What do you mean, I don't have insurance?! I just found out I'm pregnant! - Mothering Forums

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#1 of 22 Old 01-03-2003, 03:47 PM - Thread Starter
 
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Great. I just called Kaiser, because I haven't recieved my cards yet... I just assumed it was taking forever because Dh's boss didn't have my correct name for a few weeks, and had to ask Dh about it again.

My Dh's employeer just added me to the account in November, and said there would be "no problem" adding me at any time. Now I call Kaiser, and I can only be added during open enrollment, in August. Period. No ifs ands or buts.

Not only have we been paying $100 a paycheck x 4 checks now for my insurance, I just found out YESTERDAY that I'm pregnant! Re-tested today, the line is slightly darker, its pretty clear that yes indeedy I am pregnant.

We would have enrolled in August if we knew! If Dh's boss hadn't told us we could enroll ANYTIME, no problemo. I have NO idea what we're going to do now! Yes, I was hoping for a midwife, if we had the $, but having insurance to back up any problems is critically important to us!

Dh is contacting the person who does the medical stuff, so hopefully they can help in SOME way... its a small business, and they don't really have a handle on the whole insurance thing, gave us the wrong paperwork a couple of times, but this is a HUGE screw-up! For Pete's sake, I'll be due in September, I can't hold off on insurance til August! Arggggggg! Thanks for letting me vent.... Hope this situation gets better...

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#2 of 22 Old 01-03-2003, 03:56 PM
 
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Make sure the insurance / human resources person contacts the insurance company directly, and make sure dh has them explain that it was an error on thier part that this is soo late... Employees should not be penalized for employer brain farts...

Warm Squishy Feelings...

Dyan

It's lonely being the only XX in a house of XYs.
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#3 of 22 Old 01-03-2003, 04:00 PM
 
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How frustrating!
I hope everything works out for you.
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#4 of 22 Old 01-03-2003, 04:01 PM - Thread Starter
 
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I hope they will do that! I know they will try to fix it if they can... I just looked into the "personal advantage" plan you pay for yourself, and called about that... if I WASN'T pregnant, I would get approved for the plan (which costs LESS than what we're paying now.. just has a couple more co-pays) and then would be covered WHENEVER I got pregnant. But since I am pregnant now, nope, the plan would be denied. And I don't think I can play dumb, cuz they will find out I was pregnant before I enrolled...

Argggggggg!

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#5 of 22 Old 01-03-2003, 04:07 PM
 
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LIsa...

We actually had this problem when dh quit his job to start his own biz and work from home.. The HR dept at his old work didnt get the paper work right, and the insurance co was denying our COBRA benefits.. I had to call the insurance carrier to see what the prob was then call the HR lady, then have the HR lady call the insurance carrier.. IT was a pain in the @ss, but we did get our coverage continued until we had found insurance we were confortable with and discontinued it...

HTH...

Warm Squishy Feelings...

Dyan

It's lonely being the only XX in a house of XYs.
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#6 of 22 Old 01-03-2003, 04:13 PM
 
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I know this is a bit sneaky, but can you quickly enroll in your own personal plan, and then "find out" you're pregnant in a few weeks, once you're enrolled? If you haven't seen a doctor yet, they wouldn't know, right?

I had a similar scary insurance experience at the beginning of a pregnancy that ended in miscarriage a year ago. I enrolled in a plan the day I found out, and then we switched to DH's work plan a few months later when we were eligible. That way we had no lapse of coverage, and the pregnancy wasn't considered a "pre-existing condition". It made my dates a little off, but my midwife was willing to work with me on it.

Good luck...try and breathe easy!
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#7 of 22 Old 01-03-2003, 04:16 PM
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So sorry. This is stressful!

Went through something similar. I was on independant insurance through BCBS. No maternity coverage. Wasn't planning on having another! Well. stupid us....

On independant insurance there is NO WAY to add maternity coverage once you ARE pregnant. My DH's plan has maternity coverage no matter what, but we'd gotten me and DD off that to save $. (Hard to believe that individual would have been cheaper than group, but...) Any way, we missed open enrollment which was in Sept. Thought we were screwed. There are laws that prevent pregnancy from being a pre-exisitng condition. If you can get around open enrollment, they might not be able to shut you out unless they have a seedy loophole. When my DH talked to the benefits counselor, (and was totally honest as to our situation) at his employer, he was told that if we had a "qualifying event" we could enroll anytime outside of open enrollment, and that we'd be ok. What we did was 'close my business' which wasn't really a big deal, I was headed that way anyhow. The thing that I was skeptical about was that anyone could have gotten this insurance, it wasn't just because I had my own business. If you can fabricate some way to have a 'qualifying event,' whatever that means to your insurerer, maybe you'll be in luck too. Ironically, this group plan is with BCBS too!

