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Complications

Complications

Did you know that it’s possible to have a PPO insurance plan that doesn’t cover pregnancy? Maybe you do, but I’m the idiot who got pregnant without even thinking that I should check to see if pregnancy was something my policy covered.

Now look, obviously this is my responsibility, since I didn’t even bother to check my plan before I got pregnant. That was my dumb mistake, and I’ll be paying for it in the form of a rather hefty medical bill next fall, assuming this baby (knock on wood) makes it that long. Also, I’m very lucky because this isn’t catastrophic financial news for us. We will be able to pay for it, we just didn’t know we would have to.

Now, all that said, WHAT THE FUCK? Who knew this was legal? It never even occurred to me that it was something that could happen. (FYI: it is legal until 2014, assuming Obamacare goes into effect, so before you get pregnant, make sure you check your plan just in case). I guess that’s my main beef here: that this is a healthcare system that is so fucked up that you have to always be thinking about stuff that might not be covered, even something so super basic and that it’s like, you know, cycle of life type shit? Really? I’m a pretty suspicious person, and this totally blindsided me. I can only imagine what must happen to other, less cynical people every day when they find this stuff out.

When I was pregnant with Mini, I had University-affiliated insurance. I had always been on some kind of group plan before this, and apparently my insurance company has a policy of not covering individuals for pregnancy . . . EVER. Under any circumstances. Oh, but they will cover complications of pregnancy, so if I have the kid and I start bleeding out, my understanding is that any procedure to save my life will then be covered. So that’s good news, I guess.

What is not so good news is that hyperemesis gravidarum is not considered a complication of pregnancy, at least not by my insurance company (and after all, they are licensed to practice medicine, so they should know. Wait). So when I tried to arrange for a nurse to come to my house and give me IV fluids once per week — thereby avoiding the next trip to the emergency room — I was informed that, because the nurse visits would be “related to maternity,” they are not covered. So just to clarify, I asked the customer service rep a few questions:

Me: So, you’re saying that you won’t pay $375 for a nurse to come to my house.

CS Rep: Is the reason the nurse is coming related to maternity?
Me: Yes. It’s because of hyperemesis gravidarum.
CS Rep: If it’s related to maternity, you have no benefits that cover it. Unless it’s a complication.
Me: Hyperemesis is not a complication of pregnancy?
CS Rep: No.
Me: But then, let’s say I have to go to the emergency room in the next few days for the exact same reason. You will cover that?
CS Rep: Yes.
Me: But what does it cost for me to go to the emergency room? Like several thousand dollars or something?
CS Rep: I don’t know ma’am.

I mean, are you kidding me? This is insanity! I think the most frustrating thing about this is that crappy insurance bullshit like this is so stupid that you don’t think to anticipate it. And for the pro-lifer, anti-Obamacare people out there, how is not the case that nickel-and-diming like this wouldn’t encourage more people to get abortions? In many cases, I would guess that abortion would be the fiscally responsible move to make if you’re presented with a situation like this. So, nicely played, there, assholes.

I often wonder why I even have health insurance anymore — it was very tough for me to get coverage at all, given my mental health history, and I was denied coverage on the plan that Mini and Mr. Right-Click have because of my “high risk” status. I suppose you keep it because it feels irresponsible not to have it, and that it seems like health insurance is something that grownups are supposed to have. But even that one justification I’ve always had for keeping it, even when it pays for almost nothing anymore — in case of a catastrophic illness like cancer or something — after my recent experience, I’m really not convinced that I wouldn’t be better off throwing those hefty monthly premiums I pay into a savings account and just seeing what happens.

Should insurance have to pay for pregnancy? I don’t know. That’s an ethical question: pregnancy is technically (often) intentional, and therefore (sometimes) the expense of it is something you might be able to anticipate (as is the case here). A similar question might be: should you be able to get flood or storm surge insurance if you choose to live on the Gulf Coast? Should you be able to get earthquake insurance if you live in California? I really don’t know. Maybe a likely or easily anticipated situation is not what insurance is for? I really don’t know, frankly.

