Insurance ? Re: Pregnancy

Updated on July 08, 2008
B.D. asks from New Lenox, IL
19 answers

Ok so we have BCBS, under COBRA, and are wrapping up our 18 months on 8/31/08. My husband is supposed to become an "employee" and therefore, receive insurance from his employer by 9-1-08.

This was a perfect plan - a little delayed and down to the wire but status quo for our life!!

Two weeks ago I tested negative for a pregnancy... but I was still late. So I tested again yesterday and BAM! It was positive, not once, not twice but 3 times!

My question is... how is this insurance thing going to work? Will we be rejected and not covered? Should I not go to the OB? I am probably around 6 weeks, which would make me around 15 weeks by the first of September. I know I will need a repeat section so the bills will be quite high.

I know I should not worry - that will not help things. I am just looking for a bit of advice or similar stories.

Thanks in advance!! :)

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S.B.

answers from Chicago on

Hey,
we had insurance issues too. It most likely won't matter if you went to the OB but they will go by when you got pregnant...you might call your current company and also the new one and just ask questions.

If you end up not being covered (happened to us) most hospitals will give you HUGE discounts if you pre-pay...for instance I paid 2000 instead of 8000...

good luck,
S.
32, mom of 2 girls

1 mom found this helpful
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A.C.

answers from Chicago on

My cobra ran out on July 31st and I didn't deliver my daughter till October 19th last year, and Cobra paid for everything even after my coverage ended, because my doctors office bills pregnancy in a lump sum after delivery...It was a HUGE relief. You can email me with any questions @ [email protected]____.com, I will be happy to answer any questions you may have. I did get supplement illinois Ichip insurance so I dindn't have a lapse in coverage on Aug. 1st last year, but the cobra covered all my visits and doctors charges for the delivery. Go see your doctor and contrats! It all ways works out! Don't stress out! Here to help! Adriana

1 mom found this helpful
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A.W.

answers from Chicago on

I went through something similar several years ago. My husband changed jobs and that resulted in an insurance switch. I think I was 4-5 mo pregnant at the time. I called the insurance companies and was told that as long as I could provide proof of insurancefor the first part of the pregnancy it would be covered under the new insurance. The best thing I can say is to cal and ask questions. You do not have to provide them with detailed information on yourself to get general coverage questions answered.
Hope this helps.
Allison

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C.L.

answers from Chicago on

As long as you have been continuously covered, even through Cobra, they cannot reject you. I used to work with chronically ill patients who had a terrible time getting insurance, but if they were continuously covered with no breaks in coverage, they have to cover them. Don't worry that Cobra isn't "regular" insurance, it's exactly the same, except that you sadly have to pay for it! Good luck!

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B.R.

answers from Chicago on

Have you husband ask his employer if there is a pre-existing clause on the new insurance plan for pregnancy. He will need to talk to the human resource person or the one that handles health insurance within the company. Do not go by what his colleagues tell him. Insurance plans change all the time. There really should not be a pre-existing, but as always that is not always the case. Once you have that answer email me and I will help you further. I have been processing insurance health claims for 31 years.
Barb R

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C.G.

answers from Decatur on

Don't forget to make sure your new insurance plan has maternity coverage!

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M.D.

answers from Chicago on

What most of these people are saying is true. If you go from one group plan to another, you will be fine. The law says that maternity can no longer be considered a pre-existing condition FOR GROUP COVERAGE, at least it was like that 5 yrs ago. The one thing that you should be aware of, just in case, is that if something goes wrong with your husband getting a group plan, you will NOT be able to get insurance as an individual. Your husband will not either. One of the questions EVERY individual insurance companies has on their application is "are you or any dependent currently pregnant?" if the answer is yes, they will not cover you at all. I just want you to know this up front.
Again, as most people said, COBRA SHOULD cover the pregnancy because you were covered under them when you were first treated. You can call them to be sure how they will handle it.

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N.D.

answers from Chicago on

B.,

I'm in a similar situation in that we're currently covered under COBRA and our coverage will be running out this November. We'll be enrolling in new private insurance then. But to answer your question as best I know (I used to administer COBRA/HIPPA at my last job in Human Resources before I became a SAHM), as long as you do not have more than a 63-day lapse in coverage, your new insurance cannot apply "pre-existing" conditions such as pregnancy under your new plan. I've included the following link which may explain things a little better. Good luck!

