Is insurance necessary?

[BubbleMa]

SO and I are are planning to TTC this year.  We both work for ourselves, and neither of us have insurance (so getting married wouldn't make a difference).  We talked about getting insurance for the sole purpose of having a baby, but from what I can tell maternity coverage is pretty pricey and most companies make you wait 12 months before you can even use it.  Which would make it even more expensive.

Since I want to have a home birth do I even need insurance?  We can afford the cost of the Midwife without it.  The only thing I worry about is needing to be transferred to a hospital for an emergency of some sort, although the risk of that is pretty low for me. 

What do you ladies think?  Your opinions, experience, and advise are appreciated!  :)

[Full Heart]

Usually I have no insurance.  We do now but it does not cover hb so I would have to pay out of pocket anyway.  Most hospitals will have right on their website what they charge for birth services.  The hospital closest to me is $2500 for a vaginal birth with epidural.  $2800 for a cs and 3 day stay.  Thats the self pay prices, not insurance prices.  There is another one that is further away that is cheaper with a payment plan but I wouldn't give birth there (way fewer rooms, etc).  Things like NICU it would be nice to have insurance though.  So you might end up paying for insurance and for a mw for the safety net of having insurance.  Make sure the insurance covers the hospital you would transfer to in case of emergency.  I know someone who just went to the hospital in an ambulance and so didn't have a choice and the insurance didn't cover that hospital, so he had to pay for that oop.  They managed to negotiate a self pay price but it was still WAY more than the $500 hospital fee they were expecting through insurance. 

[Carson]

IMO, the issue is not the birth specifically, but any other health/transfer risks that may come up.  Personally, I had a great HB previously, but I would not attempt one without insurance for the case of PP problems - like if I started hemorraging, required more medical attention than my MW could give, baby needed xfer, etc...  I guess that would scare me into not attempting it without ins.  I am fiscally cautious by nature though.

Is there a way to get medical ins for yourself + baby that doesn't include routine pregnancy/delivery coverage? 

[samhope]

I didn't have insurance for 5 years and am very grateful for having it now through work.  That said, we planned a homebirth and after a very normal pregancy ended up with a preemie who was delivered in the nicu and stayed for 3 weeks.  We paid nothing for the hospital (paid midwives out of pocket).  I can't imagine the bill that we would have incurred, but it surely would have bankrupted us.  We are actually planning on switching our PPO to an HMO 8 weeks before the baby is due (that we when the open window is) just in case to avoid the $10,000 that we would have to pay for the PPO (of course on top of the $4000 for the midwife) this time around.  I don't think it will happen again, but I don't want to jeopardize my families future either.  Not that you will go through anything like that, but we didn't think we would either.

[maotmsmi]

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Edited by maotmsmi - 5/21/11 at 11:20am

[SubliminalDarkness]

I hope I don't end up with two replies because things are being weird. 

I would never intentionally get pregnant or have a child without health insurance. It's just not worth the risk. I would hate to be in a position of having a very sick child and having to worry and figure out how I would be able to provide care for them. I just simply would not do it if I was in any control of the situation. 

[maryeliz]

I have a worst case story.  I started my pregnancy uneventfully with a midwife.  I'm in my late 30's but otherwise had no high risk factors, and the midwife assured me that she did not actually consider older moms automatically high risk.  I am very healthy, have never been an inpatient in a hospital, have gone years at a time needing no medical care, probably had not seen an actual MD in 20 years.  I usually get all my care from NPs or midwives.  Then I hit week 27 of my pregnancy and developed pre-eclampsia.  I was admitted to the hospital for monitoring while I tried to hold out as long as possible for the babe.  Was finally delivered at 29w 5d with severe pre-e.  Baby was obviously a preemie and also had growth restriction in the womb (baby is doing pretty well now).

The bills for my hospital stay and delivery would be at least $50,000 before insurance.  I don't know what the bills for my baby will be, but the NICU charges $777 a day just for the bed-and times more than 60 days that is a lot of money.  Before my pregnancy I opted for my cheaper, but crappier insurance rather than my partner's insurance, which would have been more expensive up front, but in our current situation would have cost a lot less, and now I regret that choice, but at least we can cover the maximum out of pocket for my insurance with our savings.  If I did not have insurance I would be declaring bankruptcy.

[BubbleMa]

Thank you all for your valuable input!  I found a plan that covers emergencies only, no Dr. visits or anything.  It's relatively cheap.  I think I'll look into that more. 

Keep the advice coming though, I want to explore all options and I'm sure there's something I haven't thought of yet.  :)

[IdentityCrisisMama]

If you want insurance just for emergency situations I would look into whether you qualify for any type of aid.  During my second pregnancy I did not have insurance (well I had insurance that excluded pregnancy) and we qualified for Medicaid (which surprised me because we make a low but livable wage).  The crazy thing is that Medicaid would paid a VERY large percentage of the fee for one of the local HB midwives.  Medicaid programs also often have a fee-based plan for those who don't qualify for the free insurance.  Good luck!  