But I do think, at least, that there has to be some solution to this situation as it exists: where you are always throwing things at your insurance company to see what sticks. At some point, it becomes an irresponsible prospect to live one’s life this way. At some point, you feel like the only way to get good healthcare is to be ready to pay through the nose. And it seems like kind of a relief to realize this.

PSA Update: I’ve looked into government assistance programs (mostly for shits and giggles, not expecting much), and it looks like there are some things in place for people who are uninsured or underinsured. First, there is Medicare for low income people, and second, there is something called AIM in California, which helps “middle income” people get coverage for maternity if they are uninsured or if (like me) their insurance excludes maternity. I thought this was relatively good news until I looked at how “middle income” is defined for a family of four (gross income between $3,676 to $5,514 per month). Clearly they don’t really understand what it costs to live in California, if that is middle income. But still, it’s good news for anyone who qualifies, I suppose.

Comments (45)

  1. Mar 8, 2011

    My pet peeve, insurance. I cannot be covered by insurance because of infertility issues from the past that no longer exist. My oldest cannot be covered because of Plagiocephaly as an infant and a gross motor skill delay. When we applied for insurance my husband and other children were accepted. I had applied for the additional maternity coverage, just in case I needed it. My entire request was denied. We accepted the coverage and then decided that it was just too expensive, because even though we were spending $700 a month in premiums for 3 members of our family, we were still paying out of pocket for a lot of stuff. I realized after over 2 years of paying that premium, that they had maternity coverage on the policy FOR MY 2 AND 3 YEAR OLD DAUGHTERS.

    This is obviously a very sore subject with me. So sorry that you are dealing with the same bullshit.

  2. Mar 8, 2011

    It’s quite the complicated system. I just recently got private health insurance (a PPO) and before signing the contract the broker pointed out that maternity coverage is not included EVER, the price I pay for affordable coverage. Luckily my husband’s vasectomy will be covered. Go figure.

  3. AKD
    Mar 8, 2011

    I paid extra to have HMO insurance at work for the few years we were trying to get pregnant. I was in charge of HR for awhile so I had helped a co-worker figure out which plan to be on to maximize maternity coverage. The PPO plan we had made you pay 20% of the cost of a hospital birth. I don’t even want to think about what it would cost if you or the baby have “complications.”
    In the end, for my completely normal birth on the HMO insurance I think I paid one $10 co-pay for the whole pregnancy. Of course, we had to pay out of pocket for the fertility treatments that got us pregnant, but whatever.
    And yes, I agree, healthcare and health insurance makes me crazy!

  4. Mar 8, 2011

    Honestly, I feel sick. I’m so sorry. When I read your story, and Madge’s, I’m just PISSED. I’m pissed that people think this is OK. I’m sick that the Tea Party and others are all, HANDS OFF MY HEALTHCARE, when they don’t actually know what they mean. I’m sorry, they don’t. Ron Schiller was right: Most Americans are uneducated, even about the things they are so stupidly passionate about. No, if you’re reading this, it’s highly unlikely I mean you, so don’t take it personally.

    I hate that the mandate that everyone buy health insurance was declared remotely unconstitutional. You know why? Because ultimately, it fucks all of us, and most people don’t even realize it. Insurance companies want the mandate, but not for reasons you’d expect. Without a mandate and without pre-existing conditions or exclusions (like pregnancy), most people who are buying insurance coverage won’t buy into it until they’re sick. So what happens? Sick people get flooded into the system, without healthy people paying premiums to offset the costs. Who pays for it? We all do, because all of our premiums are going to hit the fucking roof.

    Free market this, assholes.

    This is why I live in Massachusetts. A big, big reason. I want affordable healthcare. I want to live somewhere that recognizes that shit like this is a big deal. It’s not perfect, but Jesus.

    I’m sorry Anna.

  5. Mar 8, 2011

    You want to know the real kicker to my entire story? We had been paying $1200 to COBRA for 1 year, with an extra 6 month extension (18 months total) so that we could not be denied due to lapse of coverage for me and my oldest. The PPO Insurance completely disregarded the COBRA and found some loophole to deny us anyhow. I need to stop discussing this, my blood pressure is rising. OH CRAP!! I have no health care to treat it!!!

