27 answers

Uninsured Pregnancy

I'm asking a question for my sister who is about to try getting pregnant. She and her husband are wondering if it would be cheaper to go through the labor and delivery uninsured (they probably wont qualify for medicaid) instead of spending lots of money on maternity insurance as well as pay the high deductables. We understand that if there are complications it would obviously be costly, but has anyone else done this to save on having a baby? She would also like to be delivered by a midwife, and maybe deliver at home, is this significantly cheaper? One of the glitches is that she will also have to be monitered throughout her pregnancy (probably just with a bunch of blood tests) because she has high prolactin levels which resulted in two miscarriages in the past year. She's currently lowering her levels, and getting ready to try getting pregnant again, but to some degree she will be considered high risk. I guess basically we would LOVE any advice on cheaper insurance, how to cut costs, and any experiences giving birth at home or with a midwife during a high risk pregnancy.

What can I do next?

Featured Answers

Be very, very cautious. And decide how much you want to risk for a lower price tag.

My sister-in-law, who was preparing to deliver what appeared, up until the time of birth, a very healthy baby boy, lost him at birth, at home, with a midwife. As he was being born, the cord wrapped around his neck. Had the birth been in a hospital with emergency services at hand, he probably would have lived. The home setting with a midwife, who was not qualified to deal with such a complication, proved to be lethal to my little nephew.

Get aflac BEFORE she gets pregnant. It has a cheap monthly payment and I think they pay about 3-4 thousand. Definately AFLAC.

More Answers

Being pregnant is stressful enough on it's own, especially with 2 miscarriages under her belt. I can't imagine the stress of not having insurance as well. Anything can happen with pregnancy and delivery, and if not planned for, probably will. Tell her to get some kind of insurance.

I am insured through my husband's work, but the deductibles were $1500 per person, which meant the least we could spend for a hospital birth (out of pocket) was $3,000--$1500 for me, and $1500 for Baby, since he counts as another person to apply the deductible to the moment he's out.
For a variety of reasons, I chose a home birth with a direct-entry midwife, which my insurance did not cover. We paid about $2,500 total, but that included all prenatal care, birth care and all postpartum care. It was a bit of a gamble because if we'd needed to do a hospital transfer the insurace deductible would've just started ticking even after we'd spent $2,500 for our midwife's care--the total cost could have escalated to $5,500 or more if there had been last-minute problems. But things were great and I had a healthy, well-monitored pregnancy and I would make the same decision again (and again, and again).
The home birth midwife I used is a highly experienced professional and the care I received from her was always thorough and personal and evidence-based. Some home birth midwives may charge less, but I believe experience is priceless and she was the right care provider for me and my family--price isn't always the determining factor.
I cannot speak about the details of your sister's particular health issues, but I have had babies at a hospital, a free-standing birth center, and at home. All were good, positive experiences, but the caliber of care I received at the birth center and in my own home are simply unparalleled. I had constant, direct access to my midwives via cell phone and pager for my entire pregnancy and the personal care I recevied made me feel like I was the only pregnant woman in the world--it was that good. The only reason I did not go back to the birth center for my third baby was because I didn't want to travel in labor again, so we stayed home and had my provider come to me. I live near a hospital, so if there had been some unforseen complication, I likely would have traveled to the hospital in my own vehicle, not necessarily an ambulance. (But I agree with the poster who said ambulance rides are spendy--it was about $800 for an ambulance from Brigham to Salt Lake a few years ago, and it was considered "non-emergency" travel because it was a transfer to Primary Children's and our insurance did not cover such a ride. BTW, that was for the hospital-born baby, and for an allergy issue unrelated to his pregnancy or birth.)
Most potential complications can be detected long before labor starts. Most midwives will not (and by law, CNMs are restricted in some ways) offer birth care to mothers who fall in a "high-risk" category, but the exact definition of "high-risk" varies from midwife to midwife. I suggest your sister start shopping for a midwife now so she can know her options and find out everything she can do to keep herself as healthy and normal as possible.
Another option to consider is the Birth and Family Place in Holladay. It's a licensed, free-standing birth center and the certified nurse-midwife there, Becky McInnis, is probably the most experienced and skillful CNM in Utah. She caught my second baby and I have only positive things to say about my experiences with her and at the birth center. It is top-notch in every way. Currently, I think the birth center fee is about $1,500 and the prenatal/birth/postpartum care is about $2,000 with Becky, but many insurance plans do cover portions of a planned birth center birth with a CNM. CNMs can also prescribe meds, if that is important to your sister. Direct-entry midwives cannot prescribe, although they do travel with all medical equipment and meds necessary to stablize a mom and baby if needed.
If she chooses to have a hospital birth, consider taking Bradley Method classes and using an experienced doula. Both strategies will save money by helping her avoid unnecessary and expensive interventions (usually offered by well-meaning people) at the hospital. A good doula is worth her weight in gold and a couple hundred dollars for a doula is a blue light special compared to the cost of an unwanted epidural or an unnecessary cesarean birth. Many doulas certified through DONA will also barter and trade services with mothers.
If you'd like more specifics---names, numbers, etc.--message me. I'm not sure if your sister is in Utah or elsewhere.
Best wishes!

