Insurance Question

[tracy1740]

I've recently discovered (happily) that my husband and I, who live in Indiana, are expecting our third and final baby. After suffering a miscarriage last Spring, we're delighted to have conceived again and are hoping for a healthy, successful pregnancy.

Unfortunately, though we've been trying for a full year, the timing stinks! My husband just switched jobs to move to a higher-paying position and we're currently in a 60-day uninsured window while we wait for coverage to kick in at his new job. This is pretty much the ONLY time in my adult life that I've NOT been covered. Now, I would have conceived while my last policy was in effect, if that has any bearing on the answer to my question.

I'll be about 13 weeks along when the new policy goes into effect, and will see my OB the day it kicks in, but I'm fairly certain that's too long for me to wait. You see, I'm 38, have high blood pressure, tend to get gestational diabetes, my last pregnancy ended in miscarriage and I have a history of cysts that caused me to have an ovary surgically removed after my last successful pregnancy. Clearly, I'm high-risk. I can't imagine there's a medical professional in the country who would say it's OK for me to wait till I'm 13 weeks to be seen. So, accepting my fate of at least one full-price, out-of pocket doctor visit, I called my OB. Well, full-price, out-of pocket is WAAAAYYY more than I expected. I was quoted $4000 to see a NURSE, have a blood draw and have a sonogram. Payable up front, in full, before they'd even make an appointment for me. Don't know about most of you, but $4K for a single doctor visit is a bit out of reach for me.

So, my question is this: If I were to make a single visit to one of those free clinics, just to make sure every thing's OK, would my new insurance company consider my pregnancy a preexisting condition? I really hate the thought of waiting till my second trimester to be seen, considering my health concerns, but I simply cannot risk my new insurance company not paying for any of it and making that $4K doctor visit seem like chump change.

Any thoughts?

 

[bananaboat]

Group health insurance in the US cannot legally consider pregnancy a pre-existing condition so you should be fine. I believe there are some loop-holes and exclusions in private insurance, but it sounds like yours is through an employer.

Another option would be COBRA coverage through your husband's previous employer. Very expensive though so you're probably better off going through a clinic until your insurance kicks in.

 

[belle2be03]

That's a tough position to be in. I thought with the new health care laws in the US that insurance companies cannot deny coverage for any pre-existing conditions anymore. I could be completely wrong though. I hope it works out for you!!

 

[amjon]

It doesn't matter if you begin care or don't if they consider it per-exsisting, then they consider it pre-exsisting. I would go and get checked out and worry about it later. Did you tell the doctor you will have insurance soon? It sounds like they are billing for the whole pregnancy up front and not just partial.

 

[Bmama]

I had to find out the hard way that private insurance does in fact consider pregnancy a pre-existing condition, even my OH can't get coverage until our LO is born. Obamacare isn't fully in effect yet which is why they can still deny you coverage if you go the private insurance route. Since we own our own business I'm not sure if it would be different if the insurance came through your husband's employer, but I think you should be covered. In the meantime, you can always get temporary coverage through Medicaid as they cover all pregnant woman that need immediate insurance for prenatal care. If you are seen at a local hospital they should have a case management person who can help talk to you about your temporary options and walk you through the application process. You would be eligible for care the day you apply, and since you have some medical history this might be a good option while you wait for your hubby's insurance to kick in. I would also tell the hospital that you are just waiting for your insurance to kick in and hopefully they will be willing to help you out!

 

[nevernormal]

It sounds like the nurse didn't understand what you were asking, and quoted you the price for self-paying for your care through the whole pregnancy. I self-payed all my OB/GYN visits while TTC (I was on clomid), so not for pregnancy, but the first was I think around $250 and then $75 or so per visit after that. An ultrasound would probably be a couple of hundred more, but there is no way it should be 4K for one visit!

 

[Bethi22]

You definately got misquoted! $4000 would usually cover an entire low risk pregnancy. I would call back...

 

[fionar]

HIPAA says that they can't deny you for a preexisting condition if you had no gap in coverage longer than 63 days. So if you were covered, then you were NOT covered for 60 days, and then you're covered again, pre-x can't be taken in to account. A gap longer than 63 days and the rules change, but sounds like that shouldn't apply to you.