  6. Mar 8, 2011

    That was $1200 a MONTH. Thousands down the drain for nothing!! and the whole time I was paying thousands more for infertility issues that weren’t covered!!! OK, I’m going to go pass out now…..*thud*

  7. Mar 8, 2011

    Every time I read a post about the US form of medical care and insurance, I sort of lose my faith in people a bit. They don’t consider HG a complication? REALLY?

    We have public health cover for everyone here and it works. Of course, sometimes the doctors are overworked and total arseholes and you have to choose to pay out of pocket for doctors, or take up insurance, but there is a damn sight less red tape.

    Feeling really sorry for you right now. This was not what you needed right now. How much longer until the HG abates?

  8. Mar 9, 2011

    I am so sorry. It is total BS. I have been a real toot about the radical misogyny of current political agenda and this only cements my view. I think you pointed out the heart of the issue…it is not so much that you have to buy the additional insurance (well, actually that is fucking HUGE if god-forbid you make less than $100K a year, but then again, conservatives would argue you had it coming for not “working hard enough and supporting yourself”), but that it is a “secret.” And it is only a secret for womens’ health issues. Do you get screwed like this for ED treatment? I bet not. Add in that problems like HG, infertility, mental illness (“girly problems”) are basically considered mythical and not real….holy crap there is blood spurting out my ears! Every day I am more and more convinced that I am starring in “The Crucible.”

    I am glad you are going to be okay, though I am not glad that you will have to be using the ER as your primary care (you will get used it, ask me how I know). Good luck…apparently in this country “luck” may be all you have to protect your health.

  9. JChevais
    Mar 9, 2011

    This blows my mind. I had a baby last year and it cost me virtually nothing (well, it cost me taxes).

    Vive la France.

  10. Mar 9, 2011

    I paid 20% of my hospital birth. Most PPO plans have an OOP maximum for stuff like that. As such, I paid only (hahaha “only”) $4,000 for my daughter’s birth. I did, however, pay for my ENTIRE epidural, for reasons that are unclear for me. I only used my epi for an hour before my kid was out and about, so that was a nice $2,000 hour.

  11. Kate
    Mar 9, 2011

    Sometimes I think I’ve reached my maximum rage about the insanity of our health insurance system. And then I read this, as well as Madge’s comments, and reached a new all-time height of rage.
    I second what Jonna said. People who are anti-health care reform are people who have no idea what the system is like.
    OK. No need to continue this rant.
    My apologies for having to put up with something so insipid.

  12. Elita
    Mar 9, 2011

    I used to work at a university and I had an HMO. It was the BEST.THING.EVER. I think they took $50 out of my check every 2 weeks and the total cost for delivering my son was one $25 copay. I upgraded to a private room at the hospital, for which I paid $200. If I had roomed in or birthed at home or a birth center, it would’ve been free. At my new job, I have a fancy PPO and it is going to cost me up the butt to have a baby, with a midwife, at home.

    I find it crazy that in 2011 your insurance coverage is still tied to your employment, therefore some people are paying next to nothing for great coverage and others are paying through the nose for crappy coverage. I really don’t understand the objections to a universal healthcare system. Crap like this shouldn’t keep people up at night.

  13. Mar 9, 2011

    This is so insane I don’t even know where to begin. For starters, it certainly makes me less envious of people who HAVE health insurance. Anna’s probably right — fuck it all and just put the money you’d pay in premiums in a savings account and then pray like hell nothing goes wrong. I would have never suspected a policy wouldn’t pay for pregnancy/delivery. Makes me want to scream, “Who are you going to cover in the future if you don’t cover this, dickwads?” Alexis is right in that there is a terrible amount of either outright misogyny or at minimum sexist bias in medical coverage. My daughter has asthma but her ped won’t diagnose it (write it on her chart) bc insurance companies “don’t like it” and could affect her ability to be covered in the future. The middle class is getting fucked where health care is concerned, and I really believe Obamacare (I know that’s a loaded phrase — just consider it a catchall untainted by partisan politics) isn’t the answer, either. So, I guess in our case (income far too high for Medicaid, self-employed husband who can’t purchase insurance, me a contract employee who doesn’t get benefits) we try to stay as healthy as possible and look forward to the Medicare years.

