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Forum: May 2013 Playroom

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  • 1 Post By MrsLisaT
  • 1 Post By Shufu_in_Shunan
  • 1 Post By Memi
  • 2 Post By LabLover13
  • 1 Post By EverydayJoy

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  #1  
January 24th, 2013, 09:59 AM
Mega Super Mommy
Join Date: Oct 2012
Location: TEXAS!
Posts: 1,764
Ok this is mainly for the Americans, because I don't want to hear about how easy it is for you all in Canada and the UK to not worry about spending $10k+ for this experience.. (But, actually, I'd be happy to hear it anyway)

Most of you are aware that I moved back to the States after living abroad for 2.5 years. I had insurance the entire time I was gone, but it doesn't count if it's not with an American company. So when I returned, I talked with an agent at Aetna who flat out said that no insurance company would cover a pregnant woman, not even non-prenatal coverage. She said many companies would go as far as not even covering an individual plan for my husband because of it. And even if you have insurance, it's apparently quite difficult to get maternity coverage; there seemed to be some implication that not all companies even offer it (for individuals... group plans are a big exception).

She was actually super helpful, as it was through her that we found out about the federally funded Pre-existing Condition Insurance Plan (PCIP) that was set up for the interim until all of the Affordable Healthcare Act goes into place in 2014 (like not being able to deny coverage to pregnant women). There's a good chance I wouldn't be able to qualify for Medicaid, and I don't want to use public assistance when I can afford to pay for insurance. To qualify for PCIP you have to (1) be a citizen or legal resident (duh) (2) have been denied coverage due to a pre-existing condition by a major insurance company (or been offered inadequate coverage) and (3) have not been insured for the previous 6 months, including Medicaid and Cobra, which I suspect disqualifies a lot of people from using it. I just got the approval letter the other day in the mail and my coverage starts in the beginning of February. The provider list is quite extensive, so I'm able to go to the hospital I was hoping to to give birth and there are a lot of doctors on the list to choose from.

This whole experience made me really curious as to how all of you are being covered (or not?!), so I'd be really grateful if you'd share your situation
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  #2  
January 24th, 2013, 10:20 AM
MrsLisaT's Avatar Mega Super Mommy
Join Date: Jun 2012
Posts: 1,014
I'm sorry to hear that happened to you. It's one of the few things that I like about ObamaCare, taking away all the pre-existing condition nonsense.

I am lucky and have great insurance through my job. I don't have to pay much of my own money for it and there are no deductables, which means that my maternity care will be 100% covered by my insurance besides a low co-pay here or there. I can't complain about that!
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  #3  
January 24th, 2013, 11:11 AM
Shufu_in_Shunan's Avatar Padawan Kim
Join Date: Nov 2012
Location: Yamaguchi, Japan
Posts: 537
I had an awful insurance-related experience at my last appointment yesterday. I'm just on my iPod on airport wifi right now, so I'll have to go into details later, but it involved my crying in front of people (something I HATE doing) and my dad yelling at one of the office employees...siiiigh.
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  #4  
January 24th, 2013, 11:26 AM
Purrrrrrr's Avatar Semi-crunchy Mommy
Join Date: Sep 2010
Location: Georgia
Posts: 1,715
I'm not covered, I don't qualify for assistance (although I'm trying to go through a spend-down due to being a high risk pregnancy, but I doubt that'll happen), and I don't qualify for PCIP because I was insured previously.

To me, paying for the PCIP premium, plus the deductible and copay, it's not worth it. I'm negotiating a rate for my doctor and my hospital. I'm really aggravated with the whole thing and if I end up with a premie or a NICU stay, I'm SOL.
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  #5  
January 24th, 2013, 11:54 AM
Memi's Avatar Mega Super Mommy
Join Date: Jan 2010
Posts: 4,966
In short she was severely mistaken. Most companies will cover a pregnant women but if it is individual coverage the prehnancy related charges will be excluded. That changes in 2014 but I know that doesnt help you now. If on a group plan it will be covered even if you were pregnant when you joined the policy. Nonetheless im glad you got coverage!

