Help! I Need to Do My Own High-Risk Prenatal Care

[umsami]

So, I just found out that the insurance that was supposed to start on Feb 1st (thus giving us no gaps after our COBRA ended)... will not start until May 1st. That gap, and my unability to qualify for Medicare for pregnant women or get any sort of health insurance because I'm pregnant, means that my pregnancy will now be a pre-existing condition (unless congress gets its butt in gear and actually passes something eliminating that).

I'm a type 2 diabetic.. over 41.... and will have to handle my own care. I'm hoping to have a talk with my endocrinologist tomorrow or Friday, and see if he will at least help me manage my blood sugars--perhaps for a set fee for the pregnancy. Any sort of u/s, etc. will be out.

Can any of the Mamas out there tell me what I need to be checking on myself?
I'm assuming I should get some urine dipsticks to check for protein, sugar, and ketones.
I'll monitor my blood pressure (thankfully, normally low)... as well as try and snag a doppler to check the fetal heart rate.

Anything else come to mind? Part of me is scared--but then, trying to be rational, I can do almost everything that my OB would be doing anyway. The only things I won't be able to do are the nuchal scan/bloodwork, other ultrasounds, and the monitoring at the end. Hopefully, by the third trimester, I can work out some sort of deal with somebody for at least fetal monitoring.

I can't help but be annoyed by the irony of this. DH is a medical professional--and yet we're without health insurance.

[AlexisT]

Check your state laws. In many states, pregnancy is excluded from preexisting conditions, at least for group policies.

[elmh23]

What AlexisT said! Also, call the local hospital(s) and see if they might be able to help you get care in between the COBRA and May 1. When I was pregnant with our first, we didn't qualify for any assistance, but didn't have health insurance. The local university hospital has a program set up for people like me that was basically "pay as much as you can, but we'll cover the rest." My state has since then adopted a coverage plan for uninsured pregnant women and I think the guildlines are pretty darn high!

[MaerynPearl]

Originally Posted by AlexisT

Check your state laws. In many states, pregnancy is excluded from preexisting conditions, at least for group policies.

except its not a state thing, HIPAA has this enforced nationwide for group coverage http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html (its not that far down where it talks about pregnancy can NOT be a pre existing condition)

though this is only for group coverage (through an employer or such) and not individual coverage (that you sought out yourself)

If you have individual coverage starting in May, I would call them to find out if the pregnancy is pre-existing on their policy.

Source: I'm actually formerly an insurance agent and had to deal with this a lot...

[CorasMama]

Can you not continue your COBRA coverage for another 3 months? Honestly, I'd find SOME way, even if it means going into debt, to continue having coverage. Perhaps buying an individual policy for those 3 months.

[Hedgehog Mtn]

I'm assuming that you already know all about checking you sugar level but I would caution against putting too much stock in the dipsticks. I use them as an aid but they can pail to pick up proteins and have both false pos and false neg. As a tool they can be helpful but they are not 100% reliable and are sensitive to moisture and temps. I paid a lot more attention to my actual blood checks I did at home and used the dipsticks also.

[leavemealone]

Pregnancy can't be a pre-existing condition on a group health plan. That doesn't help with care during the three month gap, but at least you can relax a little bit. I don't know what to suggest other than to see if you can extend COBRA a bit longer. If you haven't reached the max time limit, you should be able to. I would doubt that an independent plan would cover anything related to pregnancy anyway, but might be good to have on hand in case of other problems (broken bone, ear infection, etc).

[PlayaMama]

mama, you should find someone that uses a sliding scale. just about every doctor that i've seen either for me or the kids allows people without insurance to either develop a payment plan, get a large discount for paying in cash, or a sliding scale based on income.

just call around and ask.

[umsami]

No, our COBRA is maxed out--18 months, no extension. I called and they said I could convert to a hospitalization plan, in case of emergency, but that really doesn't do much good and costs way too much. It sort of sucks because had DH not gotten this job, I would have been eligible for Medicare. (Of course, it's great that he does finally have a job again. )

It's good to know about pregnancy not being a pre-existing condition. It will be group coverage--so that at least helps.

I'll have to call the teaching hospital and see what I can arrange in the meantime.

Thanks for all the advice Mamas.

[finnegansmom]

scour your state's website. I know where I am, there are plans for pregnant women that do not qualify for medicare. Ours don't cover inpatient services but do cover prenatal. Usually because you ARE pregnant, you will have more services open to you. Call WIC, even if you don't qualify finanicially, maybe they can help you or refer you.
Good luck mama

[AlexisT]

If she's in NY (sorry umsami - your name seems familiar!) that's PCAP, and it's a good program, but as she already said, she doesn't qualify. Because NYC is so expensive, a moderate salary can put you outside the PCAP limits (200% of FPL). Unfortunately, individual plans in NYS are very expensive and they can exclude pregnancy as a preexisting condition (I'm not sure if this applies if you have existing coverage, you'd have to ask). But the price would probably rule it out, it's something like $1K/mo for a SINGLE person.

However, there are health centers in NYC who will work with you and do sliding scale care.

[umsami]

I was in NY (good memory), but am now in FL. The limit is 185% of the FPL. Even for sliding scale plans, we don't qualify. I think we're going to try and negotiate something for the next three months, and then count on the group plan covering the rest. Hopefully that will work!

[AutumnMoonfire]

I suggest you keep getting care, by hook or by crook. It could be a matter of life or death for either one of you... Money or life?

I would do more research (Hopefully it's as others have said, can't be a pre-ex condition) and then see the financial counselor at the hospital you expect to deliver at. They will probably have some helpful advice for you and resources you can look into.