  14. Mar 9, 2011

    Alexis, an illustrative anecdote: My mom is a nurse who has worked in multiple specialties. She has seen episiotomies that were about as delicate as someone cutting a steak, but she said you would not believe vasectomies. They are performed with the utmost of care and precision. Same thing with circs. Every day, women get the short end in what is largely, still, an old boys’ network of doctors. It’s an exception to find med professionals who treat adult women like adults.

  15. Therese
    Mar 9, 2011

    Wow, just WOW! I don’t even know what to say because this is just completely insane. A health plan that doesn’t cover maternity? Whoever sold you that plan should have been very clear on the front end (using basic info available to them to realize you were of childbearing age) that maternity was not covered so that you would know. If an intelligent, critical thinking, well-educated person with decent resources available to her is caught off guard by this sort of craziness, what are the “average” people out there supposed to do? I’m seriously in shock over this. And to think, some people say we don’t need health reform…

    This is one reason I continue to show up to work everyday to a job that makes me crazy. I have a unversity-based HMO plan that covers pretty much everything with very small premiums paid by me. The birth of my first child cost us exactly $210 (that includes all prenatal care) and my second child’s birth next month will cost about the same. I am so very thankful on a regular basis for this job and the benefits that come with it. I wish I didn’t feel so tied to the job just because of the benefits though…I guess it’s a nice first world problem to have.

  16. Mar 9, 2011

    Thank you! Sometimes I feel like it is all in my head…glad to know is wasn’t just my imagination that my post birth repair that could have potentially left me with chronic urinary problem earned some Motrin yet Chris’ vasectomy (two stitches you couldn’t even SEE!) got top notch drugs, a dozen follow-up visits and a month off from physical training. This why I kind of don’t go to the doctor anymore….that and the fact that the Military Health System basically prevents me from doing so….

  17. Mar 9, 2011

    This makes me so fucking angry I can’t even deal. Forget whether or not health care is a right or all the other things that trip people up, let’s just look at the problems with running a company in this shady-ass, immoral fashion. Horrifying. Why would you check to see if pregnancy is covered? OF COURSE IT SHOULD BE COVERED. Would we accept a car insurance company that doesn’t cover accidents that happen on a Friday? Of course not, that would be ridiculous. Christ.

    My PPO (which is fine, a 20% copay on everything but I haven’t found something that’s not covered yet), is mostly covered by my company. But if it weren’t, I absolutely would do what you are thinking and would drop insurance and just squirrel away the money. I am convinced I would come out ahead in the end.

  18. Mar 9, 2011

    My husband is self-employed (AND diabetic), so he has to go on an insurance called MinnesotaCare, for those people that can’t get regular insurance b/c of health issues. The girls and I all by our own insurance. We EACH have a $2,000 deductible each year. My pregnancy is covered, but BOTH baby and I will have to reach the $2000 deductible before any benefits kick in, and then we still pay 20%. AND all of our insurance premiums combined are more than our house payment.

    Someone recently asked me if I’d checked into Medical Assistance, so I DID, and I’m shocked to see that I qualify. Their income limits are SO MUCH HIGHER than I’d expect. (Though our cost of living here is probably LAUGHABLY lower than yours.) And they’ll pay my current insurance premiums, AND cover what my insurance doesn’t, AND there’s no premium. I feel like I’ve won the lottery! (Assuming I actually DO qualify, which I haven’t heard officially. But it looks like I do!)

    Anyway, all of this makes me think why do I even carry regular insurance? MA will back-cover up to 3 months, so wouldn’t it be better to just stop paying our insurance premiums and go on MA if needed?? I don’t feel comfortable actually DOING that, but it makes me wonder…

  19. Mar 9, 2011

    Wait. WHAT?? Pregnancy is NOT COVERED by your insurance?? I didn’t know that was even POSSIBLE. I am absolutely stunned. I mean, the HG issue is insane as well (it obviously makes NO SENSE to force you to go to the ER, at much greater expense to the insurer, rather than have a home nurse once a week), but not to have PREGNANCY AND BIRTH as covered events is just bizarre.

