Advice about Medical Insurance for Pregnancy & Childbirth
Pregnant without Insurance
I just found out that I no longer have health insurance through my dad's policy. I'm 23 year olds, 4 months pregnant, and uninsured. I've had 2 healthy pregnancies before, and I'm open a home birth, but what if there is a complication that requires hospitalization? Plus, even the midwives that I've talked charge 5 or 6 thousand dollars, which is more than I can afford . What do people do in this situation? Where do uninsured moms deliver? What happens if I incur a hospital bill that I can't pay? pregnant and uninsured
Have you tried the Berkeley PRimary Access Clinic, off University Avenue (and 6th St.?)? I think you can go to them - they have midwives who will care for you before you deliver at Alta Bates. Maybe you can try Planned Parenthood too. As for midwives charging 5 or 6 thousand dollars - I've not heard of any midwives in the bay area charging that much (and I work with midwives) - the usual fee is from $3500 to $4000.00. Still steep but maybe more affordable. Homebirth is a great option and as safe as hospital birth but is ONLY an option if you are having a normal pregnancy (not high risk). Good luck! anon
I have the similiar situation when my husband was a student. With different parties referral, they recommended ''First Care'' Insurance. I was around 30 weeks when I submitted the application, it approved. It really released our worriness and financial burden. Good luck. ABC
If you're pregnant and unemployed I'm pretty sure you qualify for medi-cal. Apparently its very easy to qualify when you're pregnant. And 11 years ago when I had my son I was able to find a midwife who took medi-cal. shannon
Women without insurance deliver at Highland, which has improved some over the years. Lots of midwives there. You can look in to MediCal, but they will want to know who supports you, what your income is, what your expenses are, etc. You can also pay privately for insurance. . . or make a payment plan with your midwives and ask for the lowest slideing scale they can accept. hearing your concern
In SF there is a program that would cover you and kids but I don't know about the East Bay Call 415-777-9992 for info margi
check into medi-Cal - the benefits are good and immediate if you are pregnant and qualify. BTDT
Try AIM: Access for Infant and Mothers they cover all your pregancy medical expenses and then cover you post-pregnancy for 1-2 months and the baby for up to 2 years. http://www.aim.ca.gov/english/AIMHome.asp 1-800-433-2611 Good luck! EP
you may qualify for free or low cost health care: there are programs that can help. i was pregnant with my first w/o insurance too. have you looked into medical? if you qualify, it's free. if you work, you may still qualify for AIM which you would have to pay 2% of your yearly salary. (that's what i had to do. both my husband and i work...ended up being about $60 a month for 1 year and i had absolutely wonderful care). We also qualified for WIC. It helps with basic food every month (milk, cheese, eggs, cereal, juice, peanut butter). Look into these ASAP.
Good luck and don't depair with a little effort you will be able to take excellent care of yourself and your little ones! anon
Being pregnant without health insurance is a very stressful thing. We went through this a few years ago (unplanned pregancy while travelling) and didn't realize we couldn't get insurance when we came back due to pregnancy being a pre- existing condition. We did consider having the baby in Thailand (excellent medical care and very reasonably priced). But unless you are really adventurous, this probably isn't an option for you.
So hopefully what we ended up doing will work for you. Please check out a CA program called AIM (Access for Infants and Mothers). You can read all about it on the Blue Cross website http://www.bluecrossca.com/bcc_state/user_groups/visitors/aim/aim.htm and Google will give you a lot of hits too.