[MeepyCat]

Read the fine print on coverage *very* *carefully*.  I cannot stress this enough.  Some cheap plans can seriously screw you over, by paying for ER visits, but not hospitalization, or hospitalization, but not consults with doctors, and by exempting certain categories of coverage.  You also want to look into what kind of insurance coverage would be available for your baby.

I am another one of those cautionary tales:  I am very healthy, no risk factors, and with my last pregnancy I had placenta previa.  I spent a week on hospital bed rest at one point, and more time on bed rest at home (which was at least free) before hemorrhaging in the middle of the night and having to call an ambulance to take me to the hospital while DH stayed with DS until a friend could get there.  I had an emergency c-section and DD was in the NICU for 32 days.  If we had not had insurance, we would have filed for bankruptcy the day I left the hospital (when DD still had 28 days to go).  The bills for the week of hospital rest came to $11,000, which is a lot like the bill for a single day of NICU care.

[luv-my-boys]

Since you guys dont have insurance thru an employer would you qualify thru your state, if your state has a state health care plan?  Even though you might not use it for routine prenatal care if you qualify you can have it as a "backup" in case you were to transfer or have any complications that may arise.  Definately worth looking into, often the household income standards are slightly higher for pregnant females so you may qualify for that.   I would also call your local hospitals and ask about what programs they may offer and self pay patients to get a general idea of which hosptials would be willing to work with you if you do require care/hospitalization  (most religous based hospitals have some type of program to assist patients with expenses)

[Peony]

We have private insurance, it does not cover maternity. I have made it through 3 pgs just paying out of pocket, and guess I will be doing it for a 4th time. I would not consider not having some of insurance though. We don't qualify for any of the state programs. DD2 was a home birth, birth was fine, only she got ill as a newborn, very ill. We ended up paying over 20K WITH insurance for her medical bills. Most private insurance options are very crappy unless you out a fortune for it, we thought we had a middle of the road one, but they still excluded a lot. Like her O2, she was on it for 7 months and they would only cover a portion of the fee every month. 

[noahs.mom06]

Depending on the state you're in, you might not have to worry about medical bills for your baby. In CO for example, all babies are covered until they turn one. I had insurance while pregnant through DH's work, but it only covered DH and me, DS was covered under his bio-dad's insurance, and the baby would only be covered for 30 days after birth, unless we enrolled her. Our premiums to enroll her and add her to our policy would have been literally half of DH's income, so there was no way we could do it, and we KNEW that when DD was born she'd have at least a 6-12 week NICU stay due to her birth defect. Thankfully she was covered by the state until DH decided to join the National Guard and we were able to get insurance for all of us that we could afford. The state's child health program covered her $1M+ 127 day NICU stay, we haven't had to pay hardly anything. I would also look into whether or not you qualify for Medicaid or medical assistance, when you are pregnant the income level to qualify is higher than when you're not, and they would cover pretty much everything.

[Mommy2b4]

We have private insurance that does not cover maternity so we are going to pay for the midwife out of pocket.  But we also have an emergency ride on that would cover us in case of an emergency trip to the hospital.

[jcregan]

I would personally be really nervous not to have some kind of coverage, even if it does not cover the actual birth, but for you and baby if hospital/NICU/surgery stays are needed.   Although is most cases you would not have any emergency or need extra care for baby etc. you really never know.  I am sure you will be getting mostly posts from those of us who have had unexpected things occur - and no replies from the many more who don't have these things happen.   After a healthy/normal pregnancy and birth my D was born with a small teratoma (stem cell tumor).  We had has a 20 week ultrasound and everything but it had not been noticed.  It was benign but had to be removed... this involved an overnight NICU stay for an MRI and about 5 days in the NICU for surgery and recovery... also follow up CT scans during the first few years.

The NICU and Surgery costs were I think 30-50 thousand all together.  I don't know what we could have negotiated if it we were not insured but it still would not have been good and would add one more stress to an already stressful time.   This was even for relatively short NICU stays as these things go.   We had no idea or warning about this occurring and thank goodness we had insurance!

Unfortunately I am not much help in recommendations for plans for you.  I would check and see if there are any state programs for self-employed or business groups who maybe can help you find something?

[camprunner]

This.  We have a high deductible insurance plan.  It does not cover maternity. I did end up having some issues but I negotiated the costs down a little for the perinatologist which would not have been covered by condition. We decided we were willing to handle the costs not covered by maternity (though a hospital stay for preterm labor would be scary expensive). However, I would not want to be worried about money while they were treating my baby. Baby can be added to our plan immediately.

Originally Posted by jcregan 

I would personally be really nervous not to have some kind of coverage, even if it does not cover the actual birth, but for you and baby if hospital/NICU/surgery stays are needed.   Although is most cases you would not have any emergency or need extra care for baby etc. you really never know.