Medical Insurance and Pregnancy - How Does It Work???

Updated on June 10, 2009
A.L. asks from Lafayette, LA
10 answers

Anyone out there have some advice? Insurance is one topic that thoroughly infuriates me! I have a high deductible plan. It has all kinds of loopholes on how insurance will not cover costs - i.e.: if I conceive in a different YEAR than deliver - I have to pay 2 times the deductible - - so one child could cost $10K??? And that is just MY charges. Baby if any complications will have to meet a separate deductible.

Oh, and has anyone ever bought a "rider" from the hospital that they delivered at??? WHO KNEW!?!?

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answers from Flagstaff on

Yes, you might have to pay the deductible twice. However, you could switch to a different plan on the second with a lower deductible and better coverage. It might be a good idea since you will spend a lot of time at the doctor's office the first year of baby's life! (It is an unfortunate fact.) Good luck on getting pregnant. Life doesn't always happen the way we plan, but we do what we can!

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answers from Flagstaff on

I had a high deductable on my insurance as well- $5700 and after I became pregnant I found out I was not even covered for pregnancy- the agent messed up and there was nothing I could do about it. Check with your gyno- they typically have plans for people who do not have insurance that are less money than what it would cost if you had insurance and they take it in payments you set up with them. I ended up paying 75% of their fee and then decided to have my baby at home with a midwife and even though it was like paying twice it was so worth it (and still less than the deductable). If you are open to having a home birth, check out Shell's site: she covers the phoenix area is is fabulous:)

Good luck!

1 mom found this helpful


answers from Phoenix on

I would say plan for a home birth, safer, more relaxed and cheaper. Midwive fees are not so bad, for sure consider it.

1 mom found this helpful


answers from Phoenix on

Have you considered a homebirth? A local homebirth midwife generally costs about 2,000 for all prenatal, birth, and postpartum fees, and some are even willing to barter services for part of your fee. We found the care of midwives to be highly superior to typical maternity care and would never go back now that we know they're out there.

(We started looking into midwives because we didn't have insurance coverage when I got pregnant, and are SO thankful it happened that way!! We love midwifery-style maternity care.)

1 mom found this helpful


answers from Phoenix on

Hi A.,

Society may think babies are cute, but insurance companies sure don't. I went the midwifery home birth route, but I did have insurance in case we had to transport to hospital...otherwise I think I would have been terrified.
Get insurance or discount plans ahead of time (before preg). Read fine print and see if anyone on the internet is blogging about being burned (and just how that happened). See if any women advocacy organizations have any particular recommendations.
I had a plan with Assurant that would cover emergency delivery issues at hospital even in the first year...but I am not sure about loopholes (I had not planned to get preg while with them). Good Luck!!!



answers from Phoenix on

Hi A.,

I had the same questions when I got pregnant. I called my insurance company with all my questions, I made sure that my doctor was in their plan and the hospital and everything. I found out what they cover and for how long they cover. They were very helpful in answering all my questions so when I had my daughter I knew exactly what to expect. Good Luck.



answers from Phoenix on

Check with your insurance company. I am a plan administrator. The way most births work is that the doc does not bill the insurance company until the end of the pregnancy. That means that you will not have to pay 2 deductibles if you get pregnant one year and have the baby the next. It is all billed all at once as a "balloon". Double check your policy.

Be aware, not only will the doctor bill you, but so will the hospital and the anesthesiologist, if you use one. All seperate!

The doctor's office should be able to tell you what your responsibility will be. My first visit as a newly pregnant lady, the doc's office gave me a print-out showing my portion ($1800). They set up a monthly payment for me so that I would be paid in full by the 8th month. They then informed me that I would have seperate responsibilties to the hospital.

Anyway, check with your insurance company, insurance administrator (benefits department at your employer) and check with your doctor. They should all be able to give you a pretty clear picture of what to expect.

Good Luck


answers from Phoenix on

Hi A., I'm an agent so here's some other info. You can't get pregnant, then try to get health would be automatically declined! Also, very few plans will cover a pregancy if delivered in the first 12 months of the policy. You would need to check with your plan specifically.