    Not to mention that you’re having to deal with making bothersome phone calls and getting adminstrative run-arounds regarding your options and coverage when, um, YOU ARE VIOLENTLY SICK.

    This stuff makes me crazy. I mean, I have what is supposed to be good health insurance, and even so a YEAR after my daughter’s birth, we are still getting bills related to her delivery. I think we’ve paid at least $2500 or more in out-of-pocket for “co-pays” or various amounts that for whatever reason were not covered.

    The system blows.

  20. Mar 9, 2011

    I had HG with both kids, all nine months. The insurance company wouldn’t cover Zofran for me. With the second pregnancy, my blood pressure kept going up and up. My doctor said, you need to lower your stress level. I said, I am throwing up 8-15 times a day while holding down a 60-hour-a-week job. That is stressful. I need drugs to help me stop throwing up. The doctor explained this to the insurance company. The insurance company still said no.

    So my blood pressure continued to climb, and I ended up with preeclampsia…which is way more expensive that Zofran.

    Also, in the days before medication and IV fluids, people died from HG (Charlotte Bronte, for instance). I’m pretty sure things that can kill you should be called “complications.”

    But yeah, let’s roll back the tiny little bit of progress that “Obamacare” created.

  21. Mar 9, 2011

    This story made me so mad last night and today I’m even worse. I work for a huge hospital system, we are self-insured. I pay $1700 OOP a year for medical and dental for a family of 4 and MAD’s birth last year cost me a $50 copay for all of my maternity and delivery. I KNOW I ridiculously lucky and I will never complain about my coverage. But why the hell should I be so lucky? This is total bullshit. I would gladly pay more if it means that more people got coverage at affordable rates. If I left this job (which luckily I love and we have awesome childcare in the area, so I don’t want to or need to) we’d switch to my husband’s insurance which would be about 4x the cost for about 1/2 the coverage.

    Anyone who doesn’t think a universal healthcare system is a good idea has never, ever had to deal with this kind of bullshit. As I’ve said before, we live in a country where people have to have fucking bake sales to pay for chemo treatments while they have insurance. Anyone who thinks that’s ok is a douchebag.

    I’m so sorry, Anna

  22. Mar 9, 2011

    I was in your shoes a few years ago though I knew of my lack of coverage going into pregnancy. Register as a cash patient, then when the bill comes, negotiate for a cash discount. For the OB maternity care and hospital stay, we paid about what my SIL had to pay in co-insurance charges, and she’s at 20% responsibility. So it wasn’t as bad as I’d thought.

    We did have Medical coverage as a backup but only at the Share of Cost level where we’d have to contribute approx. $7000 before they’d cover anything else. If you do visit Social Services, be prepared to submit a truckload of info. They want to see EVERYTHING finance-related.

  23. Mar 9, 2011

    the theory behind not covering pregnancy (usually you have to add it as a rider or get into a group policy) is that pregnancy is very expensive and so it unfairly inflates the rates of people who do not want children. i’m not saying it’s right or wrong, but that’s the theory.

    it’s actually easier to get into a group policy (the benefit being it covers maternity and there are no preexisting exclusions) in most places than you might think… sort of. the trick is that you can actually get coverage for a group as small as one person – you just have to find someone that will help you. most insurance brokers won’t tell you it’s possible because the commission is REALLY low (like 1 or 2 %, i think for groups less than 4), but it can be done. we’re in the process of getting it now. the kicker is that it’s a 60 day application period even though they can’t reject you. weird, right?

  24. Cheryl
    Mar 9, 2011

    The catch to just squirreling away the money and paying yourself is that hospitals charge people who don’t have insurance higher prices on things than people who do.

    This is all appalling, Anna, and I’m sorry you’re having to deal with it.

  25. Mar 9, 2011

    The theory is misogynistic. Also, I may choose to have children, but most of the people who are raising premiums are not the pregnant among us, but the smokers, the obese, the diabetics–people with diseases that are, in theory, preventable.

    Ergo, the theory is wrong.

