maternity insurance Q's

my2monkeyboys wrote: DH and I have been talking about trying for another baby (woo hoo!), but I'm a little concerned about the costs. Since DH is self-employed we have to pay for our own insurance, and there is no real maternity ins out there. What we have is a $2500 policy, which means that that is all they'll pay, we're responsible for the rest. That leaves me wondering how I will pay for the rest. I mean, we could do monthly payments, but I remember when I had Will that the dr made me pay my share in full by the 6th month. I know I wouldn't have $2-3000 a month to pay him upfront. Do they allow you to pay after the birth? Technically I did have another $1200 to pay afterwards bc Will ended up being a c-section, but other than that they wanted it all early on. I almost wonder if I'd be better off (meaning that the Dr would set up pmts with me) if I had no kind of coverage at all. (By the way, what do people do who have no mat coverage and don't qualify for medicaid-type help?)
Has anyone else deal with this type of thing?
Thanks!

momofone replied: maternitycard.com

I'm not sure what they cover if you wanted to look into it.
Not sure if it is insurance or a discount card.

PrairieMom replied: I know Blue Cross Blue shield covers maternity, I was told it was the only one out here that would.
I don't know what to tell you, insurance is such a joke. Its almost as if the entire system is screwed up.

MommyToAshley replied:
We are self-employed and know exactly what you are talking about. Maternity Insurance is the one inurance that I would never recommend. Most policies require you to pay premiums for a certain number of months before you even get pregnant (usually 6 months)... so if you get pregnant earlier than expected, your policy is null and void even if you had been paying premiums (that's money you don't get back) Also, if it takes you longer to get pregnant, then you have to keep paying those premiums, which could add up to being more than just paying the hospital bill. Our insurance agent agreed with us and said he would never recommend mat. insurance as it is the one time the insurance company knows that you are going to have a hospital stay and they want to make sure they recover their money.

What type of insurance does your husband have? We have an HSA and major medical only. So, we are basically self pay unless something really serious happens.

We don't qualify for any kind of assistance, so what we did was talk to our doctor, the hospital, and the labs. We informed them that we were self-pay and asked for a discount if we paid up front. Each and everyone of them gave us a discount for pre-paying.... it was usually around 60% savings. The biggest savings we saw was on the hospital stay... so be sure to pre-pay for your hospital stay. All of the doctor visits, labs, utra-sounds, and hospital stay ended up costing us around $10,000 over the 9 months. But, I had extra visits, labs, and several U/S because I was considered High Risk.

As for your other question...
If something happened to either the baby or yourself to make the stay in the hospital longer, your major medical should kick in. (This is different from Maternity Insurance). I would check with your insurance agent on this, jsut to be sure.

Cece00 replied:
I have to say, I hear ppl say insurance is such a rip, but its NOT when you have real medical issues.

I know this because DH has racked up quite a bit in medical bills in the past couple of days....

And Evan has OT once a week and after its all paid for, I owe very very little.

I guess if you are never using the insurance, it seems like a rip, but around here, we tend to use it Even just with 4 kids getting well checks & shots...I cant believe how much those appts are sometimes when I get the EOB's!

boyohboyohboy replied: stephanie what about something like a short term disablility insurance? do you have to be working to get that? like aflec? that paid me money while i was off, but it would it pay you so you would have some kind of income for awhile?

i just assumed that any insurance should be covering a hosp. regardless for the reason..thats really awful.
it seems like you would have to apply for something like medicad or assistance because we just spent 33,000 for andrew..

PrairieMom replied:
No, I totally agree with you. I just mean as far as getting coverage when you need it, and getting as much coverage as you need, they just Look for ways to screw you.
I would never ever ever go with out insurance. Actually, that is the only reason I work.
I am un-insurable by private insurance so I am forced to work someplace that has a group plan so that I can get covered. It is so frustrating and screwed up. Not to mention the fact that private insurance can raise your rates, with out even telling you, which they did to me 3 times in 2 months before I finally got rid of them.
then whole thing just makes me so angry.

jem0622 replied: I don't know if they would put off your paying if you don't have coverage. They might. I would talk with the billing coordinator and your OB/GYN office so that you understand it.

My3LilMonkeys replied: You could try looking into state funded programs. I know here in PA, if you are PG and there is no insurance available to you, you automatically qualify for the Access card (medical card offered by the welfare office, basically) for the duration of your pregnancy and 1 month afterwards. I don't know if your private insurance would disqualify you for such a program, but it can't hurt to ask.

luvmykids replied: The last time I checked, in NM anyway, there was NO insurance that would cover maternity other than a group HMO....do you or DH belong to any groups that have insurance benefits for being a member? I can't think of the technical name, but I remember when DH and I first got married we got coverage as part of a group plan through his membership in a trade association.

mom21kid2dogs replied:
In Ohio, regular private insurance knocks you out of this unless you meet the other income qualifiers (inome at or below the 180% above the Federal poverty level, own nothing of substance, etc.). Also, not all providers (docs & hospitals) will agree to accept Medicaid as reimbursement for services some some don't accept you as a patient within the system. I totally agree with you, self insuance sucks!