Once you've talked to this person and know the lay of the land talk to the business manager at your OB practice, if it's a private practice sharpen your credit card and pay them first, then if they want further testing, beg plead and cry to have any US done at the hospital because most hospitals will not ding your credit rating if you pay at least something every month. Remember every dollar you spend now will translate into a reduced chance of a NICU stay for the baby and bigger bills down the road.

Remember, unless you KNOW the OB is an employee of the hospital PAY THEM FIRST!!! They are a "small business" and they'll be much quicker to send it to collections than the hospital would. Also bargain with them, there is quite a difference between "Rack rates" and what an insurance company actually pays them...try to get insurance rates. You may even be able to do the same with the hospital.

Try not to get services from multiple places, fewer things to unravel later, and one hospital that knows your sitch and that you are paying a little too each month will be more manageable than 10 little stand alones, any of whom will send it to collections if you don't pay on time.

Never give any of them the impression that you WON'T pay or that they are not your top priority to pay first!!

Good luck, be well and have a smooth pregnancy and an uneventful delivery!

[Realrellim]

It looks like a sliding scale might be a possibility for you. A friend told me she went to the health dept for pregnancy and paid on a sliding scale b/c she wasn't eligible for medicaid when she was pregnant with her dd.

Here is the link http://www.doh.state.fl.us/Family/famplan/index.html

ETA: I just noticed you said no sliding scales either, but I didn't know if you'd looked at that link. FWIW, we have a high-deductible plan and so the first $3000 of our prenatal care was completely out-of-pocket. We ended up running through that in two months due to the cost of generic zofran and all (and will definitely go through twice that amount out-of-pocket again in the 80/20 part of the plan) before the baby is born. If you're already second tri though, that should help with your costs. You might be able to negotiate a discount too for paying your bill upfront or something like that.

[DeChRi]

I think all of this had been said...but just to throw in my two cents..

You said you were switching to a group plan May 1. The other posters are correct, that pregnancy cannot be deemed a pre-existing condition. One thing to check (and someone may be able to answer this)...does that still apply if there has been a gap in coverage? I believe it does, which means you only have 3 months with no care. My Dr doesn't see patients until they are at least 8 weeks along unless there is a history of early m/c. If it were me, based on my limited knowledge of your situation, I would call me Dr and see if they could work with you on the first couple appt cost, then maybe just wait a couple extra weeks between your first couple appts and the next until your insurance kicks in? Again, depending on your health and other things, that may not be reasonable, but just a thought.

Best of luck!

[rhiOrion]

I thought that even individual insurance couldn't deny pre-existing conditions if you'd never had a gap in coverage?

[MaerynPearl]

individual ones usually do not claim pre-existing if there is no gap in coverage (however Im fairly sure its not illegal for them to, in most states... they still dont)

however, for pregnancy... even IF there is a gap in coverage... group plans can still not claim pre-existing.

you could get pregnant when not covered, get covered at 9 months and they still have to cover the birth. under no circumstances, in group coverage, may pregnancy be considered pre-existing

[lmk1]

I would try to negotiate a self-pay rate with any Dr or facility you may be using ahead of time. At my first OB appt, I found out (I don't know why I didn't know this) that my pregnancy medical coverage is capped at 2,500 out of which insurance will only pay 80%. The OB's office informed me I'd have to pay them $500 per visit as they will need an additional $3500 from me. This does not include anything extra, like nuchal translucency test, amnio, etc. This also does not include the hospital fee. In fact the OB office advised me to get the self-pay rate at the hospital and I already found out that it's $3500 for a vaginal birth and $6000 for a c-section birth. Needless to say, I am going to have over $10K in out-of-pocket expenses and I have to pay my insurance premium on top of it all. I personally don't think the insurance is worth it at all, but sometimes their negotiated rate is less than I'd be charged otherwise. But not always...my son needed a chest xray and I was given a choice to use my insurance and pay their contracted rate (because of the deductible) of $425 OR not use the insurance and do self-pay of $125.

[DeChRi]

My experience was this, if it helps;
I quit my full time job in August, we went on COBRA for $1312/month for our family. My DH out earned my by double, but he is technically an independent contractor, so no benis. I became pregnant in Sept. We have never had a gap in coverage. We applied for 3 individual insurance policies. We are in wonderful health with the exception of my DHs bad knee. 2 denied us as I was pregnant, 1 said okay, but the premium was $2k+/month since I was pregnant. They specified that regardless of no gap in coverage, nothing with DHs knee would ever be covered, along with any type or condition associated with arthritis, as knees that have been opperated on will eventually become arthritic. So we decided to stay on COBRA. We then applied for small group coverage until DHs biz, of which he is the only employee. They accepted us at a cost of $931/month and would cover all of DHs knee stuff. I then told her I was pregnant and she said to disregard that quote, that she would have to recalculate and see if we were eligible. We were for $2245/month. MY Dh then took a job within work that offered group coverage. (He is in real estate, and he took the agency broker job, thus becoming an employee). They would accept us, hook line and sinker. However, it was close to the cost of COBRA, and since DH is only working 20 hr week in the broker position (the rest selling/buying/flipped and other junk), his employer decided not to pay for a portion.

So we are just staying on COBRA for now.

Insurance is expensive. And unfair. And a pain in the butt. But what can you do.

[tessie]

Tell me again why people think universal healthcare is a bad thing.

To the OP, I have no advice but hope you manage to either get medicaid coverage or find a dr who will work something out with you.