    As for group coverage, this vastly depends on your state. Some don’t allow groups without being incorporated, and some allow Chambers of Commerce to form groups. It’s all such a mess.

    Again, thank you God, for Massachusetts.

  26. Mar 9, 2011

    SOMEtimes. If you negotiate up front, you can often get away with paying in the middle — i.e., asking for the insurance discount, plus a little more, in order to pay cash.

  27. Mar 9, 2011

    Also, the people who are against universal healthcare utterly fail to see how having uninsured citizens impacts us all. “But I shouldn’t have to pay for lazy people!” they argue. Guess what, assfaces? Besides your obvious heartlessness in wishing they would either stay sick or simply die (They didn’t work hard enough, clearly!), when those sick people go into the ER and receive care, despite being unable to pay (thank you, Hippocratic oath!), where do you think that shortfall goes? To the insurance companies. Which is then passed to us.

    It’s just such a broken, stupid, thoughtless way of going about things. But no, let’s not cover Anna’s pregnancy. But God forbid Anna be of a different mind and opt to terminate. GOD, JESUS, NO.

  28. Mar 9, 2011

    Who sold you the policy? Your agent definitely should have asked detailed questions! We specifically sought out a policy excluding maternity because we are not having more kids and they are a LOT cheaper (we are both employer and employee.) Jonniker gives good advice which is to ask hospital, doc, labs etc to give you the “negotiated rate” which is what they contract for with the large insurance companies. You also can get cash discounts for self-pay but you definitely will need to negotiate hard.

    By the way did you know that in NYC most ob/gyns don’t accept insurance? So even if you have a policy that covers it, good luck finding a doc who takes it. Everyone just self-pays. Crazy, huh?

  29. Mar 9, 2011

    Also talk to an expert, very seasoned agent NOW about coverage for your baby. Generally your baby would be covered under YOUR policy for the first 30 days but I honestly don’t know what the ins co would do if you have a policy excluding maternity. In the unlikely case that your baby has some complications etc after birth, you want to make sure he is covered.

  30. Mar 9, 2011

    As I understand it, it is not the price changes as much as it is that insurance companies have negotiated fixed pricing for most services in advance. Health care providers agree to take a smaller payment in exchange for the fact that they will get paid, for sure, a set amount, in a set time frame. The higher cost for “cash” is because providers have averaged in the possible cost of tracking you down, setting up financing, making sure you pay, paying a collector to harass you and so on. If you can pay in one lump sum right now, they can save those man-hours and that is why you get a “break” on the price. (I am oversimplifying here, but you all get the idea.) This all plays into how the current insurance system generally holds all of your “bargaining power” when it comes to getting the services you want/need, when you want/need them, from the people you want to see at at a price you can/are willing to pay. That is the rock and a hard place here…most of the time decent insurance can keep your costs manageable, but when they can’t (or choose not to) the sky is the limit on what you can be charged. Its a gamble either way, I might argue that having the cash instead of paying it into skeevy corporation is always a plus, but somehow I doubt we will ever come out “ahead” with health insurance in this nation.

  31. Mar 9, 2011

    Health insurance was a joke before, but it seems to have even gotten worse with Obamacare.

    I knew about the maternity thing since I have had an individual plan for quite a while now, but got screwed in another way….

    Stepdaughter (23) was covered under her dad’s plan because she was a full-time student. Obamacare brought in that every child up to what? 26? was covered, even if they weren’t a student. His rates to cover her then went up to almost $500 a month where they were just $50. It is freaking insane. She is 23 years old and thankfully, healthy, no pre-existing conditions or anything. I am 39, have depression and am battling cancer and don’t pay that much on my plan!

    I got her her own plan, $237 a month and she got a stern lecture on using birth control since, like you found, it doesn’t cover it.

    Instead of making it better for everyone, it seems that this great overhaul has totally screwed the people that were already doing their part to be responsible and take care of themselves.