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

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I.C.

answers from Chicago on

If you are insured under Cobra and you will be picked up in September from the employer, you should be fine and will be covered. Having Cobra insurance doesn't negate your status as an insured person. You will not be denied your services.

Congrats on your pregnancy.

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M.B.

answers from Chicago on

Hi B.,
I think you should be ok. I was in a similar situation 2 years ago and was told that as long is there is no lapse in coverage and you go from one set of coverage (in your case COBRA) to another (your new employee coverage), then pregnancy is NOT considered a pre-existing condition and you should be covered like normal. Just make sure your new 9-1-08 coverage DOES include maternity. Good luck!
M.

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A.L.

answers from Chicago on

I work in HR so I deal with this a lot. As long as you do not let your coverage lapse for more than 30 days you will be fine. If for some reason your husbands insurance does not start on 9/1/08 make sure you have a back up plan in place to get new insurance so you are covered. It will not be pre existing as long as you are covered for the previous 12 months with less than a 30 day lapse.

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M.D.

answers from Peoria on

I am certainly not an insurance expert but my doctor does a global charge that is not charged until the end of the pregnancy. If your doctor doesn't charge that way you may want to find one that does. I would not wait until 15 weeks for your first appointment. Good luck and Congratulations!
Way to go being a Homemade Gourmet Distributor, I am too! I just absolutely love the product.

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D.N.

answers from Chicago on

I had Cobra due to a pre-existing condition my son has. I was lucky enough to have overlapping coverage. Anyway, under HIPPAA, as long as you are under group coverage, which COBRA usually does, and you do not end up with more than 63 days without coverage, then your husband's insurance must cover your pregnancy. You can look up HIPAA on the internet as well to read the whole thing. You will need ot get a certificate of coverage from BCBS to ensure the new insurance covers you.

K.L.

answers from Chicago on

Hi B.,
You should be fine. Pregnancy is not considered a "pre-existing" condition. I had went through the same thing (husband starting new job, we had no insurance and found out we were pregnant) New insurance took over just fine. I hope this helps you! Good Luck!

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C.D.

answers from Springfield on

From my own experience, typically family insurance received through an employer does cover pre-existing conditions, thus why the rates are pretty high to add family members. It's when you get into purchasing private insurance that you won't be covered regardless of whether you've documented the pregnancy or not.

That said, congratulations, and don't wait so long to see your OB. You should go by 8-10 weeks to have your first ultrasound and all that good stuff.

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J.D.

answers from Chicago on

In Illinois, pregnancy is NOT an excludable "pre-existing condition." They cannot deny coverage for this even if you had a brief lapse in coverage.

http://www.idfpr.com/DOI/HealthInsurance/HIPAA_preexistin...

"HIPAA (Health Insurance Portability and Accountability Act, effective July 1, 1997) limits the time you can be denied coverage for a preexisting condition under your employer's health insurance plan. Under HIPAA, an employer health insurance plan can deny coverage for a preexisting condition only if the employee or dependent is diagnosed, receives care or treatment, or has care or treatment recommended in the 6 months before the enrollment date. Note: Pregnancy cannot be denied as a preexisting condition by an employer's insurer. In addition, preexisting conditions cannot be applied to newborns, adopted children under age 18 or a child under age 18 placed for adoption as long as the child become covered under the health plan within 30 days of birth, adoption or placement for adoption, and provided the child does not incur a subsequent 63-day or longer break in coverage."

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E.S.

answers from Chicago on

We had to switch insurances mid way through my pregnancy with our son. No problems. It is not considered a "Pre-exsisting" condition. You should have not problems. The only thing I had to do was pay another co-pay for the new insureance. Good Luck!

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C.T.

answers from Chicago on

Hi B.,

Congratulations! I would think that because you are currently covered by an insurance company and will be going into another one they may not consider it a pre-existing condition. Your best bet, to put your mind at ease, would be to contact the new insurance company to see if they would consider it pre-existing. Please...do yourself and the new baby good by going to the OB - all insurance issues set aside. Good luck!

C. T.

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M.G.

answers from Chicago on

As long as it is a group insurance plan you are find under the reasons the other posters gave you. I actually switched insurance a week before my son was born because I was going from full to part time at work and once my mat. leave started I was not covered by my employer so I went on my husbands plan. You should make sure/find an OB that take both insurance plans. Then you won't have a lapse in care having to switch doctors. That being said if anything were to fall through both you and your children should be eligible for health insurance through the state(you would qualify bc you are pregnant).

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