A.: I am not sure about the insurance, but I can say DO NOT have the baby at home, especially when she is uninsured and doesn't have insurance.
I had my first baby girl at home where she sustained a major brain injury, which could have been 100% avoided had I been in the hospital. Yes, 98% of pregnancies can be delivered by a new york taxi cab driver, but I was one of the 2% and we weren't even high risk, and we had the most highly recommended midwife in the county.
If we hadn't qualified for Medicaid, after the fact we would have been charged upwards of 400,000 in hospital bills. DO NOT HAVE THE BABY AT HOME. It's stupid and irresponsible, and I can say that with out anyone pointing fingers at me, because I had mine at home, and she was at the brink of death. Trust me, this is not something you want to risk for any sort of "better environment". I, more than anyone understand why people want to have their babies at home, and I more than anyone understand the risks involved.
If you want a midwife and a cheaper option get a licensed Midwife (ones who only deliver in either birthing centers or hospitals).
She should also try to get maternity insurance before the fact. Try going to the medicaid office as well, they can be very very helpful.

Definitely check CHP+ You can google it and it will take you to their site with all the info.

Be very, very cautious. And decide how much you want to risk for a lower price tag.

My sister-in-law, who was preparing to deliver what appeared, up until the time of birth, a very healthy baby boy, lost him at birth, at home, with a midwife. As he was being born, the cord wrapped around his neck. Had the birth been in a hospital with emergency services at hand, he probably would have lived. The home setting with a midwife, who was not qualified to deal with such a complication, proved to be lethal to my little nephew.

Get aflac BEFORE she gets pregnant. It has a cheap monthly payment and I think they pay about 3-4 thousand. Definately AFLAC.

There was a law passed in the late 90's that actually makes it illegal for insurance companies to consider pregnancy a pre-existing condition. So if she gets insurance after getting pregnant, she should still be covered. And if they say she's not, then she has ammo against them.

I've heard good things about Aflack insurance, though I've never used it myself.

Homebirth attended by a midwife is not only significantly less expensive (in my area a homebirth with a qualified midwife is about $2000 where a hospital birth is $6000-7000 for an uncomplicated birth w/ no anesthesia) but it is actually safer for low-risk women. There is incredibly less risk for unnecessary interventions which run rampant in hospitals and end up starting a snowball effect.

So yes, it's cheaper and it's safer.

It has been a few years since I looked into this, but, at that time it was $300 a month and you had to be paying into the plan for at least 11 months. So if you planned it out and were able to become pregnant quickly then you would be paying $3300-$4000 or so for the insurance. The out of pocket cost for a normal birth and ob care with no extras at all was $6000-$7000. So the insurance certainly seemed like a good idea. Just get the current prices and make the decision from that.
Take Care,

I would get Aflac. But you have to be on it for like 11 months before it will pay out, so check the guidelines first.

