Katlyn is having trouble getting health insurance because she just graduated from college and is 15 weeks pregnant. She’s found herself in an expensive situation.
First and foremost, I am 15 weeks pregnant, unmarried, and I just graduated from college. This should be an exciting time for me, as I’m starting two new chapters in my life; unfortunately, enrolling for health insurance has become a burden.
Pregnancy is considered to be a “pre-existing condition” much like diabetes, cancer, or any other kind of health malfunction that would label me as less than perfect. I am a non-smoker, was a varsity athlete in college, and am of average height and weight. I have no other pre-existing medical conditions at all: I have no allergies, no asthma, and I’ve never had any major surgery. When I called Blue Cross Blue Shield, they denied me coverage due to my “condition”. When I asked if this would be a common concern for other health insurance companies, they said, “Yes, you will find this with all health insurance companies.”
So I called other companies. Aetna and Assurant both denied me as well. Every company told me I was more than welcome to enroll AFTER I had my baby. Being 15 weeks pregnant, it would be tough to me to find a job since I am beginning to show, so any hopes of long-term employment with health benefits would be a long shot.
However! There is a glimmer of hope! I can stay on my father’s health insurance for $400 a month through COBRA. Had I not been pregnant, I would have qualified for a health insurance plan for about $175 with BCBS. My boyfriend has health insurance through his company, but since we’re not married, I don’t qualify. I also looked into state health plans, but with my current jobs (all part-time, do not offer insurance) I make too much money to qualify. Fantastic.
Who says health care in the US doesn’t need to be fixed?
–
Thank you,
Katlyn
Unfortunately HIPAA, the Health Insurance Portability and Accountability Act of 1996, says that group health insurers cannot consider pregnancy a preexisting condition, but doesn’t have the same requirement for individual plans. That’s why they’re able to deny coverage in your case. Also, you try to should avoid any coverage gaps because according to iVillage:
HIPAA doesn’t apply to someone who previously had no health coverage at all and then gets into a group health plan through a new job. So if you had no insurance, got pregnant, then landed a new job with insurance, your new health plan would not have to immediately cover your pregnancy. You might have to sit out a preexisting condition waiting period, a period that could be longer than your pregnancy and in the meantime pay for your visits yourself.
We don’t want that to happen to you, even if $400 a month sounds like a lot to pay for health insurance.
Have any of our readers been in a similar situation? How did you get through it? Do you have any advice for Katlyn?
Pregnant without health coverage [iVillage]
(Photo: Jonathan Harford )
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OP should either pay the $400, get married and then go on hubby’s insurance. Or find a full-time job w/health benefits. Don’t see why she can’t marry the baby’s father to get health benefits-heck I know of people that get divorced just to keep their social security.
If she doesn’t do any of these options, then find low cost ob/gyn clinics where you pay on a sliding scale (at least get that all important ob visits). If still unemployed and no insurance–most hospitals have a program where at least the hospitalization part can be paid thru a financial aid program. If under a cetrain income, the hospitalization would be free–just not the drs, labs, etc.
State of AK gov workers had Aetna for insurance, we paid about $800 total a month, of which $400 or $300 is paid by employees.
Aetna (via our contract) does not consider pregnancy a “pre-existing condition” and it is covered. Sounds like the insurance is committing fraud. Taking money and not providing coverage paid for …
Another clear cut court case (like most articles on this site).
@mikelotus: About 27K people die each year in the US due to no health insurance. How does that compare to other places?
Of their own doing. If you’re legitimately too poor to pay for it, you qualify for free health care in every state in the nation. If you don’t qualify, then you can afford your own, but if you’re too stubborn to pay your own way and want to avoid the doctor and buy more shit for yourself, I have little sympathy.
Everyone I’ve seen whining about not having insurance either has the income to pay it but prefers to spend their money on toys instead, or really is too poor but won’t apply for state benefits.
@libbybee:
“You know, I’m not a Christian, but the whole “Let he who is without sin cast the first stone” thing really is appropriate in this case.”
so you are applying christian princples only when they help your argument?
