Pregnancy health insurance question

Surferdude949

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Hi,
my wife tested positive for pregnancy (home test). I checked with the insurance company and they said pre-natal services are covered 100% within network.
Since this is our first baby and we are not familiar with the whole insurance coverage process, I have several questions, thanks.

- How many visits to the OB/GYN should we expect until delivery
- I’m looking for a new health plan that will maximize the delivery coverage any suggestions or recommendations?
- My wife has her own business, are there any insurance plans for self-employed?

We have private insurance not provided by a employer.
 
First, congratulations!

I have Kaiser, so I can only speak to my experience within their system, but I'll try to help.

I had my first visit at 6 weeks, and then about every 4 weeks after until 36 weeks, at which point I had one at 38 and then 40. All office visits were covered, but I had a copay for the urine tests done at each appointment ($7 or something). There are additional ultrasounds scheduled (12 weeks for NT scan and 20 weeks for anatomy scan) and those had higher copays (total $800). Our delivery coverage was pretty good, but we still had to pay about $1200 out-of-pocket. They put newborns under the mom's insurance for something like 2 weeks, and then he had his own account. All of his well-baby checks are covered.

We tried everything we could to get an estimate about how much L&D would cost, but they really couldn't give us a number beforehand. I was admitted on a Sunday morning and discharged on Tuesday morning. I had no drugs or assistance (vacuum, etc.), and my son was born healthy. So if you're looking into what coverage you can get, you might have some trouble. At least try to get numbers for cost per day, epidural, non-stress test, etc.

Something to be aware of is that pregnancy can be a pre-existing condition, so some insurance packages may not give you coverage if your wife is already pregnant. Those that adhere to the affordable care act can't have any pre-exisiting clauses, but not all have the same requirements. I only know this because we have additional "gap coverage" for hospital coverage that we just got, and we have the pre-existing clause. They won't cover any full-term labors within 9 months of the start date of coverage... my due date is the day before the 9 months are up... hopefully this baby comes at least a day late!

Insurance is so complicated and not meant to help the patient. It's quite disappointing.
 
Private insurance can be rough, I have heard horror stories that they didn't cover as planned, disputed costs, and made the whole thing a nightmare. And maternity coverage is really probably only for medically necessary things in your case.

My husband has a policy through his employer for 100% maternity coverage, I intend to call and ask what is covered. Their website is cryptic and says ultrasounds are 100% covered, but not which ones, etc...call and ask, take down their name so you can reference back to them later if you need to call again.
 

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