Also, whether you have health insurance or not, Aflac is another option that PAYS YOU CASH to help offset costs. Here is an example: The first plan that covers this is the Sickness Plan. It pays $500 for initial hospital stay and $100 for each day thereafter. It also has a surgery benefit for either normal or caesarian birth. This pays either $300 or $400. There is additionally up to 8 physician visits per family that can cover at $25 each. There are a couple other plans available and the premium for these are very low! Of course, you have to have the plans BEFORE you are pregnant!

Let me know if you have any questions or want more info! It's smart of you to check into this BEFORE and then maybe get some surprises if you are not aware! Good luck!!



answers from Phoenix on

Hi A.,

The bad news is you're stuck with your insurance company if you want any coverage for your pregnancy. The beautiful life you're adding to the world is now a pre-existing condition.

The good news is that although your insurance has a high deductible you haven't been paying for the low-deductible/ co-pay plans other people are paying for, which can top $1000/month. More good news is that you have maternity coverage.

Your plan probably has a FAMILY deductible, look at how much that is because you may hit it and the baby deductible and complications would likely be included. There is a max out of pocket number that is typically shown to you by your agent when you get started with the policy. If you have an agent call him/her first, they typically have a lot of information and can probably tell you how to maximize your benefits. Like, if you do hit the FAMILY deductible your husband should go ahead and have anything looked at he's been thinking needs a look. Chiropractors and massage, lactation specialists, podiatry (anybody need orthodics?) all could possibly be covered at that point, we used baby chiropractic which was great for gas and general fussyness for both of my daughters - once they were straight my life was easier.

Second, your doctor probably knows how best to manipulate the situation with each insurance plan, talk with the insurance person there. The insurance company is a good source of an explanation of your benefits but they will not clue you in on how to get them to pay more. The doctor will likely charge all of their fees to the insurance company when the baby is delivered as somebody else said, that sounds very familiar (although it's been a while for me) they will estimate your costs and set you up on a payment plan too.

Something to watch, the doctor usually gets everything all set up so that they're paid in full or close to it by the time of delivery but whoever submits their billing to the insurance first is the one that gets "applied to deductible" and you get a bill from them. In my case the doctor wasn't the first one to submit for payment so the hospital was applied to deductible, the doctor got paid by the insurance (so they got paid twice, once by me and again by insurance) and then I had to get a refund from the doctor to pay the hospital, just what you want to worry about when you're a new mom.

Usually the emergency deductible is less than the regular deductible, so that should apply in the case of complications but if you've hit your deductible I don't think it applies. For instance, say you have a $1000 deductible for emergencies, you decide to pay your pre-natal visits out of pocket and have a home birth (which would likely be less than your $5000 deductible. Then you have complications and have to be airlifted to the hospital and have an emergency C-section. At that point you should would be paying the $1000 emergency deductible. In the same example say all your pre-natal and home birth expenses are $4500, you should then only have to pay $500 toward the emergency stuff - the emergency deductible is usually designed to make your life easier not get more money out of you.

Pay attention to how things are covered after you hit the deductible too, it may only be 80/20 meaning you could be responsible for 20% even after you hit the deductible up to another amount (typically $10,000). Or it could be 100% after the deductible, which I'm sure you prefer.

It's better with a high deductible plan if the baby is born on January 1st because there are lots of doctor visits the first year. My first daughter was born on 12/12 (early, she was supposed to be born on 1/5) so we did have some deductible issues although at the time we only had co-pays for doctor visits. If well care is covered after your deductible, pay attention to that and get as many of those visits done and paid for before you start a new year. Shots in the doctor's office are expensive.

Also don't worry too much, this stuff is all negotiable. If you're willing to work at it you may be able to get the doctor and/or hospital to take less than your deductible from you and receive most of their payment from insurance. Ask your husband to help if he's any good at that type of thing. If you really struggle with the expenses and have to pay it off after the birth (usually the hospital and anesthesiologist) these expenses are more negotiable after you have gotten the services and it's been 6 months - 2 years and they've seen no payment. Although that could have an adverse affect on your credit (some people care about that and some don't).

If the hospital is willing to sell you additional insurance (rider) that saves you money, great! If you have an agent call him/her and have it looked at first. You don't want to buy something that doesn't help you.



answers from Tucson on

If you conceive in one year but deliver in another you're in a different claim have to satisfy your deductible every year. Now when baby comes along some plans may require a change of deductible since you have a change in coverage (you + spouse ==> you + spouse + kid).

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