No state plan/no insurance maternity options

[ltlmrs]

what are one's options if pregnant and don't qualify under the state plan with no maternity on your insurance plan? How much would a midwife cost? If something went wrong and one had to be transferred to the hospital how much could it end up costing out of pocket?

Also, does anyone have experience with being on a state plan when their income varies month to month? DH has income 8-10 months of the year depending on a variety of factors. If I were giving birth during a month that he had no income and we were using a midwife and had to be transferred to a hospital, could I get on the state plan just for the delivery? I hope that makes sense...

[C.Arden]

I can't answer most of your questions, but the cost of a midwife is going vary greatly depending on where you are. I paid 2,500 for my midwife in Texas and somewhere around $6,000 here in NJ. I had no insurance with my first two so I paid out of pocket

[pbjmama]

If you provide your location you will probably get a better idea of actual costs. Where I live a midwife would be 1500 to 2500, hospital vaginal birth would be from 8k to 12k (for mom only), depending on drugs and surgery, and expecting a 2 day stay. Transfer to a hospital would likely be because of needed intervention and then you are looking at much more $ in most cases.

[ltlmrs]

Okay, it turns out a midwife in my area costs around $2500. They increased their fees this year from $2000. Unfortunately, there are only a few midwives in this area and no birthing center

[pbjmama]

Do you have anything to barter? I find that most midwives are open to bartering. $2500 is alot of money but at the same time it is the most affordable and often provides the most support for mom.

[ltlmrs]

Originally Posted by pbjmama

Do you have anything to barter? I find that most midwives are open to bartering. $2500 is alot of money but at the same time it is the most affordable and often provides the most support for mom.

We could actually pay the midwife with cash. My concern is not the ability to pay the midwife, but being bankrupted by medical bills if something went wrong. Two of my friends had to be transferred to a hospital after a homebirth, but they both had incredible savings and were able to pay for everything with cash. We don't have enough savings for both a homebirth and a hospital

Here's our situation: I may be pregnant. Our insurance has a $10,000 deductible on it, it's a catastrophic policy and I think it may actually have maternity on it. But, we just got it and there's a 12 month wait for maternity (we had this policy before with a lower deductible). We live paycheck to paycheck barely and we could pay the midwife with our tax refund that we expect to get next year (I'm almost positive that we'd get enough even though DH's income went up). But, our income is about $500 more per month than the state allowance.

However, if DH quits his PT job (he works FT & PT) and if I quit mine, then we'd be right at the limit, but we can't do that till January. DH's job is also seasonal, so there's good reason to believe that by the time the baby is actually delivered, our income would be much lower (which is why I wouldn't want to quit my PT job because that's what has historically tided us over during the times when he was out of work).

So my main concern is not about paying the midwife, which we should be able to do with the tax refund (which we were planning on applying to our debts), but rather about paying the hospital if something goes wrong. If it turns out that we do have maternity on the insurance (and I can't check till tomorrow), there is probably still a 12 month wait for pregnancy, beside the fact that we wouldn't be able to pay a $10,000 deductible.

[kittywitty]

Do you mind me asking which state? Honestly, in your situation...I'd move or get a job without the maternity wait. I know that is probably not an option for you. I just don't know what else I would do.

Can you go talk to public aid and explain your situation? I know here in IL they will back pay up to 3 months if you qualify, so if you need a bill from Feb payed and get medicaid with a lower income in March/April, you can ask them to pay it for you.

[MisaGoat]

Have you applied to the state plan or just looked at the guidelines?
I would apply even if it doesn't look like you meet the requirements. Then if your income changes go back and reapply. Some states have sliding scales insurance options. Like your income may be to high to qualify but they will put you on the plan with a reasonable premium for you to pay. Or they might be able to direct you to other resources.

We were on the state plan when my son was born along with our Cobra coverage (which really barely reimbursed the hospital as much as we paid in the premium) and were able to qualify based on our current income at the time we applied, not the prior income. Which made a drastic difference. They did require my husband to apply for unemployment even though we knew he didn't qualify, but I guess they needed to make sure he was denied.

Hospitals also will make arrangements for self-pay patients or utilize their own charity care program. Call the hospital that you might end up at directly and ask about payment plans/charity care/self-pay discounts.

BTW $2,500 for a midwife sounds great! I am in NJ and the quotes I got were $6000-$7000. I am going with a CNM who delivers at the hospital and is covered by our insurance.

[mountainsun]

I know in Florida (where I live) your insurance HAS to cover any emergency pertaining to pregnancy, even without maternity coverage. We only carry catastrophic coverage, as well - but in the event that I got pregnant and had an emergency (emergency C-section, PPH, etc). it legally has to be covered under the plan.

With my last pregnancy, we paid for our homebirth out of pocket. We had no insurance at the time, and I really had to get to a point mentally that we would be OK if something went wrong and had insane medical bills. Have some faith that things will work out - there is only so much you can do. KNOW that everything will be OK. Eben in the event that you had to transfer, the hospital would more than likely work with you on payment....they don't have much of a choice. And at that point, you may have access to medicaid for pregnancy - Medicaid works in strange ways like that.

s it is a rough place to be. Congrats on your (maybe) pregnancy!!