  32. Mar 9, 2011

    The Affordable Care Act (actual name) does mandate that for plan years after Sept ’10 that anyone up to age 26 as long as they don’t have other coverage thru own employer, can be covered by their parents regardless of student status, married, dependent on parents, etc. But it does mean that employers can charge more for it. So a baby cannot be denied after it is born. And 70% of employers are self-insured so they pay for their own plans and own claims and an insurance company is only involved to administer the claims or rent their provider network. The Act also eliminates pre-ex for children on new plans so anyone who had to keep a job or keep a plan and not change policies can now do so (again, the rates may be sky high). The Act also no longer allows drugstore over the counter items to be included in flexible spending accounts. Also eliminates lifetime maximums and annual maximums (but many plans can get a waiver for this). I digress.
    Individual policies have different rules than group policies and they are allowed to have policies that do not include maternity and charge lower rates as a result. And if the policy does cover maternity there is usually a waiting period. In Calif you can get a group policy for 2 people. Not sure what Mr. Right-Click does or if you have a tax ID number. Two people can be one owner and a spouse. There is no pre-ex for maternity for a group policy. There is no pre-ex for anything if it is an HMO like Kaiser. And of course if you don’t go that route do ask the doc and hospital for a cash upfront cost so you will know what it will be.

  33. Mar 9, 2011

    Totally, totally vehemently disagree with this. Obama has nothing to do with why insurance companies are crappy. In fact, this makes me violently angry. Unfortunately, I’m also extremely sick and beaten down so I cannot fight at present. But I’m really tempted to delete this comment, that’s how offensive it is to me.

  34. Mar 9, 2011

    Uh, really? I don’t live in NYC, but this seems crazy to me. I know three or four people who gave birth in the city and didn’t self-pay (Lawyerish, above, is one of them).

    Do they not take it out of the gate, and then have you submit the claims? Because even if your OB doesn’t “take” insurance, you can always do that, although it might count against your out-of-network deductible.

  35. Mar 9, 2011

    Jonniker, most ob/gyns in Manhattan are not in any insurance company networks which means that yes, you can submit directly on your own, but won’t get even the “provider” rate, not to mention “preferred provider.” I had a friend live in Manhattan temporarily for her husband’s job and she had several months of her pregnancy during that time. She is from CA like me and she was shocked. I actually did some asking around for her because my husband is from NY and I was able to ask his female cousins (in addition to getting their tips on best hospitals etc.) I was really surprised that this is consider SOP in Manhattan and everyone just deals with it by basically self-paying.

  36. Mar 9, 2011

    Juliet’s idea of asking for the negotiated rate is a good one.

    Have you thought of switching to a High-Deductible (HD) plan with a Health Savings Account (HSA)? As a self-employed person with an HD ($3,500) plan and HSA, I pay the negotiated rate for out-of-pocket expenses covered by the plan. The premiums for HD-HSAs are far cheaper, and I can tax-defer the premium savings in my HSA account up to the annual limit. The premiums themselves are also tax-deductible. The coverage for my Anthem Blue Cross plan is pretty good once the deductible is met — maternity is covered.

    I don’t think you can always get the negotiated rate for expenses NOT covered by the HD-HSA. It depends on the doctor. My doctor gives everyone the negotiated rate for out-of-pocket expenses.

    I’m wondering if you could switch to an HD-HSA and get the pregnancy covered — if the plan covers maternity you should be able to get it despite the preexisting pregnancy because I believe Federal law prevents Insurance Companies from considering pregnancy a preexisting condition.

    But I just checked and see that Anthem Blue Cross has a “six month waiting period.” How is this different than treating pregnancy like a preexisting condition? Wait. It looks like you have to be in a HIPAA plan to not have it treated like a preexisting condition.

    Well, scratch that idea.

    I’m sorry Anna. Given that it’s not covered, I hope you will only have to pay the minimum necessary to get the care you need.

    I applaud the fury of the other commenters.

  37. Mar 9, 2011

    I wrote a comment and then deleted it, because honestly, it’s just too stupid.

  38. Mar 9, 2011

    Are you familiar with the term “correlation does not equal causation”? Because this is the kind of ignorance that prevents any sort of forward movement. This stuff is important — and for the record, this is Anna’s life, and it’s actually happening to her — and when you make statements about it, you damn well better know your shit inside and out.