We were able to qualify for this program using my income only (as reported separately to the IRS). Since I only worked a few months that year, I had the 'right' amount of income to qualify. You pay a small percentage of your income to enroll and then everything is taken care of for you and your baby during pregnancy and delivery (and for your babies first year after delivery). This program was a lifesaver for us! If you have any questions, I'd be happy to try and help. sfdeva
People who cannot afford private insurance always have insurance through the Medicaid program. In California it is called Medi-Cal. I am assuming that you cannot afford insurance and not that you have simply chosen not to get it. The vast majority of people who are uninsured are in fact eligible for MediCal or have made a choice to spend there dollars on investments or other consumer items. If you are in category 1 then you need to contact the local county hospital or public health service to find out how to apply for the MediCal benefits. dave
Hi, I had no insuranace when I got pregnant 14 years ago. At the time I was making very little money and was eligible for Medi-Cal. I think the system has changed since, where you can be eligible for coverage depending on how much income you have. It's called something like Share-of-cost and/or Healthy Families. I would call the nearest Medi-Cal office and ask them if you are eligible and how to apply. There might even be a website. Google Medi-Cal. I found a midwife who accepted Medi- Cal and gave birth at Alta Bates. Everything was covered. The pedicatrician was covered, as well as the follow-up with the midwife. It was a real lifesaver. You might go to Bananas on Claremont Ave. (just up from Telegraph) in Oakland and ask them if they have any info about Medi-Cal, and also midwives and OBs who accept it, they are a great resource. Good luck and happy birthing! anon
If you are in ''middle class income'', you can apply to AIM program. It is called Access for Infant and Mother and provides covers everything. It covers all the prenatal care, delivery (no co-pay), and also covers baby up til he/she is two years old. Your income has to be more than Medi-cal criteria and less than certain amount. If your income is lower than AIM's program requires you to be, you can apply to Medi-cal. Good luck sachiko
If you are unmarried to the father and aren't making enough money on your own, you can apply for Medi-cal. They cover everything. Even food stamps. They also offer WIC. I used Medi-cal because we weren't married and I only worked 3 days a week. We delivered at SF General-- a fine delivery area, i might add, and they have nurse mid-wives or doctors. We delivered in the bathtub in water (first time in history at SFG that anyone has done that!!), and you can write a disclaimer requesting specific do's and don't practices (i.e. no meds, all natural, freedom of movement, no male doctors, no guests, special food, etc..). If you want more info, email me and i can tell you how to apply and some loops that help you get as much as you need. tinygirl_oak
There is a program in Oakland called IPOP (Improving Pregnancy Outcomes Program). They should be able to give advice and know who to contact.
Contact info: Alameda County Healthy Start Improving Pregnancy Outcomes Program (IPOP) Applicant Agency: Alameda County Health Care Services Agency Address: Alameda County Public Health Department 1000 Broadway, Suite 500 Oakland, CA 94619 Phone Number: (510) 208-5980 Fax Number: (510) 267-3270
Have you applied for Medi-Cal? It sounds like you would qualify, and they cover all the expenses including prenatal care, delivery, and c-section if necessary. I don't know where you live, but there is a really helpful woman at San Antonio Clinic (on International Blvd in Oakland) that will fill out the paperwork for you. wishing you good luck
A couple years ago, I had a friend who had no health insurance but found herself pregnant (she was working part-time and was a student). She went to Planned Parenthood and got her medical care through them. She was happy with her care. The only downside I recall is that she only got one ultrasound done (but then I only had two prior to giving birth in December, and I have health insurance). I would call them up or go to PlannedParenthood.org for more information. Lori
There's a state program called AIM (Aid for Infants and Mothers) that may work for you. There are inclome restrictions in order to qualify. 800-433-2611. Call them for specifics. Good luck
I am sure you will get many responses, but in any case.. All pregnant women in California are eligible for Medi-Cal. The website is http://www.medi-cal.ca.gov/ or you can look for your local office in the phone book under the dept. of human services. It can be demeaning to go through the process of applying, but the coverage is good, and free! Medi-Cal will cover your pre natal care in a hospital or birth center. I had my son in a birth center in San Francisco called Sage Femme. naturally! And if you need insurance for your children, your whole family may qualify. Feel free to email me with more questions. Good luck! k-west
Don't worry! One thing that our lovely country/state does provide is medical coverage for pregnancy/childbirth. I was in your same situation not so long ago. Medi-Cal is the way to go. Although it does take time and patience, I have discovered that they will not reject you if you are pregnant. After all the paperwork was done, I was able to have a midwife and deliver at Summit all for free!!! Many local midwives accept Medi-Cal, I chose Debra Coleman (she was great). It seems weird, but I was told that many women who have health insurance (maybe with high deductibles), also apply and receive Medical for pregnancy. All I know is that I had a wonderful experience with it, you just have to do the leg work. Good luck and congratulations. Oh and by the way, your baby will also be on Medi-Cal for the first year, this has been a wonderful help to me. I Healthy mom, healthy baby
I'm currently 23 weeks pregnant and a stay at home mom. I had COBRA coverage with Kaiser from my former employer that ended on January 31st, 2004. My family and I applied for a Personal Advantage Plan with Kaiser at the end of December and got accepted before the end of the year for coverage effective Feb. 1st. At the time of the application and acceptance by Kaiser, we didn't know I was expecting. I found out about my pregnancy in the middle of January. Since I had Kaiser for about 10 years, it never crossed my mind that I would have a problem with coverage.
Well, after paying Kaiser insurance premiums for the past 4 months and receiving regular healthcare, we got a letter in the mail informing me that my health insurance had been revoked as of February 1st, because I misrepresented myself as I failed to inform Kaiser about my pregnancy before the coverage for Personal Advantage took effect. I never lied, I wasn't aware of my pregnacy at the time I applied and at the time I was accepted by Kaiser.