Im covered on my husband's company policy and have no issues with coverage pregnant or not. We thankfully have great coverage with a very low deductible so delivery and hospital stay will not cost much.
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  #6  
January 24th, 2013, 12:39 PM
Liztastic's Avatar Super Mommy
Join Date: Sep 2012
Posts: 776
I'm also covered under my fiances policy. I'm sorry it was such a pain for you to find coverage.
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  #7  
January 24th, 2013, 12:53 PM
Brock's minion
Join Date: Nov 2012
Location: Chicago, Il
Posts: 1,120
I sorry you have to go through this much crap for insurance. One of the greatest union benefits is our insurance, I am grateful.
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  #8  
January 24th, 2013, 01:08 PM
Mega Super Mommy
Join Date: Sep 2012
Posts: 2,259
Im covered under my DHs work insurance. Were in Mass and for the last few years insurance has been manditory here. We also have Mass Health to help cover any extra stuff.
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  #9  
January 24th, 2013, 01:42 PM
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Join Date: Oct 2012
Location: TEXAS!
Posts: 1,764
It actually hasn't been that bad I'm glad I got covered under the PCIP and, relatively speaking, it's happening pretty quick. The most I could pay with that plan is $6250 out of pocket (and that would be hospital bills around $16k; probably more than this thing will cost... i hope), and that's doable. Negotiating with a hospital/doctor's office was something we considered, but I would totally worry about any kind of unexpected complications. I don't want to get slapped with a $50k hospital bill EVER.

I only know that Aetna wasn't about to give me any kind of insurance and I suspect it would've been difficult with any company. I had the impression a lot of you were included on group plans via an employer, which is by far the best way to go. Before my dad retired he had awesome insurance with his job, and it was certainly no problem that my mom was pregnant when he started working there (although that was 27 years ago).
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  #10  
January 24th, 2013, 02:06 PM
LabLover13's Avatar Veteran
Join Date: Oct 2012
Location: Marysville, WA
Posts: 306
I have amazing, amazing coverage through my work. DH is covered under his own work's policy. I pay about $90/month in premiums, and I know my company pays over $1k/month for me (medical/dental/vision).

I have 100% coverage, excluding any co-pays. When I give birth, I'll end up paying $250 total (that's the hospital co-pay).

I realize how extremely lucky I am...I can't imagine having to go through this process without insurance!
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  #11  
January 24th, 2013, 03:38 PM
TeresaV's Avatar Mega Super Mommy
Join Date: May 2012
Location: NY State
Posts: 1,734
I am lucky that my boss pays 100% of my insurance premium for myself and DH. Unfortunately, it's a high deductible plan, so I've been paying through the nose for all of my doctor visits.
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  #12  
January 24th, 2013, 04:59 PM
EverydayJoy's Avatar Platinum Supermommy
Join Date: Dec 2011
Location: Pacific NW
Posts: 6,601
I am lucky right now that I qualify for state insurance, because hubby doesn't have any medical benefits through his job. He works for just an individual guy who is having DH drive the truck he owns, so all he does is just pay us a check and that's it, no benefits. So luckily I can get Medicaid because I would never be able to afford to see the doctor as much as I have needed to so far. I could maybe go once a month or something if it was out of my own pocket. Medicaid pays for everything 100% no copay, including prescriptions. I only qualify for it because I'm pregnant, and don't have any other insurance. After delivery I'll be back to no insurance again (I think they give you your 6 week post partum checkup as well, then you're cut loose).

I'm also lucky I had regular insurance through DH's company job when I had the miscarriage last year, plus secondary insurance through Medicaid, because with the complications from the miscarriage I would have had a $50,000 medical bill. Instead it was covered 100%. Whew!

My son is also covered under state insurance, which is good because he wouldn't be insured otherwise.
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  #13  
January 26th, 2013, 07:02 AM
markswife's Avatar Mega Super Mommy
Join Date: Mar 2010
Posts: 3,680
I'm also covered by insurance through work and love our union because it's great coverage. I think the total bill for DD and I was close to $18000 and we paid less than $700 out of our pocket. I also got my breast pump for free.
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  #14  
January 26th, 2013, 09:36 AM
MrsNHigh's Avatar Mega Super Mommy
Join Date: Sep 2012
Location: Texas
Posts: 1,414
My husband is an officer in the army, so I'm covered under tricare prime. We pay nothing. He's getting out soon, but we will then go to the reserve's insurance for 3 years.
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  #15  
January 26th, 2013, 09:41 AM
Elly M.'s Avatar Mega Super Mommy
Join Date: Jul 2012
Location: New Jersey
Posts: 1,306
I am covered under my DH's insurance. He is amazing insurance and this whole pregnancy will cost next to nothing. I could not be more grateful for that. I do not get insurance through my job, and I am so glad that I don't have to deal with trying to find insurance. I have many friends who struggle with insurance problems for their kids and I truely feel for them.
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