I would also still try for medicaid or any other state program for pregnant women. I was told I wouldn't qualify but I did when I actually filled out the paperwork.
Also, I had a co worker that paid for labor and delivery out of pocket when she had her kids. Her husband owned a business and it was cheaper to pay out of pocket then for the insurance but she also had no complications. She said to talk to the hospital because alot of them, if you pay up front ahead of time can give you a discount on the delivery and also the anestiologist on an epidural if you want one. I don't know about midwifes.

I would call Aflac for sure. We used them as supplementary insurance; it saved our butts! She needs to call before she gets pregnant. You have to be on it ten months before hospitalization for the plan to be effective. We signed up for three plans and it was so worth it. message me if you want a number.
Going without an epidural, and natural is cheaper. It is cheaper to deliver at home. My sister in law does this with a midwife. She has extremely easy pregnancies and normal if not really fast deliveries. She is about to have her fourth at home and no problems but i would never do it. I delivered at the hospital with a certified nurse midwife. I had some complications and an OBGYN ended up having to do the actual delivery. This is why I would never do it at home. If there are complications, an ambulance ride to the hospital is RIDICULOUSLY expensive. Be aware that some midwives will not handle high-risk pregnancies, it depends.
Having a baby costs way more than the deductibles with insurance. I would really really reallly have her call AFLAC.

If there are any chances of high risk, get the insurance. I had my first son by surprise and as self-employed massage th erapist I was able to get insurance that month it just happened to be my birthday 30 day window for excepting small group of one with no exceptions. I was lucky. My son was 9 weeks early and in the NICU for 8 weeks. Huge bills! $145,000. My next son we had gotten insurance through my husbands job, decided to get pregnant and 5 months along he lost his job. Then we had Medicaid due to lost job. Medicaid is for people in a emergency. If you can afford something please get it. 2nd son was 4 weeks early, but they had me in and out of hospital for 10 days before delivery. You need peace of mind and going without insurance is not the way. Good Luck

I went the midwife home birth, without any insurance route. First of all if there is a high risk home birth midwives generally will not treat you. You'd have to check in your area, in Colorado, I think is against the law, but I'm not confident about that. Second, if your in Colorado you can get insurance while you are pregnant, I did. I ended up getting insurance through my Husband, in Colorado if it is a group policy they don['t consider pregnancy a preexisting condition. Also, my pregnancy went perfectly fine, but in the end I had to deliver in a hospital, because my pelvis was on the brink of shattering and I had the flu and kept passing out during labor. So it was decided that I go to the hospital. My point is it is good for piece of mind even if you she does plan a home birth that, there be some sort of back up plan for payment, it's very expesive. The other point is if there is insurance and it isn't covered, at least having insurance might lower your cost, because insurance companies get very big discounts. I think my birth and everything ended up costing $6,000 for the hostipal delivery, and $3,000 for the midwife. Now I still wouldn't change having the midwife and planning the home delivery. She gave me great care and talked and listened unlike regular medical professional. We usually had an 1 1/2 appointment. Hope this helps.

Obviously she wants a baby very much, so I would spend the money to be sure the labor and delivery are covered. She appears to be high risk, therefor there are many things that can come up during the pregnancy that are extremely costly. I was not high risk and my pregnancy went relatively smoothly, but had a difficult, emergency, and costly delivery. Thank goodness I had coverage, even with high deductible. It was worth any cost to get my baby here safe and sound, and have myself survive and be healthy too. If she is high risk, I wouldn't deliver at home, since things can happen very quickly! She would feel horrible if she didn't do everything possible to ensure that her baby arrived safe and healthy. So personally, my opinion is to go ahead and pay the insurance for the duration, and deliver in a hospital, because I'd rather be safe than sorry. I hope this helps a little bit and good luck to your sister!

Call around and get cost information. I don't recommend anything unless you can truly compare costs plus the cost of insurance for the baby. They need LOTS and LOTS of dr visits in the few years.