I'm now in the process of appealing to get reinstated, however, it takes about a month for them to let me know. I can't understand how they can just dump me if I was a member under a different plan when I got pregnant.
I'm desperate, I don't know what to do. I've been told about AIM (health coverage for pregnant women & newborns), but we don't qualify, because our income is higher. Can anybody give me any ideas? I do need to get some sort of coverage, if I have complications or something goes wrong during the birth, we couldn't afford to pay all the medical expenses on our own! PLEASE HELP!!!! Martha
AIM is the only option I can recommend for a pregnent woman. My first course of action would be to push back on Kaiser. DL
I applied for Kaiser in August after moving here. At first we were rejected because my children had a mild history of RAD (reactive airway disease - childhood asthma) and it was going to take a month or more to appeal. I just kept calling customer service and, while most of the people were surprisingly knowledgeable and nice for a health insurance phone service, every few calls I'd get on with someone who really cared and would go the extra mile to help me. We ended up getting on Kaiser a month earlier than we would have. I was always very polite when I called and just tried to explain the situation over and over again. I imagine you could find people sympathetic to your situation as well. Email me if I can answer more questions.
Hi Martha, Contact Integral Health Insurance Services in Walnut Creek I got my health insurance through them and they were very helpful in answering questions about my health insurance options. They are health insurance brokers so they work with all of the carriers. 925-935-9775 www.integralhealthis.com Cynthia
Questions about Childbirth Coverage
I need to purchase health insurance for me and my child. I am new to this country and don't know much about how to choose the right one. I am also planning to get pregnant soon, so I need one that covers maternity. Is it better to go with HMO or PPO? I know most HMO covers maternity, but I'll have to pay 30%-50% for PPO. I don't know how much it cost to have a baby here, so could some one tell me which is better? Amy
In my experience, an HMO is better than a PPO for pre- and post- natal care - for example, my Blue Shield HMO didn't charge a co- pay for prenatal and well-baby visits, and covered almost all of our hospital expenses for the actual birth. Of course, there's a higher monthly fee for this insurance, but my feeling was that we still came out ahead. Whatever you choose, make darn sure you get the insurance nailed down BEFORE you get pregnant - I tried to switch carriers while pregnant, and I don't think there is a single insurance company that will take you on after you become pregnant. JP
We are currently planning on getting pregnant before the end of this year. I have Blue Cross PPO with a high deductible and it does cover maternity although we would need to find 30% of the fee - which will probably be about $10k with the deductible and the high probability I will need to schedule a C- section.
My question is this? Should I shop around now for another health insurance policy and hope they cover more? I have heard sometimes they make you wait a year until you will be covered. Or should I just bite the bullet and use my current plan. Any advice is welcome. Anon
I am a health insurance broker who helps individuals, families and small businesses find health plans tailored to meet their needs. I work like a real estate agent who helps families find homes. You need to shop for a plan before you get pregnant. No one will cover you if you are pregnant. I think an HMO is a good option for someone planning to have a baby. Most HMOs have no deductibles and very small co-pays. You did not say what coverage you have currently, but it's likely that that your current doctor is also in the HMO network. Denise
If you can do it, I would recommend changing coverage. You just never know what can happen and while 30% of 10,000 doesn't seem like a tremendously huge expense, just keep in mind that 10K represents your best case scenario. After a relatively normal delivery with my first, I ended up with pre-eclampsia with my second - a 3 week stay in the hospital for me and a 6 week stay for my baby and a hospital bill in excess of $500,000. Fortunately for me, my hmo covered all but my $250 co-pay and more importantly we are healthy and happy now thanks to the great care we recieved at Alta Bates. Happy HMO Momma
hi, i don't know what the original question was but if you find yourself pregnant without insurance or with a high deductible an option is AIM (Access for Infant and Mothers). It's a state sponsored program that provides insurance for pregnant women who make too much to qualify for free insurance but don't make enough to buy there own or if you have insurance and your deductible is higher than $500. It has been a godsend. We were approved in 2 weeks and the coverage includes all prenatal visits, the delivery, 6wks postpartum for me and 1yr of pediatric care for the babe all for 2% of our yearly income. Then for an additional $100 I can get another year of pediatric care. I live in Alameda county and was able to get bluecross. I've received excellent care from my nursemid! wife (deborah coleman) and will be delivering in Alta Bates sometime in September 2004. It's worth investigating. http://www.mrmib.ca.gov/ libby
A question about insurance. Hypothetically, if a woman were pregnant & left a job in the middle of a pregnancy & then got on husband's insurance through a new job he is starting (after pregnancy started) would the woman be covered? Do the rules about ''preexisting conditions'' apply when the insurance is through employment?? Am contemplating pregnancy but concerned as I may leave my job (which presently supplies our health insurance) and my husband starts a new job in a few months and is not clear when his insurance will start & when I may leave my job. Thank You for any information, Tangled Up in Blue (Blue Cross That Is)
Regardless of any advice you get, you can only know for sure what benefits you are entitled to under your husband's new insurance by calling his new insurance company, or have someone in HR at your husband's new company verify the benefits for you. That said, I can tell you that my husband's insurance (which covers me) was scheduled to change to a new carrier within days of my due date; with our obvious concern, his employer verified for us that I would be covered by the new carrier--it didn't matter that I was pregnant prior to obtaining the new coverage. Don't forget that when you leave your job, you will be entitled to continue your existing coverage under your employer's group plan (at your cost, but at the same price your employer pays) under COBRA laws. You can con! tinue your coverage in your employer's group plan for 18 mos. following your termination. So this would be a good way to bridge the gap, should you leave your job before your husband's new insurance kicks in, as you only need pay on a monthly basis and can terminate the COBRA coverage when you don't need it anymore. Tracy
Be careful. You may not be covered if you switch insurance companies half-way through pregnancy. I can't speak for your specific situation because I'm sure it depends on the new insurance provider, but we had insurance at one point (I think it was Blue Cross) which would not cover a birth that occurred within 10 months of coverage beginning. Meaning that one had to become pregnant AFTER coverage began for prenatal care and the birth to be covered. Liz O.
We had been getting along fine with my wife's OBGYN when we received a letter from his office asking for the delivery fee (or installments) halfway through her pregnancy. The letter had an estimate of what we ought to owe after our insurance coverage and promised to repay us any overpayment. I called our insurance and was told that this is strictly not allowed for networked doctors. I would hate to see an antagonistic evolution in the relationship between ourselves and the man who is supposed to deliver our child. Has anyone had any experience with such an arrangement? Does anyone have any advice for communicating with the doctor's office? Sean
I had the exact same experience with my OB, but I didn't even think about it and I paid it. Especially since they estimated that without insurance my cost would have been around $2000 and they only wanted $200 from me. Jill
It is not only legal but the standard of billing, because doctors' ''allowable'' reimbursements have been diminished so exceedingly while overhead and malpractice has increased, that the patient pay, up-front, the discounted projected balance after the calculated insurance payment, after the insurance company has discounted the doctor's fee(s). An ob/gyn couldn't possibly afford to open his/her doors without being paid part of his/her fee before delivery. (malpractice, alone, in this area averages between $600 and $1000 DAILY!) In fact, at Cedar-Sinai, in L.A., the prospective parents pay the entire fee up-front, and most OBs there do not accept insurance, anymore, for deliveries; payment is never delayed until half-way through the pregnancy. You might want to speak to someone else, a supervisor, maybe, at your insurance company. F Been on both sides
This sounds really strange. How can they possibly ask for a delivery fee when they have no idea what will happen during delivery. Will mom end up having an epideral or natural childbrith? What about the possibility of a c-section or, though unlikely, not even making it to the hospital. Then there are all the other costs to consider. Will mom need some stitches? Will baby need to be suctioned? What about other medications that may be involved. Labor is unpredictable so I can't imagine they can predict the cost. Maybe, you can try to discuss this with someone other than the doctor. Perhaps a secretary or billing person. Otherwise, maybe you can just politely ask how they deal with the payment and unforseen circumstances. Good Luck LIZA
I recently gave birth (a beautiful, healthy son), and I pre-paid the delivery fee in installments to my doctor under his office's mandatory payment plan. There were no problems with my insurance company (Blue Cross Individual PPO), although the company didn't count the payments toward my deductible until the doctor submitted an insurance claim after the delivery. Since my pregnancy deductible was so high ($3500), paying the installments during the pregnancy spread out the ultimate cost and reduced the amount that was due at one time after the birth. My doctor was fabulous, and so was his staff. We didn't attempt to negotiate the timing of the delivery payments, but I'm sure his bookkeeper would have been willing to work with us if we couldn't meet the standard payment plan. (We received the paperwork for the payment plan after our initial visit with the doctor; it seems strange that you weren't informed of your doctor's prepayment requirement until midway through your pregnancy.) Like your situation, the delivery fee that we paid was one that was ''estimated'' by the doctor, based upon his contracted rate with my insurance company and factoring in any payments that I had already made toward my deductible. The actual delivery fee ended up being $400 more than the estimated amount due to additional insurance allowances. I was meticulous with my records during my pregnancy, and kept track of the many medical payments and insurance allowances through an Excel spreadsheet and paper documentation. Everything worked out perfectly in the end, and I didn't pay a penny more than I was obligated to pay under my insurance contract. Kathy