By the way, the uncomplicated "normal" hospital birth would have cost us about $8500 out of pocket without insurance, yet the uncomplicated "normal" birth center/MW birth would have been about $4200 out of pocket without insurance. SO I KNOW WHAT YOU'RE FEELING! I hope so much that the benefits people can fix their hideous mistake!!!
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#8 of 22 Old 01-03-2003, 04:29 PM - Thread Starter
 
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Thanks so much for the support, stories that worked out, and ideas. MUCH appreciated!

Quote:
I know this is a bit sneaky, but can you quickly enroll in your own personal plan, and then "find out" you're pregnant in a few weeks, once you're enrolled?
Only problem would be I wouldn't have coverage til Feb 1st, by which time I'll be 5 and a half weeks pregnant, and I doubt I could get them to buy I didn't know that... My period was due oh, today (in fact, even with faint-but-still-there tests I'm still holding my breath over my period today!), so I doubt they are going to believe me that I simply didn't notice missing my period for a month, or I'm going to be able to play off over a month of pregnancy.... and when my last period was, since I have LONG periods, they'd think I was pregnant even earlier than I was (I checked due dates, and from ovulation its 11/17/02, but from fist day of my period its 11/6/02). So, ah, I'm not familar with the whole Dr experience while pregnant, so please tell me how can I make this work by fibbing?

But you know what? I know that somehow this all is going to work out. I'm nervous and churning the brain, but I have faith that this is all somehow going to get worked out. If I had checked into our insurance, we would have had to stop TTC, and I DID mean to check into it all last month. There was a *reason* I didn't find out... this little life growing in me is meant to be. Right now, not in August after I'm comfortable. We will somehow, someway, do this. Course, Dh is not going to be thinking this way... He's already freaking out at work... and I *am* still worried myself, so don't let this whole 'it'll be ok' speech make anyone think i'm not!

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#9 of 22 Old 01-03-2003, 05:23 PM
 
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I've heard of this very thing happening (open enrollment blunder) several times. Maybe half the time with wives and half the time with brand new babies. In every instance, it was resoved through phone calls and letters and HR and time. Step one would be getting it in writing that the boss said it was always open. Step two would be gettting very motivated...you can do it!
Respectfully,

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#10 of 22 Old 01-03-2003, 10:06 PM
 
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A little OT, but CONGRATS!!!!
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#11 of 22 Old 01-03-2003, 10:26 PM
 
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I just asked my husband about this--he used to be a benefits manager for a big company. He explained that if the plan is self-insured (which is less likely for a small business because it is essentially a bet on a large pool) there is generally no problem getting the insurer to take someone outside the normal process, since the employer is taking the risk in terms of claims. However, with a fully insured plan--where the insurer is taking the risk regarding employee claims--an insurer might refuse to bend the rules because of the self-selection problem; that people tend to sign up when they already need care or think they will soon.

He suggested the following, in addition to working through the company's HR folks:

1. Have you had a qualified family status change, which entitles you to enroll within 30 days regardless of when open enrollment is? These changes include loss of other coverage or a significant change in the cost of other coverage.

2. Use the formal appeal process provided by the employer. Make sure to document all misinformation, providing copies of any inaccurate documents and summarizing conversations in which bad information was provided.

Good luck!

Beth
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#12 of 22 Old 01-03-2003, 10:38 PM - Thread Starter
 
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Thanks Beth! I'm not sure what my husband's company is, but its a group coverage.... I just spoke to Kaiser, and they said the HR person could get an expemtion for me via their contact, its just a lot of paperwork. So I'm passing that news on to my hubby for the HR person. Thanks for the ideas, if this doesn't work, we will certainly start looking into other loopholes and ways to get in...

Unfourtuantaly we don't meet and of the requirements to get in with a status change...