[JTA Mom]

I would just apply. They usually have 'tiers' of maternity coverage, with a pretty high income limit. Also, with variable income, you can submit your tax returns for last year if, with that, you would qualify for aid.

Ami

[EdnaMarie]

My midwives gave cash discounts. I paid cash because it was less than paying the deductibles, which charged for mother and child each for each year in which the pregnancy occurred, and the deductible was $1,000. Yeeeeeah. So $3,800 was a good deal. I dropped my insurance plan, though.

Okay, it turns out a midwife in my area costs around $2500. They increased their fees this year from $2000. Unfortunately, there are only a few midwives in this area and no birthing center

That's actually really awesome. I had access to ONE CNM (luckily she rocks). See what payment plan you can work out with her.

[Mulvah]

As others suggested, I would apply just to see.

Originally Posted by mountainsun

I know in Florida (where I live) your insurance HAS to cover any emergency pertaining to pregnancy, even without maternity coverage. We only carry catastrophic coverage, as well - but in the event that I got pregnant and had an emergency (emergency C-section, PPH, etc). it legally has to be covered under the plan.

With my last pregnancy, we paid for our homebirth out of pocket. We had no insurance at the time, and I really had to get to a point mentally that we would be OK if something went wrong and had insane medical bills. Have some faith that things will work out - there is only so much you can do. KNOW that everything will be OK. Eben in the event that you had to transfer, the hospital would more than likely work with you on payment....they don't have much of a choice. And at that point, you may have access to medicaid for pregnancy - Medicaid works in strange ways like that.

s it is a rough place to be. Congrats on your (maybe) pregnancy!!

Definitely look into your current insurance just to see. Before my maternity coverage kicked in, my insurance company would only pay for my hospital visit if my life was in danger. The representative told me they would not pay if the life of the baby was in danger. Sick, but true.

[ltlmrs]

Thanks everyone for the replies, they have really made me
feel better.

We do not have maternity on the insurance policy now and it would only be about 60-100 more per month to add it, which we could handle. But, the deductible would still be $10,000 Of course, the company does not know I'm pregnant and there is a 12 month wait (although with Ladybug they waived that for some reason). And according to the guy I talked to insurance would not cover anything related to a pregnancy without the maternity rider.

We don't have CNMs doing home births in this area and the nearest hospital with a CNM is 45 minutes away. The state also does not license CPMs, but there are a couple of fantastic lay midwives here that I trust.

I called the state plan and finally got through to a person . I explained our situation and the ups and downs in income and she said she had no clue because she's never encountered a situation like that . I have to go in to apply in person with documentation from our doctor (not midwife!!!) that I am pregnant, at which point they may provisionally approve me while the application goes through. But, we won't have the funds for a doctors' visit to confirm that for at least another month. Nor do we particularly want to be on the state plan now (would I have to go to prenatal visits with a doctor?) or really ever, unless it's an emergency and our insurance wouldn't cover it. I wonder if they would accept something from a pregnancy resource center. Hmm.

The whole situation is rather ridiculous. We're too rich to be having babies, I guess .

[alegna]

Most states cover pregnancy and birth even if you wouldn't otherwise qualify if you don't have other insurance coverage. So I would think you could be covered retroactively if an emergency came up that landed you in the hospital, but I'm just guessing from what I've put together.

-Angela

[Ianthe]

You could wait until January to get on state insurance, when your income goes down. From what I understand, is when you qualify- you are qualified for your entire pregnancy, regardless if your income goes up.

You can still go to a midwife until then, as her fees will still be lower... and either stay with the homebirth plan and pay with your tax return, and keep state insurance for in case of emergency (that is what I did), or just transfer your care to a hospital midwife so you don't have to pay out of pocket.

[Ianthe]

Originally Posted by ltlmrs

I called the state plan and finally got through to a person . I explained our situation and the ups and downs in income and she said she had no clue because she's never encountered a situation like that . I have to go in to apply in person with documentation from our doctor (not midwife!!!) that I am pregnant, at which point they may provisionally approve me while the application goes through. But, we won't have the funds for a doctors' visit to confirm that for at least another month. Nor do we particularly want to be on the state plan now (would I have to go to prenatal visits with a doctor?) or really ever, unless it's an emergency and our insurance wouldn't cover it. I wonder if they would accept something from a pregnancy resource center. Hmm.

The whole situation is rather ridiculous. We're too rich to be having babies, I guess .

When I applied, I went to the Women's resource center, which is a place that does pregnancy tests for $10 or $15, and give you a statement of pregnancy, with due date, etc. You can get the state plan, and use it just for emergencies if you want to be with a lay midwife.. you don't HAVE to go to the OB.

ETA: With my first pregnancy, I went to the birth center and ended up transferring to the hospital- on medicaid. With my 2nd pregnancy, I planned a homebirth, switched to birth center, and had medicaid in case I needed to be transferred to the hospital again- luckily I didn't. My midwife didn't take medicaid at all, and the only thing I used it for was hypnobirthing classes at the hospital! You can just use it as a back up, and I don't see at all why that would be a problem, since the only reason you want it is for an emergency. It may be different from state to state, but that is what I did here.

[kittywitty]

I agree-go to Planned Parenthood or a crisis pregnancy place to get the confirmation. And what's so bad about medicaid backup? Best to have just in case with your deductible and you aren't forced to see anyone.