Health Insurance Vs. Self-Pay

Updated on May 01, 2008
S.S. asks from North Olmsted, OH
5 answers

Being the indecisive and over-analytical person that I am, I'd like to hear some opinions/suggestions from other moms. Currently I do have health insurance with maternity coverage (my benefit amount will be $2500). I just found out that it covers only a routine vaginal delivery and not a c-section. Well with my first, I didn't have any insurance and ended up paying everything out of pocket, that too I had a c-section. We ended up paying around $5,000 for everything (we were fortunate to get a self-pay package through the dr. and hospital). I have private health insurance (I'm a SAHM and my husband is self-employed). He makes too much to qualify for anything (we've already been through all that).

My question is what would you do? Is it worth it to pay for the insurance and in the end, get stuck paying the bill yourself anyway?

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So What Happened?

Thank you so much to those who replied. I've just been making myself crazy trying to go over the numbers again and again to see what I'd be paying w/insurance and w/o insurance. The $2500 benefit amount is the total amount (dr + hospital). And from what I remember, the actual dr and hospital charges are ALOT more than the self-pay charges. I'd like to try VBAC this time around but I'm still in the process of looking for a OB/GYN/midwife. I felt the dr I saw the first time wasn't attentive enough. (Any suggestions on OB/GYNs/midwives would be much appreciated!) I think I'm gonna do the self-pay. Makes me so angry to see how you can pay and pay for insurance and it still doesn't do you any good.

More Answers



answers from Youngstown on

Contrats on the new baby!
I myself had a c- section and will get another with my 2nd child due in Nov. I would never try vbac, it seems unecessary and dangerous. But I would not pay insurance and for the surgery, when you know the chance is off the charts that you'll have another. That seems like a waste. I heard of a maternity card that might help your situation. Good luck.



answers from Dayton on

Does it cover anything else. Is it covering your prenatal care? What about after the baby is born? Does it cover any complications like infection or any of the other things moms can go through postnatal? I gues my questtion is does it cover everything except the surgery itself or because of the c-section is nothing covered. If it does, then I wouldn't cancel it.



answers from Dayton on

I am not sure what to tell you as far as what to do about the insurance. I have never heard of insurance that would cover medical but not a c-section. ?? I would strongly encourage you to look into getting a doula. If you look at the research, they reduce the need for c-sections, medication during labor and so much more! I had one for 3 of my 5 births. My first birth was c-section and the next 3 were v-bac births with a doula. I am now a certified doula myself and I can give you more information if you would like under NO obligation. There is usually a charge for doula services but they could help you avoid another c-section. May I ask who your doctor is and where you will be delivering? That will also increase or decrease your chances of having another c-section birth.
I would be happy to answer any other questions you may have if I can. :)
G. C.



answers from Fort Wayne on

My neighbors just went through this too. If this helps make your decision, he SELLS insurance, and still decided to not pick up the maternity coverage. They're just paying out of pocket. He has regular insurance for his daughter and his wife, but none for himself. So, I know atleast in their situation, he found the numbers to not be worth the maternity coverage. You figures are the same as theirs too, they said something about paying about $5000 out of pocket. She is now 5 months pregnant.



answers from Dayton on

I would have a vbac if you can and let insurance cover it. You could also take them to small claims court. I think it is 2500 a claim maximum 5000.


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