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#13 of 22 Old 01-03-2003, 11:48 PM
 
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Congratulations!
I just wanted to add that in CA insurers cannot deny your pregnancy as a preexisting condition as long as it is through work (the personal advantage can, but not your hubby's plan). Worst case scenario, you will be covered in August for the Sept. birth. At least that's one thing you won't have to worry about.
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#14 of 22 Old 01-03-2003, 11:59 PM
 
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Quote:
Originally posted by Lisa_Lynn
Only problem would be I wouldn't have coverage til Feb 1st, by which time I'll be 5 and a half weeks pregnant, and I doubt I could get them to buy I didn't know that...

you never know. they wouldn't even THINK of seeing me in the dr's office until I was at least 6 weeks pg (with a clinical test) and 8 wks pg with a home test.

Kristin -- mom of Erin (11/5/02) and Leah (9/29/05)
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#15 of 22 Old 01-04-2003, 12:25 AM
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I second what kerc said... most ladies are at least 7-8 weeks, if not more, by the time they figure out they were pregnant. I was a solid 8 weeks with Xiola before I realized that I was late! It's ladies who are ttc who know at 5 weeks, because they are actually paying attention. So since you have only had HPT's and there is no actual official 'proof' that you are pregnant, I would feel no shame about just not mentioning it till after you are in. They could'nt prove that you knew, because your periods were'nt clockwork anyway. And not telling is a different thing then lying IMO, epsecially in a situation like this.

If all else fails, you should be able to get benefits through the state (in WA all pregnant women qualify for state medical) although I am not sure if DH's income would be enough to disqualify you... ?

You'll find a way. Ooooh, September baby!

XM
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#16 of 22 Old 01-04-2003, 01:01 AM
 
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They don't go by when you find out you are pregnant...they go by when you see a doctor. If you had been having asthma symptoms for two months, and waited until you got insurance to be seen, the insurance company isn't going to say, sorry, you were having these problems previously, no coverage. The same goes for insurance (at least in our area). We always have clients who present late in their pregnancy...when asked why, often the answer is "We didn't have insurance until now."

Unless you are having problems, there is no reason for you to be seen until February anyhow. Take a good prenatal, eat healthily, get enough rest, and enjoy the beginning of your pregnancy!
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#17 of 22 Old 01-04-2003, 01:18 AM
 
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If you cannot work out coverage through your dh's employer, try the AIM program. (Access for Infants and Mothers.) One of the stipulations of that is you cannot have insurance covered by an employer. It does require a certain income bracket, but is higher than the bracket for Medicaid. In our area they offer Kaiser or Health Net HMO, and what you pay is a small percentage of your annual income for coverage for you during your pregnancy and for your baby's first two years.
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#18 of 22 Old 01-04-2003, 02:50 AM
 
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I also work in a clinic setting and MOST people don't know they are pregnant until 6-8 weeks .... and may don't get in to see a dr until 10-12 weeks... The average is suppost to be 11 weeks for first prenatal.

I would encourage you to "not remember" when your last period was (especially with a history of irregular periods) and slide yourself in. You should not be punished for being on the ball and for company mistakes.....

good luck.
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#19 of 22 Old 01-09-2003, 09:53 PM - Thread Starter
 
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I just wanted to update all you wonderful women who helped with suggestions and gave me support. I got my insurance fixed! WOO HOO! Got to go down yesterday for the "offical" test and yes, the doctor confirms I am pregnant Duh, I took like 8 tests so I *knew* that but still I get my first prenatal on the 28th!

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#20 of 22 Old 01-10-2003, 06:56 AM
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Fantastic! What a load off, huh? What were the details of your particular fix? I know we breathed a trememdous sigh of relief when we found out we'd gotten maternity coverage.
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#21 of 22 Old 01-10-2003, 07:12 AM - Thread Starter
 
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I called kaiser (since Dh's work does NOT know what they are doing) and spoke to a sympathetic woman who told me to have whoever did the insurance call their Marketing Rep and get an exception to get me on the plan. So I told my Dh this, and he passed on the word. Tad-dah all better! Getting it started in Jan, so we get a month of no payments for our insurance! Woo hoo!

Lisa, mama to Orion (7) , Fiona Star (born sleeping @ 38wks 12/6/08) , our bitty (m/c 7/27/09) , and Charlotte Athena (11/5/10)
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#22 of 22 Old 01-11-2003, 10:39 AM
 
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I just wanted to add that leagally they cannot count pregnancy as a preexisting condition (they can raise your rates but they have to cover you. We got insurance on Nov. 1 and had Ava on Dec.4 and every day of my pregnancy was covered. Oh, but that is only on group coverage.

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