Pregnancy and Insurance

Updated on October 23, 2009
E.S. asks from Conroe, TX
16 answers

My sister just got insurance in October however it does not become effective until November 1. She is now 6 weeks late on her period. If she was pregnant would this be covered or considered a pre existing condition? Should she wait to take a test until Novemver 1 so she can say she didn't know she was pregnant? She has been very late before and doesn't think she is pregnant but we were just wondering how this would all work. Thanks ladies.

Update: This will be through my husbands company. I had insurance through my company until my daughter was born then I decided to stay home with her. I have not been insured for 2 years.

1 mom found this helpful

What can I do next?

  • Add yourAnswer own comment
  • Ask your own question Add Question
  • Join the Mamapedia community Mamapedia
  • as inappropriate
  • this with your friends

So What Happened?

Thank you all for your advice. I let her read them all and it made her feel better. I always know I can count on all you girls for advice!!

Featured Answers



answers from Houston on

Same thing happened to me. If she waits to get it confirmed after her coverage begins, then it is not a pre-existing condition. The docs won't care when she found out at her home.

More Answers



answers from Houston on

It depends on the policy. Some policies won't cover you for a certain amount of time whether you "knew" you were pregnant or not. I was without insurance when I got pregnant. Because of thyroid problems, my cycle had never been regular. But, I was experiencing PMS problems but never started. So I got a home test, positive. I went to my boss and inquired about insurance and told her I was pregnant. She called the insurance agent, and inquired. Luckily, the policy we had at the time covered me from the moment the policy was active. And, since I had not been to the doctor yet for the "official" diagnosis, it was not considered a pre-existing condition. This was mid-Sept. Policy went into effect as of Oct 1. I called the ob/gyn and told them I had taken home test but couldn't come in until after Oct. 1. I think my first appt. was Oct 1 or 2.



answers from Austin on

been through this myself. pregnancy is not considered a pre-existing condition. however, if she has not had a dr confirm the pregnancy, it does not exist as far as the insurance is concerned, even if she has taken a home test.



answers from San Antonio on

Depends on the insurance and if it is job offered or individual. Just call and ask. They will tell you and then she can prepare accordingly.

If they don't cover the pregnancy, they will cover any complications of the delivery, usually. Just ask.



answers from Austin on

My understanding is that it's not considered "pre-existing" unless you've been diagnosed by a health professional. If she waits to go to the doc after the insurance kicks in, then it **SHOULDN'T** matter. And those home tests aren't as accurate. So even if she does take the home test to find out for herself, she doesn't need to "tell" anyone (doctors or insurance co).




answers from Houston on

It would depend on the insurance but almost always pregnancy is not considered a pre-existing condition.



answers from Austin on

WAIT until the insurance kicks in!!!!!!!!!!!



answers from Beaumont on

I found out that I was pregnant in October 2004 with our second child. Our insurance didn't go into effect until Jan. 2005 and everything was fine. It worked out perfectly because my first appointment(3month) was scheduled for January anyway. Hope this helps!



answers from Houston on

Is this private insurance or through your company? That makes all the difference. If it's private then the pregnancy is considered pre existing and they will simply not insure you at all. I fought tooth and nail over this. I understand the pregnancy was pre existing but why couldn't they insure me if I broke a leg or arm? That went to deaf ears. That was my experience. I hope this is through your company. Good luck!!



answers from Waco on

I don't believe most insurance companies consider pregnancy a pre existing condition. I know mine doesn't!



answers from Austin on

Hi E., I read your post and went thru the same thing. After research and contacting my insurance carrier they verified that pregnancy is not considered a pre exsisting condition. Pre exsisting conditions are illnesses such as cancer or tumors. I hope this helps.

Have a Great Day!



answers from Houston on

Hi there,

It all depends on the insurance company. The bigger the company is that she works for the more likely the pregnancy will be covered. It also depends on if she had insurance coverage prior to getting the new insurance.

Personally, I would wait it is only 2 more weeks.

On that note I am 30 weeks pregnant, I was on private insurance for the 2 years before I started working at a company with insurance benefits. My coverage started 10/1/09 and i just found out yesterday that they ARE covering the balance of my pregnancy :)

There is alot of informaiton out there, but noone really knows until you submit your first bill and you can see if it gets paid.

I hope this helps a little.



answers from College Station on

It depends on the insurance. If it is through her work, she is more than likely covered. If it is a personal policy, it is more than likely NOT covered.
She just has to call and ask.



answers from Sherman on

Not knowing exactly about the insurance but I work in our Employee Benefits department and with our insurance it is not considered pre-existing. So hopefully if she is pregnant that insurance wont either. I would say go ahead take the home pregnancy test, the company doesn't have to know when she took the test and then after her insurance goes into effect if she is pregnant go to her dr. I really don't think she will have anything to worry about but again not knowing the insurance policy I hate to say its a for sure thing. Can someone annoumously call and ask that question at the company? There is ways around it! lol!



answers from Dallas on

I suppose if I were her, I would take a test at home and if its positive kinda wait it out until November 1st. A week or two really isn't going to hurt as far as prenatal care goes if she IS pregnant. It would be a very complicated situation to try to get anything covered SOONER than November 1st, I would just wait.



answers from Houston on

I've worked in the health industry with medical insurance for over 10 years. I am currently and insurance collector and I can tell you from experience that almost all medical policies that have pregnancy coverage do not include pregnancy as part of the pre existing exclusions. She just needs to either contact the human resources insurance rep, or call the insurance eligibility dept directly. If the policy is a group health plan through an employer most likely she will have the prenatal and delivery coverage, but if it is a small business or individual policy it may not be a covered benefit.

Just have her call the insurance to verify the pore existing conditions and general benefit info, or if her husband was given a book for his insurance or a web site the information should be in there.

For Updates and Special Promotions
Follow Us

Related Questions

Related Searches