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.