Question about health insurance/maternity coverage

[funschooler5]

We've been self-employed and uninsured for several years now. I'm 12 weeks pregnant and would like to have a homebirth with a midwife. We did this with baby #3 and paid out of pocket. One of the main reasons we did this is because of the price ($1500 for a homebirth vs $6000 for hospital).

 

I haven't been to a midwife or doctor yet, because DH recently got a temp job with the government. He's doing well at his job, and we are hoping this will help him get a permanent job with benefits (he doesn't have any benefits as a temp). He has had a few interviews, but those jobs went to others permanent employees. We're still hopeful he will get on permanently.

 

Anyway, my question is....how long should put off making an appointment with a midwife? If I were to make one now, and DH *did* a job with benefits, would I be covered, or would that be considered a pre-existing condition? I guess just the fact that I'm 12 weeks along makes it a pre-existing condition, though....I'm not sure how all of that works. It's been awhile. :blush:

 

From a quick internet search, I'm only finding one midwife in my area that does homebirths. I'm kind of afraid of waiting too long to contact her, in case she gets too busy. If I end up having to have an OB and a hospital birth, and DH *doesn't* get on permanently, we'd be screwed. There's no way we could handle a big debt like that right now.

 

Any experiences or advice would be appreciated!

[Mom-ninja.]

Contact her now and talk to her. You don't have to make an appt now if you don't need to. However, I'd at least contact her.

[funschooler5]

That's a good idea. Thanks for the advice! :001_smile:

[linguistmama]

Yes, I would ask the midwife about her schedule and if she usually fills up quickly.

[chepyl]

Generally, a group plan covers pre-existing conditions with no waiting period. We wanted to set up a plan for our business, If we did a group, I could be covered for maternity if I was already pregnant.

[PentecostalMom]

In my experience, pregnancy is not a pre-existing condition. The midwife (if she is worth her salt) should let you either pay per visit until you are certain of insurance coverage, or work out a payment plan with you. I do know that Medicaid has "pregnancy medicaid" that will cover you as well, should she accept it. It all depends on what state you are in and what laws are there regarding midwifery and homebirths. The pregnancy overage permits you to have a bit more income than just having full medicaid coverage. We had to have part of last dd's coverage through medicaid because dh was a student and we had no insurance or money. The midwife that we saw at a birth center took it, and then once dh got a job (about 1/2way through the pregnancy) we simply switched to our insurance. They did not consider the pregnancy to be a pre-exisiting condition and it was no problem. The midwife did offer home births but for a variety of reasons we chose the birth center for the birth.

Edited October 1, 2011 by PentecostalMom

[texasmama]

Pregnancy is not a pre existing condition, generally speaking. One of my pgs occured while dh was in a waiting period for group health insurance in a brand new job. I went to the OB at about 10 weeks, offered to pay out of pocket until my insurance kicked in, and she told me that the insurance would "catch up" later and charged me nothing. I cried at the kindness of this. Indeed, insurance covered my pg. Other health issues can be a preexisting condition if you have a lapse in insurance like yours, but pregnancy is not one of them (that I am aware).

[jennsmile]

I think it is only an issue if you are trying to get individual insurance....I did that and got pregnant before it was covered. We did a homebirth and it worked out fine.

 

Jenn

[StephanieZ]

To my understanding, employment-based insurance usually is pretty good about pre-existing, etc.

 

Personally, in such an important time, I wouldn't change my medical plan in order to suit the insurance men. If you want/need to go to the DR soon, then go. If you feel comfortable waiting a few more weeks, and are taking your vitamins, then that'd likely be fine, too. I know different doctors vary a lot in their standards as to when to come in for the first time, and it's been a long time since I've been in an OB's office. :)

 

FWIW, I'd bet if he gets a gov't job, the insurance will cover you 100% from the day you gain coverage. So, pray for the job!!

 

p.s. So sorry you have to worry about insurance at such an exciting time!! It'll all work out fine in the end. LOL, take heart: kids are so crazy expensive to raise that the birth is peanuts in the end. :)

 

BTW, CONGRATS!!!!!!!!!!!!!:party:

[gardenmom5]

I dont' know what state you are in, but in WA being unemployed and pregnant should qualify you for the state health insurance pool (medicaid) and cover your pregnancy. I believe it also covers midwives.

[GESTEP]

I worked in insurance and OB billing and this was my experience, though every plan is different. If you see the same doctor throughout a pregnancy they will usually bill at the time of delivery as a global billing, meaning that they do not bill each office visit individually to the insurance. This does not include labs and ultrasounds though. So often times the insurance will look at pre-existing unless the delivery is close to the effective date.

 

However insurance has been known to consider pregnancy as pre-exisiting if you saw the doctor prior to the effective date of coverage. It is not based on when the pregnancy occurs but when you first were treated, i.e. saw a doctor/midwife or some documentation in a medical chart. If it has not been documented by a healthcare provider it is not pre-existing. I have seen women not go to the doctor until late in the pregnancy to avoid prex denials. It is sometimes hard to convenience the insurance you really did wait and you may have ot fight them on it. Some policies do not consider pregancy pre-existing so it just depends on the coverage. It can also depend on your state, my info is based on Ohio.

 

I just wanted to point out that it can be excluded, I have seen it many times with group insurance and individual coverage.

 

REgarding waiting periods, from what I recall, that does not count as pre-existing time periods. The purpose of pre-existing denials is to avoid people getting insurance only when they find out they will have major expenses. Pre-existing is the time prior to the effective date (usually date of permanent hire), so although there is a waiting period with no coverage you have insurance so to speak, it just doesn't cover anything.

 

Congratulations and I hope your husband finds a permanent position with full coverage:001_smile:

[LittleIzumi]

It depends on your state, too. In my state it is illegal to consider pregnancy a pre-existing condition. However, none of my insurances would pay for a homebirth, either. :glare:

[funschooler5]

Thanks so much for your responses!

 

I think just to be on the safe side, I will contact the midwife to see how busy she is, without actually making an appointment. Looking at her website, it seems she does take payments, so if DH doesn't end up getting benefits, I think we'll be ok.

 

Thanks again!!

[funschooler5]

Thanks for all of this info! This is good to know. Maybe there is some way I can take a look at the plan my husband might get to see how they would handle it.

I worked in insurance and OB billing and this was my experience, though every plan is different. If you see the same doctor throughout a pregnancy they will usually bill at the time of delivery as a global billing, meaning that they do not bill each office visit individually to the insurance. This does not include labs and ultrasounds though. So often times the insurance will look at pre-existing unless the delivery is close to the effective date.

 

However insurance has been known to consider pregnancy as pre-exisiting if you saw the doctor prior to the effective date of coverage. It is not based on when the pregnancy occurs but when you first were treated, i.e. saw a doctor/midwife or some documentation in a medical chart. If it has not been documented by a healthcare provider it is not pre-existing. I have seen women not go to the doctor until late in the pregnancy to avoid prex denials. It is sometimes hard to convenience the insurance you really did wait and you may have ot fight them on it. Some policies do not consider pregancy pre-existing so it just depends on the coverage. It can also depend on your state, my info is based on Ohio.

 

I just wanted to point out that it can be excluded, I have seen it many times with group insurance and individual coverage.

 

REgarding waiting periods, from what I recall, that does not count as pre-existing time periods. The purpose of pre-existing denials is to avoid people getting insurance only when they find out they will have major expenses. Pre-existing is the time prior to the effective date (usually date of permanent hire), so although there is a waiting period with no coverage you have insurance so to speak, it just doesn't cover anything.

 

Congratulations and I hope your husband finds a permanent position with full coverage:001_smile: