it.
Please feel free to send me a message privately if you like. I am an insurance agent, but after breaking my leg, I am not employed right now or affiliated with any insurance carrier, so I can be completely objective about all of this.
I strongly urge you to look into qualifying for AIM. You can find all their information at www.mrmib.ca.gov
Since your husband is self employed, there are ways he may be able to set up his own group health plan. I specialized in those things.
I hate to say it, but I had so many clients that gave up other policies to go to Mega and were unhappy so I had to try to fix it. I don't want to disparage Mega, but from my experience, there are too many "holes" in the policies. One woman I know, a doctor's wife, no less, was talked into giving up her other policy by the fiance of a friend who was selling Mega. Lo and behold, which was never explained to her, it didn't cover the condition for which she needed her insurance in the first place. It was a terrible mess.
Anyway, check into AIM and write me a note privately and let me know what town you are in. I can help you think of some other avenues that may be better for you. Like I said, I'm on disability right now so there's nothing in it for me. When it comes to insurance, what you need is a good agent who knows the plans inside and out.
Hang in there, check out AIM, and if I have a little more info, I can find someone in your area to help you out.
I live WAY in Northern California, but you need someone close by.
I wish you the very best. Write me!

1 mom found this helpful

Experience has taught me that without insurance, you can negotiate a discount for medical care. You will need to speak with each medical provider individually (hospital, ob doc., etc). Work out payment plans with each as well.
As far as Mega insurance goes, you may want to check on their rating as well. My husband and I have been self employed for 30 years. About 20 years ago we joined NASE to get their insurance. It was like having no insurance. The agent promised the insurance covered this or that, but when it got right down to it, every medical bill required a fight and almost nothing was paid by insurance. We switched to Blue Cross and haven't looked back. You want a company that has a good rating AND a history of paying claims, especially now with medical costs soaring.
Best of luck to you!

Hi T.,
I sympathize with your frustration. Having dealt with such obnoxious practices by insurance companies myself, I have a few ideas--I hope maybe they will help you. First, you should check with your OB and tell her your situation. She may believe that a C-section is medically necessary because of your prior C-section and if she writes a letter to that effect, that may solve your problem. If not, you might seek a second opinion--there is some medical literature that suggests that VBACs are not always ideal. (Why would so many hospitals refuse to do them?) Again, this is a medical decision and should be made by you and your doctor, not some clerk at an insurance company.

The second issue is that you were perhaps misled by your insurance agent and the insurance company. Sometimes suggesting that you may need to write a letter to the insurance commissioner in your state can help insurers quickly change their minds. The insurance commissioner's office may also have some consumer resources that may help you, even possible legal options.

Finally, I think that you should write your state and federal representatives and anyone else that you can think of who may have some influence about this, because it is stories like these that will help us all get some meaningful health care reform. You are paying good money for your health insurance and you should not have worry about shelling out tens of thousands of dollars in order to get the care that you need.
Good luck and I hope that you get a quick resolution. And enjoy your pregnancy!

I'm so sorry you are experiencing so much stress at this time in your pregnancy. You are in a difficult spot. If it makes you feel any better at all, I know 3 people who had VBACs and none of them had any problems! They were all happy they did it. My doctor told me that, although it sounds scary, ruptures do not happen very often at all with VBACs. Talk to your doctor again about the frequency of rupture and I'm sure he'll tell you it is rare.

You and your doctor may be able to write a letter together to your ins co. explaining that the hopitals near you won't deliver for you and that it isn't safe to drive that far in labor. The ins co may feel there could be liability on its part if you are forced to drive and do have problems and may give in to your request. Worth a shot??? Hang in there!

I don't know what else might be available to you, so I am sorry that I cannot help you in that way, but I do know that pregnancy is NOT a "pre-existing condition" and you may be able to buy insurance (through Mega or another company) that will cover your labor and delivery (or at least cover more than you would pay in premiums). They cannot deny coverage because of the pregnancy (which is not to say they won't find another loophole). I am so sorry that you are so stressed and frustrated. I hope you find quick-ish resolution!