If she's in CO, she can get CHP+, although, dependent upon income, she may have to pay premiums and copays. There is no need to go without insurance in CO. I was very pleased with the care I got on my last pregnancy. When we were first looking, insurance would not cover the pregnancy if you got pregnant in the first 12 months (counted by 13 payments of the premium). The difference at the time from insurance without maternity and insurance with maternity was over $800 a month. This was 3 years ago. I'm sure that number has increased. We were looking at almost $1200 a month for insurance and they still wouldn't have paid for my daughter because I got pregnant days before the 1 year. If I were your sister, I would apply for Medicaid and they'll tell you what you qualify for and what the cost will be. She does have to be pregnant to apply. I was very high risk and had very good (and expensive) care.

--If she decides to get insurance, make sure she does it BEFORE she gets pregnant. Depending on the state that she lives in, it may not be possible to get insurance that covers pregnancy if she is already pregnant.

I've done a pregnancy without insurance or Medicaid and got off pretty cheap. I paid about $3K for my OB and $2K for the hospital. After everything was said and done, total out of pocket was about $5,500. That was in Nevada.

I'm currently pregnant again, (got pregnant in Nevada and was going to deliver there again, but moved to Oregon) and am now on Medicaid. Before I got on Medicaid, I figured out how much it would cost me to pay out of pocket again, and I was looking at about $4K for the OB and then at least another $4K for the hospital + $1K for the baby, so at least $9,000.

I would have her do the research and find out if they don't have insurance, how much will it cost her out of pocket. If she knows how much the deductible will be that she would have to pay + all the premiums, have her figure that out too and find out which way is cheaper.

However, all that being said, if I had the option to purchase insurance before getting pregnant, that would be the route I would take as there is definitely more piece of mind involved. When I had my first daughter with no insurance, I was worried that I would have to have an emergency c-section or that something would be wrong with her and she'd have to spend time in NICU. Luckily, everything went off without a hitch.

Good luck to her! I hope everything works out the way they would like it to!

I second the Aflac suggestion.

Also, she needs to find a midwife now and figure out if she actually will be considered high risk or not. If her levels remain in check, and she doesn't have any other major risk factors, she should be fine. If she is in a position where she can use a midwife and is not at risk for complications, the average cost for a midwife and birth center here in Ut is $2000-significantly less than a hospital cost. Some home birth midwives are even less.

There are other things to keep her hospital costs down if she does end up going the hospital route. An epidural typically costs around $1000-sounds like she's willing to go w/out since she's looking at a home birth, so that saves a ton right there. Part of the way they break down the cost for l&d includes time spent in l&d over and above their allotted time (last I checked it was 3 or 4 hrs depending on the hospital). Waiting until as close to delivery as possible is a great way to knock that down. Also, leaving as soon as she feels up to it bumps things down again.

With my second baby we had horribly bad insurance and knew we were going to end up paying a ridiculous amount out of pocket, so we employed some of those tricks. It was my first natural childbirth experience (and sold me on doing the rest of them that way!), and I went home 18hrs after birth. Our hospital bill was only between $2-3000, which is about half of the average cost for a vaginal birth. We did still have to pay the OB on top of that, but he was willing to work out a payment plan and even write some of it off since we were w/out insurance. We also had Aflac for that baby, and though it payed significantly less than it does now ($800 then), it was a huge help!

There are many options available out there, we are just so conditioned to think that childbirth=emergency that we are often afraid to consider them. The vast majority of the time pregnancies and deliveries are without complication, and even when there are bumps in the road, they can usually be dealt with without serious intervention. If she's monitored well during her pregnancy it will give her a good idea as to whether or not she's a good candidate for a home birth.


IF she feels comfortable with a home birth, then yes, they are significantly less expensive. Whether she is medically considered "high risk" will vary from state to state. Different states have different rules for home birth midwives. I have delivered all three of my daughters with midwives in Colorado, and our births were the most wonderful experiences of my life. I was safe, supported and encouraged the whole time. Midwives are highly trained, reasonably priced, and an excellent alternative to traditional doctors.

