How can my friend get maternity coverage under her insurance policy?
Author: My friend and her husband have private insurance (he is self-employed) and they did not select the "maternity" option because they were done having children. Unfortunately they took a risk and now she's pregnant. They are actually not thrilled by the pregnancy and are pretty devastated in general, emotionally and financially. Her insurance won't cover anything and they are looking at ,000 out of pocket for the whole pregnancy, labor, and delivery.
Are there any creative ways that she can get her policy to cover it? Or where could she work part-time to get coverage? Or are there any organizations she could join to get a new policy (Major organizations that would have an insurance buy-in option?)?
I feel lucky to be covered under my husband's job! What a terrible position to be in.
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Tags: having children, insurance, job, labor and delivery, maternity, part time, pregnancy labor and delivery, private insurance, risk
She has limited options. VERY limited options.
1) She and/or her husband can get a new job. One that comes with group health insurance benefits that would provide maternity coverage.
2) She can try to qualify for Medicaid, if their income/assets are low enough.
3) They can pay for the birth/prenatal care out of pocket. Try looking into lower cost alternatives and/or negotiate a cash payment plan with the providers.
That’s it…there are no "creative ways" to scam the insurance company. They took a gamble and lost. Its unfortunate, but they are the ones who declined to purchase maternity coverage and got pregnant anyhow.
P.S. Tell them not to fall for the "maternity discount cards"…those are a scam, they could negotiate the same discounts themselves.
Also, the types of benefits that most employers offer part-time employees are very limited benefit plans. Some of those plans are almost not even worth having coverage at all. We see those frequently at the hospital system I work for…they typically have low limits on what they’ll pay per day or per hospitalization, and the patient gets stuck with the rest of the tab. Those plans are okay for if you just want a few doctors visits per year, but if you’re going to have a planned hospitalization the coverage stinks.
As a former Life and Health insurance underwriter and a current multi-line insurance agent, I can give the following advice. First, insurance is the one thing you cannot buy AFTER you need it. In other words, she cannot already be pregnant and buy the maternity option. Normally, any maternity option, once applied for, carries a waiting period before the policy benefits kick in. Second, IF she is able to find a company that will write the option, the premium will be so high, that it would equal approximately what it will cost to birth the child. Finally, there are no "creative" ways to get an insurance company to cover this. The policy limits and benefits are very clear cut in the policy contract. Now, there certain coverages under a policy without the maternity benefits that may apply. If there are complications of the pregnancy and delivery, such as a c-section, that can sometimes be considered as illness rather than NORMAL pregnancy and delivery.
No, she cannot go back and get retroactive maternity coverage on that policy. They took the risk and lost.
Does she want to try to get car insurance after she has smashed her car into a tree?
The above answers are correct. If she could add maternity coverage onto her policy, most insurance company would not provide coverage for 10 months (for most companies).
Her best bet is to get a job that provides coverage or pay for the maternity herself.
While she is talking to insurance agents, make sure she and her husband have enough life insurance coverage. There will soon be an extra mouth to feed.
Plan ahead.
When you done having kids you should get your tubes tied or cut. I know this is after the fact.
What your friend could do is look at alternitives of where and how to have the baby. She could have the baby at home with a nurse. And, there are less expensive "birthing centers". Baby’s can be born anywhere and usually are.
It’s too late now! Once you add it, anyway, it won’t cover any pregnancies that are conceived in the first year after you add it.
Sure, she could work part time at Walmart or Starbucks to get group coverage, but that’s hard!! There’s no group you can join to "buy in" to group rates.
Best bet, is to educate her about her birthing options. If you birth in a hospital, you have a 40% chance of having a C section (faster for the doctor, more money for the hospital). Birthing centers and home births with midwives are safer for moms and babies, and much, much cheaper – and their c section rate (for emergencies) is under 10% in most states.