Until this fall, my husband and I thought we were done having children. We already have four beautiful children ranging in ages from thirteen years to two years old. Because we weren’t planning on any more additions to the family, we had a private insurance that did not include maternity coverage. Imagine our surprise when despite the fact that we do use birth control, we discovered that we were indeed expecting a new baby to be born in June 2010. What would normally be a happy scenario in our family was now a very stressful one. With no maternity coverage, how were we going to pay for this pregnancy?
Keep in mind that most of the changes in the newly passed healthcare reform bill won’t be in effect until 2014. Until that time, pregnancy will still be considered a preexisting condition, making it nearly impossible to purchase insurance with maternity benefits if you become pregnant. For the first time ever, I had to begin research on how to pay for pregnancy when you don’t have insurance. If you are a women in this predicament, here is my advice to you.
First, see if you are qualified for medicaid. Medicaid covers maternity in full, but getting medicaid is difficult. Qualified applicants have to meet strict eligibility guidelines. For example, family income cannot exceed 133% of the federal poverty level, and assets cannot be greater than $2000. I was not eligible for medicaid, so I had to explore my alternatives.
If you do not qualify for medicaid,ask your physician about a discount for cash paying patients. Fortunately, my physician does offer a 30% discount on his prenatal and delivery fees. My ob/gyn has delivered my last two children, and because I have a long history with this office, my husband and I asked the billing representative if my doctor would be willing to give us an additional discount. She talked to him on our behalf, and he gave us an additional 20% off of the discounted fee. Our fee does not include ultrasounds, lab work, a postpartum visit, non-stress tests or any problem visits that are not related to pregnancy. It is important to get not only the fee structure in writing, but also what services are and are not included. For example, our physician’s fee does not cover the hospital charges either.
Consult with your local hospital(s) about their policy on cash paying patients. My husband and I talked with two nearby hospitals. One of the hospitals told us about a special program that they, along with a few other hospitals, participate in. The program involved using a physician from a specific list (ours was not on the list) and the fees involved for the program, which was strictly for patients without insurance. This particular hospital didn’t force people to use this program; they had their own separate cash paying policy in case a patient wanted to use their own doctor. We found that the two hospitals we interviewed would charge similar fees–about $2000 for a 24 hour stay. This fee would include everything for mother and baby for a normal vaginal delivery, except an epidural. Epidurals, we were told, would have to be paid for in advance directly to the anesthesiologist, who also offered a cash discount.
Do consider hiring a certified midwife. My husband and I entertained this idea early on in the pregnancy, but ultimately, he didn’t feel comfortable with the idea of a home delivery. If there were complications, I’d still be directed to the hospital, and our fees wouldn’t be reimbursed. However, we found that the midwife’s fee also included all prenatal visits, a postpartum visit in our home a few days after the baby’s birth, as well as a postpartum visit in the midwife’s office six weeks after delivery. Although my husband didn’t feel totally comfortable with this option, for a total cost of $2200 for absolutely everything except ultrasounds, lab work and an epidural (not offered!), this would have been the most economical choice.
Use Aflac. If you have any Aflac policy that has maternity benefits (usually covered under sickness or hospital confinement) use it to help pay for hospital and physician fees. However, many Aflac policies don’t begin benefits until the policy has been in effect for one year. Therefore, this option only helps if you already had the policy in place at least three months before getting pregnant. Our family has had several Aflac policies for years; some of these policies do pertain to pregnancy and some do not. After the birth of our last baby, Aflac reimbursed us a whopping $1900 for hospital, physician and epidural/anesthesiology expenses.
It is unfortunate that there are so few options available to those who don’t have maternity coverage. It is even more unfortunate that the healthcare reform bill will make women wait until 2014 for even a little improvement in maternity benefits.