Looks like insurnce will not cover this pregnancy. What to do? - Mothering Forums

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#1 of 5 Old 09-22-2011, 11:50 PM - Thread Starter
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I am trying very hard not to freak out.


With baby #1 I had pretty good coverage, but it did not cover a home birth so we paid $1600 out of pocket for that birth. That was 8 years ago, times were better.


With baby #2 I had no insurance, but we went the same route and we were able to cover it, but it was tough. It was a little more expensive to do and I had to do a lot of self care (midwife was out of state, she traveled to me for my birth, so I did consult with her with my self care, did blood work with my GP, so I had something.) I chose to go that route. I could not find local midwifery care that seemed safe and I could not afford an OB out of pocket.


This pregnancy was a bit of a surprise. I would not have planned this (my other 2 were very planned.) But it is a welcome surprise. A lot has happened in our lives over the last 4 years since baby #2. Like so many, the economy has been rough on us. We don't have a lot of extra cash. We have some insurance, with the promise of the ability to get more should something change our situation.


Our family has been covered by medicaid in various forms. My son was diagnosed with cancer last year and he has down syndrome, he was eligible for full coverage (well in theory anyway, it has not completely worked out that way) and the social worker that helped us get his coverage lined up encouraged us to apply as a family so each one of us qualified for something different. I am covered by share of cost, very high share of cost, but enough to cover a true emergency. I looked into the pregnancy coverage and saw that with the new baby, our income was well below the maximum for a family of 5 so I was not worried I would be denied. I went down to the DCF, applied for a change of status in person and was assured by the folks there all was in order and I would be getting my coverage in a week or so. I was very happy to hear this since I am really wanting prenatal care, even though we will be paying out of pocket for our beloved midwife to come to us again for the birth should all things go well.


I got a call today saying at them moment, my husband works to many jobs so they can not grant me coverage. (WTF, since when is there an upper limit of number of jobs? Our income is what it is. What does it matter how many jobs it takes to get it?) DH is a high school teacher and he works for 4 different online universities on the side. The work is sporadic, the income is irregular, but we need it to cover more than just the minimum necessities. It's a little like freelancing.


I am at a loss for what to do. I am going to appeal the decision, and I have not given up hope, but what if it doesn't work out? My share of cost is 2 times the cost of local midwifery care. Local care is more than 2 times what I will be paying my out of state midwife out of pocket. I really can't afford local care, even without using my out of state midwife. I am grateful that my share of cost would cover an emergency hospital birth, but the last thing I want to do is to risk a transfer to the hospital without legal local care and Medicaid. That seems like a ticket for big trouble.


Not to mention that April is a long time away, what about getting care and dealing with any issues that might come up. I can cover blood work, other labs, and routine stuff like that, but what if I need medical care? My share of cost resets each month. Even if I need to use it for one big emergency issue one month (and it would have to be hospital stay big to reach the magic number), I still have to meet that high number the other months to continue coverage.


I'm feeling very low that this baby could be the straw that pushes us into financial ruin.

One happy momma joy.gif to a very spirited little girl dust.gif, her tough little brother superhero.gif, and a happy little suprise late April 2012 stork-suprise.gif. Wife to an overworked and under paid husband geek.gif.

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#2 of 5 Old 09-23-2011, 06:36 AM
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I hope this doesn't come across as too forward, but I want to put it out there. 


I think your situation is pretty complicated, and I think you might benefit from an advocate.  Someone who is less emotionally tied in but still on your side.  A lot of law schools have clinics that can give you free legal services for things like this--I worked in one for a while doing special education entitlement hearings.  Yes, they're students, but they are supervised by attorneys and they have a lot of time and motivation to do well for you.  So if you have a law school nearby--in FL you must! I would see if they have a legal aid clinic.  Totally worth a couple of phone calls. 


As for income--would it be completely dishonest to say that his regular teaching job is his "primary" income, and somehow not count the other gigs, because they aren't permanent?  I guess it would depend on how things are worded....


FL lawyers have an annual pro bono requirement, so someone may be able to help you for free.  If you happen to be in the FL Keys or Tampa area let me know, I could give you some names of people to try.


I'm so sorry you're dealing with this right now.  hug2.gif

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#3 of 5 Old 09-23-2011, 06:59 AM
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Sounds like your family qualifies financially but because of some arbitrary "too many jobs to feed the family" rule, they are turning you down.  Is there any way to "bundle" the online jobs?  Like saying he owns his own small business - "Online teaching consultants" and the fours universities are his "clients".  So he only has 2 jobs but his income is the same. 

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#4 of 5 Old 09-23-2011, 02:25 PM
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You've got one tough situation to deal with. I hope someone here comes up with something that will really help. I like JustKate's advice; legal aid might be a great option to look into. 


I don't know much about it, but there is also WIC, a program specifically for women and children and nutrition. I know it sounds unrelated, but I think they do work for prenatal care. http://www.fns.usda.gov/wic/


Also, do Planned Parenthoods offer any type of prenatal care on a sliding scale?

Married to my favorite man in '07. Our firstborn came along in April 2012 (HBC), and our second is on the way, due sometime in May 2014 (planning an HBAC).
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#5 of 5 Old 09-24-2011, 06:08 AM
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that's so stupid, too many jobs. would they rather he just not try to support his family and go on full gov't assistance? Grr.  I'm sorry I don't have any valid help to offer. Justkate pretty well came up with all the good options (that I never would have thought of). I just wanted to say sorry and I hope and think the appeal should work. I am also in Florida on shared cost medicaid and waiting to see what the status of my mediacaid will be when they finish processing our new paperwork. They make it quite difficult.

Courtney and Cree, baby made 3, added one more then there were 4, sakes alive, then we had 5, another in the mix now we have 6!

A Momma in love with her Little Women-Jewel Face, Jo Jo Bean, June Bug, and Sweet Coraline.



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