My best recommendation is this:

First, she needs to decide if she feels comfortable with a home birth. She should probably do some research, read some of the studies that have come out. The idea that we should be in the hospital delivering babies "just in case" is an American medicalized idea. For healthy mothers and babies, the medical evidence DOES NOT support the idea that it is safer to be in a hospital. Nearly every study that has come out in the past 40 years comparing home and hospital births in healthy mothers and babies have shown that home birth is equally safe for babies and MUCH safer for mothers. That being said, if you sister does not feel safe delivering at home, she should not seek a home birth. If she absolutely cannot qualify for any assistance and cannot find a doctor to do prenatal care and deliver her baby, maybe she could pay a midwife for her prenatal care and then go to the hospital to deliver the baby. That would not be ideal, as she would not know the person delivering her baby, and that doctor would not know her history. She would also still have to pay the hospital something. Still, it might work out. She can probably make payment arrangement with the hospital. They will typically cut a portion of the bill off for someone without insurance.

Second, if she wants to seek a home birth, she needs to meet with a local midwife and talk to her. Find out what her restrictions are. She needs to know if home birth is even a possibility for her. As I said before, different states have different parameters for who midwives can attend at home. Just because a doctor calls her "high risk" doesn't mean that she is medically/legally considered high risk. Often that is just the doctor's idea or label. A midwife also might be able to recommend some dietary changes and some alternative treatments for stabilizing her hormone levels. A midwife will certainly offer dietary and lifestyle advice to help your sister prepare her body for another pregnancy. Most midwives will meet with you for at least an hour at no charge. In fact, most doctors will also offer a consultation for no charge (but not for an hour - my doc offered a 15 minute visit for free).

As far as the previous poster's comment to go to the hospital just in case something goes wrong, yes, things can go wrong at home. Sometimes those things could have been prevented if the birth had taken place in a hospital. However, it is not true that the hospital is a risk-free option. The national cesarean rate is up to 31.8%. There are hospitals where it is up to 40 and even 50%. Women in hospitals are subjected to unnecessary inductions, pitocin drips, episiotomies, and cesareans. Babies are routinely removed from their mothers in the important moments after birth. Breast feeding relationships are routinely interrupted by "standard procedures." It is sad, but the fact is that babies die in hospitals also. Babies in hospitals are also are born injured and brain damaged. When you choose a hospital birth, you are not guaranteeing your baby a safe birth. Many, many women do not choose home birth because of the "experience," but rather because of the dangers of a hospital birth. Your sister needs to weigh her options and make the right decision for her and her family without buying into the horror stories.

If your sister would like more information about home birth, or would like to hear about my experiences, please feel free to private email me. I would strongly recommend that she reads Henci Goer's "The Thinking Woman's Guide to a Better Birth" no matter where she plans to deliver. I can also recommend some other wonderful books if she wants to do more reading about birth. I love to talk about my births, and I have extensive contacts in the Northern Colorado area among the birth community.

Best of luck to your sister,
S. L

We didn't think we'd qualify for medicaid with our 2nd pregnancy, but we did. We had to do a "spend down", which meant they looked at our assets/savings and we had to pay them a certain amount of that, and then we had medicaid for the pregnancy. It was DEFINITELY worth at least applying. The application's not that hard to fill out. It also paid for an IUD afterwards, which was great since my husband's insurance (which kicked in 8 weeks after the birth of our baby) did not cover birth control.

I found out I was pregnant with my last son while I was on an insurance policy that did not cover pregnancy. I found a midwives group at a phenomenal hospital in my area and before they see you, you see their financial advisor for a consultation. She went over your financials, and applied you for Mediaid or CHP if you would qualify. In the meantime, you can be seen on "presumptive eligibility". If they were sure you would not qualify for aid, they put you on a sliding scale & you had a monthly payment, but it would not exceed $3,000. They also were "connected" with a doctor's office which you were transferred to in the event of a high risk pregnancy. She should look for something like that!! My entire pregnancy and birth ended up being around $25!! One more thing, and I can't stress this enough- PLEASE do not entertain the idea of a home birth- ESPECIALLY if she is high risk. The story the woman told about her nephew is ALL TOO COMMON, and even if she were unable to find something cheap and had to pay it off forever, its a small price to pay for a baby that is alive when it may not have been if she had done a home birth. Thanks!!

