Interview with an Insurance Company

Insurance is something my husband and I were anxious about when we first learned about my pregnancy. What will they cover? What won’t they cover? Will we be left with enormous debt if something unforeseen happens?

We were very nervous, but everything worked out. We had a few things come up, but with good communication with our insurance company we were able to survive financially the childbirth.

With that in mind, we went out and contacted an insurance company to answer some common questions woman have related to insurance while pregnant.

In today’s post, we took the time to interview Nisha Rk of

1. Are Midwife and/or Dula covered by insurance?

It depends. Midwives that practice in hospitals, if they are legally licensed to practice in your area, are probably covered by insurance. It is much more difficult to find an insurance company that will cover home birth midwives, and if you can, it’s very likely that the midwife will be “out of network,” which usually means that your deductible and out of pocket expenses will be higher. However, since many home birth midwives have been practicing in this environment for many years, many of them have very reasonable cash prices they can quote you, which may be less than the out of pocket expenses for a hospital birth. To find out what would be covered under your plan, call your insurance company, but also read your plan documents. When I wanted to get a home birth covered, my plan documents said it could be, but the insurance company initially stated that it would not be. I had to speak to several people to get the misunderstanding clarified, and I did eventually get about half of the costs covered by my insurance company.

Doulas are much less likely to be covered by your insurance, but again, it’s worth asking your insurance company.

2. Are birthing centers covered?

Very possibly. Many people view birthing centers as the middle ground between home birth and hospital birth, and many insurance companies do cover the cost of delivering at one of the centers. Start by asking your insurance company if they will cover the cost, and then ask which centers are in-network for your plan.

3. I am Trying To Conceive, how do I know if I’m covered for maternity with my current policy?  If not, what do I have to do?

If you have an insurance policy through a group (like your employer) or through one of the new ACA Marketplaces, your policy almost certainly includes maternity benefits. To be sure, review your plan documents, or call your insurance company to ask.

If your plan does not cover maternity care, you still have options. Many states offer expanded Medicaid income limits to pregnant women, so contact your state’s health insurance line to find out if you might qualify. If you are over income for the program, talk to your provider to see if you can arrange a cash price up front, which you can budget for over your pregnancy, so that you’re not trying to pay for it all at once. Also, consider looking for care through a birthing center or a midwife; since these providers often work with patients who do not have insurance coverage for their services, they often have a lower cash price than an OB in a hospital.

4. If I get insurance after conception is my pregnancy considered a pre-existing condition?  What does that mean?

As of January 1st, 2014, the answer is no. Before the Affordable Care Act, this was a possibility; pre-existing conditions meant that a person could be denied coverage for any illness or condition that they knew of before they applied for health insurance. After the ACA was passed, insurance companies were no longer allowed to deny children benefits due to pre-existing conditions; in 2014, this will be true for all plans, other than certain individual plans that you purchase on your own. If you are going through a Marketplace or insurance through an employer, pregnancy will not be considered a pre-existing condition.

5. Am I allowed a limited number of ultrasounds & blood tests?

It depends. In general, maternity care is considered an Essential Health Benefit under the ACA, so if your plan is not grandfathered, all medically necessary care during pregnancy should be covered under your plan. Where this can get sticky is the definition of medically necessary. During my first pregnancy, for example, my OB preferred to check the baby’s heartbeat with an ultrasound instead of a doppler. All of the visits were covered, but my copays were higher when the ultrasound was used.

6. Is Anesthesia and/or epidurals included?

Almost certainly, but call your plan to be sure. That said, so many women request epidurals that they are almost always covered, though they will increase the cost of your bill for the birth (more providers = more fees = more coinsurance to pay).

7. What is a deductible?

A deductible is an amount of money that you have to pay out of pocket before your insurance pays anything. You might have a $500 deductible for maternity care, for example; the first $500 your OB bills would still be sent to the insurance company, so they can keep track of it, but you’ll be expected to pay for it out of pocket.

8. If I give birth in a new year do I have to start paying the deductible all over again?

Probably, but call your plan to see if they make an exception for situations like this.

9. How long a hospital stay will be covered for vaginal vs. cesarean birth and how is the time determined?  Hours or days?

It depends on your plan, but most will cover two days after a vaginal birth, and four after a c-section. Depending on how you recover, and how you feel, you may be able to leave earlier, though hospitals usually want you to say at least over night, to make sure that no sudden complications (like a postpartum hemorrhage or pre-eclampsia) arise.

10. If I have to have a cesarean birth, what is and is not covered?

I know it’s frustrating to hear over and over again, but it depends on your insurance. What shocked me when I had my c-section was how very many bills I got; each department of the hospital (the general hospital care, the anesthesiologists, the NICU team that evaluated my daughter immediately after her birth) all billed separately, and then I also got separate bills from my OB’s office for her fees as the surgeon, as well as the remaining balance from my prenatal care. Some of those things applied to different deductibles as well, which shocked me, and we ended up owning more than we budgeted for. More insurance companies now have cost estimators on their websites; use them. I cannot recommend it enough.

