Anyone else have crappy maternity insurance coverage?
That's almost exactly what our insurance is like through my husband's job. Co-pay for appointments and labs, but we have to pay 20% of delivery costs before we meet the deductible. Not as bad as nothing covered, but it would still add up to a lot since we don't use our insurance for much, mostly just for well checks and appointments for the kids and I got new glasses a few months ago. Our deductible is $2800. All that being said, we're having a homebirth with a CNM and our insurance plan specifically states that it does not cover out-of-hospital births so we're just paying out of pocket. However, by our calculations we'll still be paying less to the midwife than we would have to pay if we delivered in the hospital. Plus, the care will be better and we get to do it at home. Do you have an HSA or anything like that? Those can sometimes help out with stuff like that. We'll probably use the money in our HSA to help pay our midwife.
I should also mention that I tricked our insurance company into covering 20% of our midwife's fees last time. She suggested that we might have better luck if we submitted the claim ourselves instead of her submitting it so we tried that. It took them 5 months(and quite a few phone calls) to process it but we got some money back! I was pretty excited about it.
This stinks, jjh!!! Mine covers all kinds of maternity options, but my birth center is considered out-of-network. However, their biller sometimes has success getting an exception, and I hear our insurance company is one of the better ones for midwives. We'll see how it all goes. I hope you can minimize your stress somehow. I wish I could help!
I assume my coverage is crappy (we have the cheapest plan possible... so cheap they won't even be able to offer if after the new health insurance policies kick in at the end of this year.) But so far we haven't gotten a single bill! I'm a little confused because so far everything thats showing up on my account online is getting paid. My mom keeps telling me I need to get on the phone with the insurance company and find out exactly what they do and don't cover as my Dr is a little test happy and keeps sending me for blood tests/ultrasounds/etc. and I just can't imagine my insurance will cover a lot of this stuff... but alas I can't call the insurance company during the day as I'm at work. And can't call at night as the are closed! (I've tried calling on my lunch break but ran out of time after being on hold for 30 minutes).
If you saved the books etc you got when you signed up for your insurance, they may have a grid that tells you what is and isn't covered in maternity care. Most standard testing is covered at the usual rate, and the definition for standard testing is pretty broad for most insurance companies. Ultrasounds at secondary facilities are usually limited to a certain number per pregnancy or only for certain indications, but ultrasounds done in-office with an OB at the time of an appointment are usually covered.
Sometimes even insurance that seems crappy can have really good maternity coverage. There's a plan that I work with sometimes that covers most things 60/40 but covers maternity at 100%, where my clients wind up paying me a single $30 copay for the entire pregnancy, birth, and postpartum.
It is typical in maternity care to bill for everything a few days after the birth. Absolutely do not trust that your responsibility will be small just because you haven't gotten a bill yet.
We have a huge ($3600) family deductible, but we're probably going to meet it this year before I give birth thanks to a couple of accidents that DS and DH have had that have needed a lot of chiropractic care. We're kind of lucky that way, that chiro is 'covered' (we're paying out of pocket right now because the deductible isn't met, but it does count towards the deductible) and the small expenditures this year are adding up to the point where by the time I have a baby we'll just have our coinsurance left, because it will be the end of the year. Then next year we'll be hopefully only using well-person type visits which are covered at 100% and we'll be able to let our HSA funds build back up again.
Our insurance was just changed last year. We joke that we were downgraded to Cadillac insurance.... The old plan was 100% of everything paid forever no matter what. The new plan is 90% in network and 40% out of network paid up to our out of pocket maximum ($3000- we chose it) and then 100% of everything else paid. We can pay the OOP portion (copays, etc) from an HSA that DH's company puts $500 into at the beginning of the year and that we can contribute to tax free. We are certainly going to hit our maximum this year, so we're already salting money away into the HSA. We're also going to do everything else possible to maximize insurance use this year 😉. DH is getting some dental work done, going back to the chiropractor, etc. The good news is that OOH birth and my midwife are covered and I just found out that the insurance covers a breast pump at 100% with no copay.
All in all, it's not bad- to us $3k isn't a ton of money or else we would have chosen our plan differently. But I sure do miss the 100% of everything with $0.00 out of pocket plan.
Last year my insurance would've been awesome--100% coverage for maternity care and only $30 copy per office visit (the rest covered). They discontinued that plan, so I had to go with the next best option for me. It covers 80% after meeting the $750 deductible, although it doesn't cover midwives who are out of the network (which means only hospital births). It covers my asthma medications & healthcare 100% even if deductible is not met (they do this for diabetes and I think CHF and COPD as well, though I'm not sure since I don't have those.) Fortunately, my cousin is a midwife and is not charging us anything at all for her services. I have been going to an OB in order to get labs & ultrasound, but I'm planning a homebirth with my cousin/midwife. I have to check on whether/how much breast pumps are covered (all insurance plans are supposed to cover breastpumps under the Affordabla Care Act, aka Obamacare, although not all models or types are covered) with my plan, but since it's a health insurance company owned by our clinic system, they are usually pretty good about coverage.
I shake a fist at all insurance companies. :P It seems like they exist just to make life complicated.
Right now we don't have any insurance at all. This is less than ideal - my husband's company is having a dispute with their former insurance company, and don't seem to have plans to get new insurance... and apparently paying for it yourself is ridiculously expensive. I'm hoping they figure something out soon, but if we have an emergency or something before that, we're in big trouble... so that's not good. I've got my fingers crossed, not much else I can do about it. It's looking like we'll have to at least get an emergency plan or something on our own.
Luckily, we're planning a homebirth, and we're used to not getting much money back from insurance for that. Still, it's pretty annoying.
We also have relatively poor maternity coverage. After pricing hospitals, we decided to go with a homebirth as we will save money even after insurance is applied. There is some hope that insurance will cover part of the homebirth as well which will be an additional savings. With our last one we just set up payment plans with our hospital and ob/gyn. I personally wouldn't put it on a credit card because of the high interest rates being paid through that. Especially since most providers will work out a plan for you to pay it off if you ask.
jjh5351--Hope you have had success figuring out your insurance stuff!
We're in a crappy insurance situation too. Our current coverage doesn't include maternity AT ALL so DH had to go get a full time job and the new insurance is supposed to start Oct. 1. It's tough because I work from home and have our DD (4) to contend with. I'm on the phone a lot and she loves to come into the office talking very loudly, which I'm sure the folks on the other end can hear. Oh well. We know it's temporary, like until I go back to work in January, and DH will stay home to care for our little guy.
I'm VERY curious how the changes to insurance will impact everything next year.