Hi there :)

I had a C-section with my first child 19 years ago and 19 months after that had my second by VBAC and everything went GREAT! No problems at all. I think the key is to finding a really good doctor. My prayers are with you. :)

The Birth Center in Sacramento is about 30 min from you that Erin W was talking about. http://www.sactobirth.com/services.htm ... it might be a nice and relaxing.

Hi, I don't know how you feel about having your baby in a birth center, but they do VBAC. You mentioned having your baby at home, but this birth center is just like home and has technology to deal with emergencies. The midwife there is great(Ruth). So if your interested in more info, please email me. Good luck!

Isn't insurance fun! Ok so I guess you've tried AIM & you don't fit the income parameters(unborn baby still counts as a family member so make sure you count baby). If not google them to see if you qualify. You can also google - maternity insurance - I've seen some that you can get even after you are already pregnant. HTH! Good luck!

I'm sorry you are having to deal with all of this, no fun at all. A few things you may or may not know about VBAC's, and also a few things to consider if you do decide to have one. VBAC's really don't have a very high rate of rupture, only 1% end in disaster. That being said, unless that is a 0%, it can happen and does and when it does, it really is a disaster. VBAC's are usually only done at bigger facilities that have more staff and resources. ACOG (American College of Obstatricians and Gynacologists) has guidlines for this type of delivery and it is usually only the bigger or teaching facilities that follow these guidelines. They are however guidelines not mandates and facilities can make the decision not to follow them. If you do chose this route, I would recommend investigating the following things as well as reading these guidelines. Will there be an anesthesiologist and OB available for you (and only you) in house the entire time you are laboring. This is to be able to take care of a possible rupture in a VERY timely manner. Is there a NICU in house for the baby if there is a rupture. Is there blood quickly available to you if there is a ruptuer. These are all things to think about when making your decision. I would recommend chooseing a doctor and hospital based on thier beliefs about the ACOG guidelines. Another note of interest, and not something I would personally recommend, is that if you present to any hospital in active labor and are a VBAC they can not turn you away or force you to have a c-section. You would however have to realize that they may be angry and not so nice about things. You would also have to realize that the doctor may say you need a c-section for xy or z to get past the c-section and then you would be back in the same boat as the beginning. I hope some of this advise is helpful and that this is all stated from a professional and not personal viewpoint. On a personal note, I will mention that 2 years ago when I had my first and only child, I presented 2 months early wilth HELLP syndrome. This is a 0.1% complication of pregnancy and one that can have grave results for both mother and baby. 0.1%, I never saw that one comming!!!

Go on-line and go to maternitycard.com, it is not insurance but they will negotiate a discount of up to 20% for the pregnancy and you can apply when already pregnant. It's only $99 per month and I used it when I found myself without insurance and pregnant.The girl who signed me up was very nice and walked me through the whole process. As a matter of fact I miscarried and hemhorraged about 3 days after I got it and they ended up saving me about 40% total, and for sure check out AIM because I could have done that had I known about it at the time but didn't find out until way after...Talk to your Dr. about the "medical necessity part...most will be happy to justify a C-section if there is increased risk for mom and/or baby...also alot of hospitals (especially CHW ones) will give you a 20% discount for paying cash...if you start saving now. P.S. had the same problem with MEGA...dumped them for that reason...they lie through their teeth and then don't pay!

Hi T.
My daughter just had her second c-section in less than 2 yrs and was advice by her doctor that a vaginal birth might re-open the first c-section due to the contraction and pushing. You might to discuss this option further with your doctor and start asking a lot of questions. Sorry to hear your problem with your medical insurance, I am in the insurance business and could not get coverage for my daughter since she has the the pre-existing condition(pregnancy). She had her baby Oct.27,2008 . I will pray that everthing goes well for you and your soon to be new baby. V.

Hi T.,

My first pregnancy I also had to have a C-section and with my second pregnancy I did not have medical insurance. I did have a VBAC so fortunately I was not stuck with a more costly procedure. I spoke with my doctor and he allowed me to make payments and cut costs by providing my own supplies needed, such as bed liners and my own baby items. Definitely check with your doctor and the hospital for tips to reduce your cost. Just to let you know I had two VBAC and without any complications. Good luck to you when the time arrives.