11. How long after giving birth do I have to add the baby to my insurance?

Having a baby (adding a dependent to your household, so adoption counts too) is a qualifying life event, and you have 30 days from the date of the event (your child’s birth) to make changes. It sounds like this will be plenty of time, but remember that you’ll be trying to do paperwork with a newborn in the house. Get the paperwork from your employer before your baby is born, and do it as soon as possible, to make sure it won’t get forgotten. Most insurance plans cover babies for their first 30 days of life, as long as Mom was insured when the baby was born, but if you miss that QLE period, you’ll be waiting for open enrollment to get the baby covered, and that’s a real problem with a newborn.

12. Do all your plans cover well-child care visits?

Well-child visits are Essential Health Benefits, so all non-grandfathered health care plans must cover them, usually at no cost (since they’re preventative medicine).

13. I like my current OB/GYN, can I keep him/her?

It’s definitely possible. Call your OB/GYN and see if they’ll accept your current insurance plan.

14. Will I need a referral to an OB from my primary care physician?

Some plans are called HMOs, and require referrals; some plans are PPOs, and do not. To find out which you have, contact your plan.

Final Words

I can not thank  Nisha Rk enough for all the great information. I hope you found it as useful as I did.

Remember that it is important to read over your insurance paper work and to take the time to call your insurance provider to make sure they are up-to-date, and you have all your questions answered.

Annoying Pregnant Women

Annoying Pregnant Women CartoonI attempt very hard not to let my pregnancy, and all its symptoms put other people out.  I have often heard myself using the phrase “I’m pregnant, not feeble” and have only ever once asked for somebody’s seat, and that was because sometimes I have a bit of trouble breathing comfortably while standing.

But I happen to believe that pregnancy does not entitle a woman to any special treatment.  Here are a few stories of women who apparently don’t subscribe to my line.

The Entitled Pregnant

This is the woman you’ve probably met and definitely resented.  The woman who automatically cuts to the front of the line, even though you and your fellow liners have been waiting patiently for your turns,  without casting one apologetic ‘may I please?’ look over her shoulder to the rest of us.

And why should she ask for permission?  Isn’t the fact that she has a belly an all access pass?  Isn’t the word ‘pregnant’ synonymous with the word ‘entitled?’

The Sickening Sap Pregnant

The pregnant woman who gets teary-eyed whenever she thinks about or mentions her ‘pwecious widdwle baby bean.’  Nothing in the world has ever been this important, this momentous before and nothing (nothing) ever will be this important again.

She speaks only in baby talk even when out with the girls so her baby won’t feel left out.

Later she will send out mass mailings of the DVD with her birth on it, and calls you later to compare notes.

The Over Protective Pregnant

I was listening to a radio story a long time ago, so long that I cannot give proper credit to whom it belongs, where a pregnant woman (she described herself as just beginning to show) was shopping, pushing a grocery cart.  When she chanced to come around a corner at the same somebody else and their cart was coming around that corner.

This woman flings her cart away ahead of her, huddles on her ankles with her arms over her belly and screams.  One presumes she couldn’t think of a better way to handle the situation?  Like, remembering that you’re a pregnant woman, not an active bomb.

The Annoying Pregnant

The woman who gets pregnant and then willfully refuses to talk about anything else.  She has even been known to break into your conversations (say, on the virtues of Lynyrd Skynyrd.) and switch the tracks with something like ‘my baby’s almost a free bird!’

This behavior elicits nothing but a collective eye roll, with some heavy sighing.  But do you think she’ll take the hint?


That will just remind her that she hasn’t told you that her mother-in-law is hardcore hinting middle names and isn’t that horrendous behavior?

The Pageant Production Pregnant

This woman likes to stage things.  She hires a professional photographer to take her pregnancy photos complete with the one where she and her husband’s hands make an oh-so-adorable heart shape over her stomach.

She hires a baker to insert gender-specific buttercream filling into oversized (overpriced) cupcakes and invites everyone over to watch her eat them.  Oh!  It’s a boy!  I could’ve just called you, but I wanted everyone to take a couple hours out of their day to drive over here and consume empty calories before driving back from whence you came until I beckon again.

Then she’ll have a belly bust done, casting her stomach in paper mache and painting/beading/bronzing it so you can then eat gender-specific nachos out of it at the baby shower, which, by the way, she has not allowed her ‘host’ to plan for her.  Why?  When she could just do it herself and get it right.  Right?

The Critical Pregnant

This is the mother to be whom, upon seeing you enjoying chocolate-covered peanuts at the movies, rolls her eyes and scoffs loud enough for you to notice her disdain.  “I would never eat that, my baby deserves to have proper nutrition.  Doesn’t your baby deserve better?”

Wherein, if I had the nerve to think of something like this off the cuff, I’d say, ‘You deserve to know the truth, nobody cares what you have to say, #@tch.’

Here is a song by Garfunkel & Oates called “Pregnant Women are Smug”  If you’re offended and can’t laugh at yourself a little… then it probably hits too close to home.  Hmmm?