Ways that people I know have cut costs include having a higher deductible to make premiums lower (it's closer to paying for the prenatal visits and delivery out of pocket, but you're still covered for catastrophic events), not getting an epidural for the delivery, and staying only one night in the hospital after the baby's born. I know women who have delivered at home, but I don't understand enough about your sister's high risk nature to know if that would affect her delivery.

I know you said this, but the biggest reason you have insurance is for all of the unexpected stuff. One of my babies had to be in the NICU for one week (obviously that's unexpected). The bills were over $20,000 just for the NICU--not including the oxygen we had at our home afterward, the cost for my delivery in the hospital, the cost for my hospital stay, and the extra doctor's visits he had to have after we brought him home from the hospital. That was only one week and a fairly minor unexpected occurrance. If the baby had greater special needs, the bills could really add up quickly. Fortunately our insurance had a cap on what we have to pay out-of-pocket, so we only had to pay 10% of our expenses up to a capped amount for catastrophes.

I had a pregnancy and delivery without insurance in a hospital with no complications for about $8,000. Of course all of it was with a discount by paying up front otherwise it would have been thousands more. I had made a calculation that if we had purchased individual insurance with the high premiums and then a $5,000.00 deductable it would have ran over $9,000.00. Crazy how much it costs! It may be worth the peace of mind to pay the extra and have insurance. We did have a hospital plan though Allstate (American Heritage)which is like Aflac that saved us financially, it paid us out about $3500.00. When my brother had their last baby he purchase 3 different plans with different companies to get a bigger pay out. Looking for and buying good insurance is stressful and can take some time so if that is the way to go they better be sure to NOT get pregnant until they have it otherwise she will be uninsurable and will have spent the time and stress and money for no reason! Also I was told by an agent that if I didnt have insurance and ended up having a c-section that I would be uninsurable afterwards for at least a year! I was lucky with my last baby and my husband was able to pick up Health insurance with his company a month before she was delivered. I stressed at how we would be able to pay for everything and the Lord then blessed us to be covered after not having insurance for almost 4 years! Good Luck to them on whatever they decide!

Shop around for insurance, but do it before getting pregnant! Be insured in case anything goes wrong! A full OB ultrasound costs $800. Less extensive ones still cost at least $400. I've had 7 ultrasounds so far this pregnancy. My doctor has been concerned about me delivering prematurely, so I had 4 fetal fibronectin tests midway through pregnancy. They were almost $400 a piece. We've maxed out portions of our insurance and are having to pay some bills out of pocket now, but I can't imagine how we would have done it without insurance.
As far as delivering at home...I don't think that is safe with a high risk pregnancy. Find a good OB who you trust and are comfortable with and know that you (your sister) and your baby will be as safe and well cared for as possible.

i recommend Aflac pregnancy... too many things can go wrong, and you never want to be in the position where you may decide not to seek medical treatment during pregnancy based on finances.

Only other thing I can think of is to get a doctor that is willing to decrease their bill like they do for contracted medical insurance companies if you agree to pay cash. Good luck with this one, but if they go cash only I'm sure they will pay much more than what their friends with insurance total bill ran. But it's more than the doctor, you've got the hospital and the anesthesiologist too (those guys are PRICEY), blood lab work, etc.... Unfortunately insurance is important (even though it's the one topic that gets my blood boiling!!!)

I agree with other moms about needing insurance if this is a high-risk pregnancy. She may not be able to see specialists in a timely fashion without insurance, and my premature baby had $214,650 worth of hospital bills for 3 months in Neonatal Intensive Care. The point of insurance is you pay up front hoping not to have to use it in case of an emergency, of course.

Well, If she plans to get any insurance, make sure she has it for 90 days before getting pregnant. Any less and the insurance will not pay for any of the maternity costs. I learned this the hard way. I waited 34 days after getting insurance to get pregnant (took less time to conceive than I thought) and then found out after paying for 4 months that nothing was covered. Wish her good luck!

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