  39. Mar 9, 2011

    I am very sorry if it came out wrong or you took it the wrong way. Insurance companies do suck and they did suck before the new legislation. I was just trying to say that it is going to get a lot worse for all of us before it gets better.

    I truly believe that our rates have gone up in reaction to the legislation. Insurance companies are going to find every loophole they can in order to get more and more of our money and give less healthcare in return.

    I never meant to offend and I am really sorry that you are facing this when you thought you were covered. Feel free to delete this and my other comment.

  40. Cheryl
    Mar 10, 2011

    Oh, I agree with all of this, and a person I know who had worked in hospital administration said that they actually expected to write off a large portion of the “cash” patients’ payments, so the numbers they were charged were pretty fictional anyway.

    I just remember getting the bill for having been admitted to the hospital overnight after an ER visit. It just said something like, “Charges: $13,476. Adjustment: $10,732. Balance: $2744.” The “adjustment” wasn’t any transfer of actual money from one party to another, it was just the difference in what my bill was because I was insured.

    So since I was insured, I got a gigantic non-itemized bill that was “adjusted” so most of it didn’t matter, and I could ignore it until my insurance company decided how much of the rest it was going to pay. If I’d been uninsured–and so more likely to have a crappy job and hence less financial capacity, since this was fifteen years ago when most full-time jobs came with insurance that your employer paid much, if not all, of–I would have gotten a gigantic non-itemized bill and been expected to pay it.

  41. Lisa
    Mar 10, 2011

    I might agree that it is in reaction to legislation, but ultimately so insurance company execs can keep their fat salaries and bonuses. If they can’t just drop everyone on a whim and actually have to cover more people (gasp! the horror!) they have to get the money from somewhere. Cover more people + charge everyone ridiculously inflated premiums = more money for rich guys! Especially when some of those people they have to cover are kids in their early 20s and less likely to have huge claims.

    Insurance companies are just greedy bastards. Also, drug companies.

  42. Mar 10, 2011

    Don’t forget employers. Because if you think they weren’t passing on a much bigger percentage of the cost of your insurance on to you this year knowing they could blame “Obamacare” and get away with it…you’re crazy.

  43. Lisa
    Mar 10, 2011

    @Kerry – Definitely, I should have added employers. We’ve seen our insurance costs increase, but I won’t know the exact ratio of our portion to their portion until the end of the year when we get our benefits summary. It will be interesting to see how this year compares with last.

    In my case, we’re also seeing really shitty raises after a record breaking year, while the executives are driving new, rare luxury cars to work. But that’s another story.

  44. Elizabeth
    Mar 10, 2011

    My husband had to get a different job entirely because we couldn’t afford the childbirth expenses that we had to pay with the insurance that we had when he worked at a small family run business. My son cost us around 1oK to have, and we didn’t realize it would cost that until the bills started arriving. If we’d known about it ahead of time I would have refused a lot of tests and services.
    With my daughter, I paid nothing, because we had really good health insurance at the new job. Literally, I think I paid $10 for parking, and that was it. And every single time I walk in those doors now I think “Thank god for this insurance thank god for this insurance thank god for this insurance” and more than anything else it just pisses me off SO MUCH that this system is so screwed up that NORMAL people can’t afford to go the doctor. Unless you have INSANE AMOUNTS of help from your employer, it’s not affordable. That’s just screwed up.

  45. Mar 10, 2011

    I would never have thought that pregnancy would not be covered on an insurance plan, but that shows how much I know. I am glad you will be able to pay for it, because I know when my kidlets were born I would have been SOL.

    On a side note, I discovered recently how crappy my insurance was when they decided to stop covering my son’s non-stimulant add medication. He was diagnosed in June with Bipolar We always knew he had adhd on top of that, but I was relieved to find that there were non-stimulant add meds because my son’s manic phases manifest as anger and extreme irritability. What this means for him is that a stimulant adhd med heightens the anger and irritability he feels during a manic episode. So make a decision…protect him from heightened anger and irritability (more than normal, lol) or take care of the adhd. Insurance companies are stupid and they should all be taught that they don’t know enough about anything to make medical decisions for my family or yours. They suck!!

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