gr33n3y3z replied: Just call up the Dr and ask the price from start to finish and see if they take what insurance you do have
If not ask about payment plans or Other help thats out there for you they will know about that.
Here they have a clinic and depending on your income thats what you pay
I hear bad about the Dr's there but then again I hear the good

lovemy2 replied: I am not sure - we have really good insurance - great coverage and low co-payments but my husband works for the county as a Sheriff - I also have a supplemental disability plan which provided for the difference between my regular state disability and the rest of my salary so on maternity leave I basically had my regular salary - I don't know where you live but check with your County or State I know the State of NY has fantastic and pretty affordable programs for unemployed, stay at home and also self-employed people. Good luck

MommyToAshley replied:
You probably have insurance through your or your husband's work. The employer pays part of your premium and it's a group benefit, so your actual premiums are much much lower. Private insurance is different -- A basic insurance plan would cost us about $1500/month. So, that's why we are going with an HSA and major medical. We are only reallycovered if something big happens... for every day expenses and trips to the doctor we have to pay. I didn't realize what a big benefit insurance is until we became self-employed. So, for those that have to get private insurance, insurance does suck and it is a joke.

MommyToAshley replied:
We looked at that option as well, but I think most plans require you to have three employess. Rod and I could count as two but we would have had to hire someone and have a third employee to qualify.

luvmykids replied:
Thats a bummer, it was great as far as cost and coverage since it was the only way we could get into an HMO...there was a hefty fee to join the association in general but the benefits were so worth it.

I've been trying to find the name of the trade group ( something like Homebuilders of America but not quite) to see if they still offer it b/c I need to get coverage again, but I can't remember the name

MommyToAshley replied:
HBA and NARI both offer health insurance for contractors. I only know this because we do a lot of work for both groups, remodelers, builders and contractors.

lisar replied: The insurance here is pretty good. I paid #25.00 to have Raygen which included all the dr visits, sonograms, blood work, c-section, 2 weeks in the NICU, and me in the hospital.

I have United Health Care.

mommy~to~a~bunch replied: I wish I had advice for you! I don't know much about insurance, we use what DH gets through work (Medica), and it never pays for enough . Which is why we have about $4000 in medical bills to pay.

luvmykids replied:
I was just getting ready to start looking for them again, thanks!

Boo&BugsMom replied: If your doctor wants you to pay your share up front or after a small amount of time (6 months is a joke), I would switch doctors. We have good insurance now, but it wasn't always that way. I have had quite a bit of procedures and never once did a doctor or hospital tell us that we had to pay everything by such and such a time, only helped us set up a payment plan. I have a friend who has had 3 children without maternity coverage, and never did they once ask for everything to be paid by 6 months. Legally, they can not send you to collections if you are paying "something" every month.

my2monkeyboys replied: We have a policy through Golden Rule, which is under United Healthcare. It is just a policy that has a $3500 deductible, then it pays 70-90% of the rest, depending on the exact thing (some procdures they cover more than others). The maternity part that will cover $2500 costs us $60 a month with it paying the full amount after the first 3 months (which we've actually had it a little over a year).
Self-insurance certainly blows, but without it we'd be in financial ruin if something massive happened. I almost wonder if we'd be better off with something else, though... it's so confusing.
I think I'm going to just have to talk to the Dr. about everything and see where he stands. I'm not concerned about not having a dr to deliver the baby since I could always go to the ER, but for the regular check-ups I'd really like to be able to have those, ya know, just in case something went wrong...
I may look into that MSA insurance. Atleast we'd get back some of what we pay in. At the rate we're going now we're paying $320 a month just to have a $3500 ded we have to meet every year!
Thanks for the help ladies!

gr33n3y3z replied:
Same here also with Eds work insurance

My2Beauties replied: Wow I had no clue how bad private insurance is and I used to work for a health insurance company (except I was in payroll so I had no clue what went on on the commercial side of things, I wasn't part of the day to day sales and customer service of privarte insurance products we carried), however, i do know the insurance they offered us as employees SUCKED. We had to pay upwards of $300-400 per month for a $6000 deductible for family coverage It was horrible. Anyways, I'm so glad i do not have to deal with that now that DH has coverage through the railroad....so hon I don't have much advice but I wanted to offer and here's to hoping you get it figured out.

Cece00 replied:
I agree...we have no copays, except for inpatient & ER, and good coverage, 80/20, with many things like immunizations & well child checks 100% covered, and one check up per adult (general checkup) per year free....we have pretty good coverage.

Now dental insurance...I find it sucks across the board if you need any major work. Good for preventative care, crappy for anything big you need.

my2monkeyboys replied: Crystal, do you have ins through your work or are you self-covered?
I had great ins when I worked, but buying your own makes it tough to find good ins at a decent price.

Cece00 replied:
Are you asking me? If so..

Yeah, we have it through DH's work.

I know insurance for the self employed is not nearly as good, though. I think that really sucks