health insurance? help! - Mothering Forums
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#1 of 8 Old 06-25-2012, 10:26 AM - Thread Starter
 
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I just quit my job to start my own business and then found out I was pregnant. As I've been applying for private health insurance, I found out that maternity is not covered, or that we'll be denied access to the affordable plans because of my "condition". Should I lie about this? I haven't been to the doctor yet, but have an appointment in July. I'm about 9 weeks right now.  I have no idea how our income is going to shake out over the next couple of months...my husband has been running his own business since March and doing well enough that I don't think we qualify for medicaid.

 

I would just save up money, but I had a c-section with my last baby, so when I called the local birthing center, they said they would take me as a client, but I would have to birth at the local hospital, which is the expensive part. And what if I need another c-section? I honestly have no idea what it cost last time.

 

I'm really freaking out about this. This was supposed to be a step in the right direction for our whole family...get DD1 out of daycare and reduce stress for all of us. But now I'm feeling like I made a stupid decision, and it would have been better to work through this pregnancy.

 

Anyone btdt with getting private health insurance? Any tips?

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#2 of 8 Old 06-25-2012, 11:38 AM
 
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I can't offer much help, but you should check out supplemental Medicaid, which covers prenatal care and delivery.  The income qualifications might be lower, depending on your state.  I would start with the Medicaid office before you start worrying about what private options are or are not available.

 

Either way, I would not lie.  First, they'll figure it out anyway most likely, and you would be putting yourself in a serious legal position.  I'm not sure how it would work since the pregnancy has not been validated by a doctor, so it wouldn't be in your chart, but it still seems like a very risky move. 


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#3 of 8 Old 06-25-2012, 12:06 PM
 
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I agree you should not dismiss the state plans. The requirements for maternity care are often different than for regluar care regarding income and family size. You will likely still need private insurance for your regular care but your maternity will be covered. I am in this exact situation right now. The insurance through DH's work does not include maternity coverage so I have the private insuance for regular care and state insurance for maternity. My options are limited and the paperwork can be a PITA but I am paying nothing for all prenatal care and hospital costs. Also. your unborn babe should be considered when claculating your family size. I would start sooner than later, it can take a while to get everything in and your application processed.

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#4 of 8 Old 06-25-2012, 12:09 PM
 
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I agree you should not dismiss the state plans. The requirements for maternity care are often different than for regluar care regarding income and family size. You will likely still need private insurance for your regular care but your maternity will be covered. I am in this exact situation right now. The insurance through DH's work does not include maternity coverage so I have the private insuance for regular care and state insurance for maternity. My options are limited and the paperwork can be a PITA but I am paying nothing for all prenatal care and hospital costs. Also. your unborn babe should be considered when claculating your family size. I would start sooner than later, it can take a while to get everything in and your application processed.

It likely won't do you any good to omit the pregnancy from your private insurance applications. When they find out the will call it a pre-existing conditions and refuse coverage anyway.

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#5 of 8 Old 06-25-2012, 12:10 PM
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I just wanted to add that even if you lied (or even if you genuinely didn't know about the pregnancy), there is a waiting period for pre-existing conditions of which maternity is one. Typically it is a 9 month waiting period (gee - any guesses as to why it's specifically 9 months?). 

 

So even if you lied, and were accepted onto an affordable private plan, they would not cover anything maternity related. So don't lie. 

 

Sorry about the situation you're in, hope you find a good solution. 


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#6 of 8 Old 06-25-2012, 12:48 PM
 
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Private insurance policies generally do not cover maternity unless you add in a maternity rider that will have a waiting period, often a year even before the coverage starts.Once a woman is pg then often she can qualify for state insurance even though she would never qualify otherwise. If everything fails, and I've had to do this myself previously, you can work out a self pay option with the hospitals and providers. 


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#7 of 8 Old 06-25-2012, 01:00 PM
 
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Can you get cobra coverage from your last job?  It can be expensive, but it might cost less than a delivery at the local hospital.  Of course, not all employers are required to offer it.  


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#8 of 8 Old 06-26-2012, 07:10 AM - Thread Starter
 
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Thanks so much for all the responses! I looked up the supplemental medicaid for my state, and I think I would qualify for it. I can apply for private insurance for all our other medical needs, and then get the supplemental on top of that. Also, I found the sliding scale clinics in my area, and my family practice happens to be one...I just never knew about it because I had insurance. 

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