You have my thoughts and prayers. Just hang in there; do the footwork, stay positive and the Lord will provide!

I wonder if you can get supplemental insurance? You might want to call around and see but they may not allow it since you are currently pregnant. I think in general VBACs are discouraged, too many risks are involved but I know two women who did and were successful. Although one had a lot of bleeding two weeks later and had a blood transfusion thereafter. They both delivered at UCSF. I would go to the hospital immediately once you start labor. Riding in an ambulance is costly but you may need it so you'll have to factor that in to the total cost. It can take hours before you begin to dilate so you may have some time to get your husband to drive you, unless you are quick like I was. I had to push in the middle of my epidural. I ended up delivering with out the meds. UGGH That hurt. Go an interview doctors who will do a VBAC and set a game plan that should help alleviate your worries. Good luck.

I can understand the stress you must be experiencing due to frustration, misinformation, hormones, etc. To be honest, the biggest thing that caught my attention was that your husband won't let you consider home birth. My son was at born at 25 months ago in a state where midwives weren't legal, so I definitely understand the insurance aspect. However, with the recent moves by hospitals to not allow VBACs, even though they're usually safe, I would do some research on your own about homebirth if it's something that YOU would consider. There are MANY midwives in the Bay Area, and you can start with bayareahomebirth.org.

Both my sisters were born at home, and I knew that's what I wanted. My husband didn't want a homebirth, wouldn't even read the articles or information I had found about it, but it basically came down to what *I* as the pregnant, then laboring mother really wanted and was comfortable with. I know homebirth is not for every woman, and I know a lot of women have very rewarding births in hospitals. However, you're facing an hour drive in labor, and you wouldn't have to go through the urgency if you were able to relax and stay home. I didn't have the history you do, but it wouldn't hurt to just talk with a few of the midwives from the website. They also might have a lot of information regarding insurance, cost, etc.

In a realistic financial sense, homebrith is MUCH cheaper than a hospital even WITH insurance. I can't imagine how much a hospital birth would cost with no coverage!!!

Whatever decision you make, make sure YOU are comfortable with it!! I wish you the best, and congratulations on baby #2!!!!!!

This might sound lame, but the community college near us offers an insurance plan through the school. My husband and I did this with our unexpected 2nd child...he took a class, and we paid the premium for the insurance, and they covered my Csection with minimal amounts for us to pay. I had a gallbladder attack right after the birth, and they covered the entire gallbladder removal as well. Good luck to you and your family.

I am so sorry that you are going through this! Our medical system is so messed up. It just pains me that you have to be considering and weighing out potential medical risks vs financial risks. First, please try to stay calm and focus on re-claiming that joy. You have excellent support.

Another angle to consider exploring is your age. If you give birth over age 35 I believe it is considered "advanced maternal age" - I had my daughter at age 37 and hated seeing it on my charts, but I believe that it opened some doors for coverage. I am not 100% sure but perhaps this can work in your favor in terms of medical necessity. Talk to your doctor.

Best thoughts!

Hi T.,
I think the other mom gave you some good advice - negotiate in advance with the hospital for a better rate! I have not tried this on labor & delivery, but recently my husband had shoulder surgery. I almost fell over when the surgeon's bill arrived at OVER $40K!! Thankfully we have insurance but just on the principle of the thing I called the surgeon's office to demand to know what on earth all that money was for. Guess what they said? The lady told me that the reason they charge that much is that then the insurance companies knock the charges down by as much as 90%, and the doctors can claim a loss on their books, and the insurance companies can claim that they saved their insured all this money - basically it's a big paperwork game. So just because people with insurance get billed for $20-50K for labor and delivery, doesn't mean that that is what the doctor/hospital gets paid! In reality it's less than $5K for a vaginal delivery, I think. So negotiate from that point in advance and see where it gets you (if you think for a minute that the insurance company would EVER lose money on a maternity policy, think again... that $3600 is probably about what they would end up paying). Also it might be possible to start making monthly payments now, so the bill when it does arrive won't be so daunting.

Other than that, I don't suppose a move to Canada is in the cards? It may be cold up there, but at least they have affordable health care?! =) Good luck and please let us know how it turns out!

i would do some research about homebirth with your husband. a friend of mine had successful vbac after 2 c-secs, and we live 30 min from nearest hospital. my homebirth cost $3000 -- and i got twice as much care as with my hospital birth. each situation is different, but it is worth looking into. men are cautious with birth stuff, but you know your body.

FIrst of all, take a deep breath. You do have several months to figure this out. Although it is very stressful I'm sure. FIrst drivign 4-50 minutes in labor is uncomfortable (I've done it twice) but doable. If you choose that route I reccommend finding a park or other place that you can walk close to the hospital where you would deliver and then plan on going there earlier in the labor (if it is daytime) and walking around until you are ready to check into the hospital. Also I would do your own research into VBAC. Whatever article you read is tainted by the authors's views either pro or con. I believe that most doctor's discourage them mainly because of liability (if something goes wrong with vaginal birth even if the doctor wasn't at fault they often get sued) but if they did a ceserean and something happens juries typically say the doctor did everything they could because of the ceserean). I wouldn't rule out homebirth just yet. Call some local midwifes and find out how many VBACs they have done. They will probably have some literature for your husband and then consider your proximity to the hospital. I am asuming form your post that you are a Christian. I would pray very specifically, ask GOd for clear direction. Meet with a midwife or doctor who does VBAC and ask God to make the meeting spectacular or awful (nothing in between) to give you clear direction on what path to take. Ask others to pray too! Remember Jeremiah 29:11-13 and Phillipians 4:13.
I will pray for you today.
H.

I would talk to your doctor about this. It's possible that your doctor may feel that a C-section would be medically necessary and maybe he/she would agree that when the time comes he/she would indicate that on your medical record. So, maybe you don't schedule the c-section ahead of time but the two of you can prepare for one and when the time comes, you do go ahead and have one and the doctor indicates it on the record. I would talk to your doctor and see what he/she thinks.

I would also like to suggest The Birth Center. I had both of my children there, and had a wonderful experience with each.

It is significantly less expenive than a hospital birth. Also, if there is any risk with the VBAC they will let you know, and that may help with the "Medically Necessary" part.

Good luck!

Have you tried Kaiser? They do VBACs.

Your dh is correct about a home birth, do not consider it with your history. I am a nurse. I had 2 c/sections due to complications (cord around the neck x 3, then fever of 103.6 and preterm labor), then I had an uncomplicated VBAC with pitocin and epidural for the third child. I then had my tubes tied under epidural. I know that the costs are daunting, but delivering a healthy baby and mother are foremost. Also more cost-efficient in the long run, because complications are costly. Have you talked to your health care provider for options? If a hospital won't allow vbacs, how can they say that a c/s is not medically necessary for a woman who is delivering again? Talk to the insurance company also, and document all conversations. There is a solution to this...be calm, be joyful for this child, and think logically when talking to the doctor, the hospital, and the insurance company. You will find the answer for your delivery! Good luck!

Hi T.,

Congrats on your expanding family.

First, I had a girlfriend who had a very sucessful VBAC at home. It wasn't planned, it just happened. She didn't realize she was in labor until it was too late to get to a hospital. She did have a midwife with her. The midwife came over to escort her to the hospital and realized it was too late. All went well and everyone was fine.

As far as the insurance, I went through insurance hell too as I was using COBRA from my former employer so when my daughter was born, my husband's insurance and mine decided that the other should pay so for two years the insurance companies denied the claims. I called the California State Insurance Commissioners office and filed a complaint. The clerk at the State office gave me advice on what to say to the insurance companies and to let the insurance companies know that I was working with the State office to get this resolved. My husband had his HR department involved too....what a mess. It was finally paid. If your insurance salesperson mislead you, find out from the State if you can do anything about it. Did the policy change after you purchased it? Again, I suggest calling the State office and seeking their advice.
Good luck to you - and best wishes for your growing family.
J.

oh i'm so sorry about the spot you are stuck in. my sister is from the sac area and she and her husband where also not okay with home delivery. when looking at the price of hospital birth compared to using a birthing center they decided to go to the birthing center. i want to say it cost under 5,000 for all prenatal and birth. i know it was in the area but i'm not sure of the name. i'm sure an internet search would turn something up for you. good luck.