If so then they should have been married before having sex.
I hate that people pick and chose christian belifes to attack others. Using it as some sort of sheild.
Yes the christian thing is to help her out. However it would also be to try to get her to see the error of here ways.
please dont preach what you dont belive.
@RandoX: I’d be interested in seeing statistics of victim-blaming for female OPs versus male OPs.
@opfreak: single-payer = the standard system used in every developed country except for this, piss-poor, arse-backward, sorry excuse for a superpower.
My parents married after my brother and I were born, it mad no difference in our upbringing.
Katlyn, graduate school is a fine idea. All the best!
@opfreak: Please learn to spell before you lecture others about their “belifes.”
@Kajj:
omg spelling police.
instead of discussing ideas, you attack the person, how big of you.
Ooh! Ooh! Check with your school’s alumni organization to see if they have a group health insurance plan you can get on. Mine does, and joining the alum organization costs me like $49 for lifetime membership. Worth a shot!
Here’s an example:
[gradmed.com]
Seems there should be two catacories for comments: “helpful” and “everything else.”
Sometimes the “everything else” is fun to read, argue with, and laugh at, but I for one would actually like to offer up the kind of advice she actually asked for.
For the record, the pregnant gal said essentially this: “Here’s my situation. Here’s what I’ve decided to do in this situation. What’s some advice on how to save money and live well in my situation with these decisions I’ve made?
Telling her that she made the wrong decision might be invigoration to your moral senses, but it’s not the question she asked and she’s not likely to read it.
I think that’s the biggest “suckyness” around here is that we’re always veering off-topic.
Should have played dumb about the pregnancy until she got coverage.
It’s impossible to blame the healthcare companies for not wanting to cover you. In states where you would automatically be covered (New York and New Jersey come to mind), your premiums would be a little under a $1,000 a month.
COBRA is the cost of the health care coverage to employer plus up to two percent in administration fees. She’s making out like a bandit.
@libbybee: If you don’t want to be judged on your choices, you probably shouldn’t reveal them on a public forum with the implication that you’re somehow being victimized.
I don’t know what the complainant thought. You can’t get cancer and then buy insurance later, why should the insurance company pay thousands and thousands of dollars for almost the literal definition of pre-existing? You can’t just be reckless like this and expect corporations to foot your bills later.
@dumblonde: I agree with you on the meds – I’d be SOL if I didn’t have my meds! There would be nothing better than my twitching and spacing out all over the place because of seizures.
@rdm: Keep in mind that this is only a temporary inconvenience. Both Clinton and Obama have stated that they wish to force insurance companies to accept the customers who “need it the most,” those with pre-existing conditions.
Wow, I’m surprised no one has suggested going outside the establishment on this blog.
Find a midwife. Have a home birth.
A homebirth will be less than the price of your 400/month COBRA (home births run about $2000-3000 with all prenatal care usually included in that cost)
You are young, and chances are your body is in the best condition it every will be to give birth. the probability that your pregnancy will be without problems is great. For young and healthy women, pregnancy shouldn’t be a medical condition, it’s a natural condition.
“That ain’t no Etch A Sketch. This is one doodle that can’t be undid, Homeskillet.“
Love that line.
Been there, except for me it was a surgery, not a baby. A Certificate of Creditable Coverage should cover this, as long as the dad’s insurance coverage didn’t lapse for 62 days (I’m pretty sure that’s the limit). The Certificate of Creditable Coverage got my surgery covered, so my co-pay was “only” $2500 vs. paying $15K out of pocket. Worth the phone call and fax.
I’d also recommend checking out a clinic/birthing center run by midwives. A lot of times they’ll do what’s called “global billing,” which hospitals won’t do. With global billing, you go in for all of your prenatal exams and you can give birth at the birthing center, and at the end of the pregnancy you get a bill for ALL of the services. It can be easier to pay out of pocket when you know how much it’s going to be and you have several months to plan. Give that a shot.
@libbybee: Uhhh – clearly you didn’t read the 340 comments prior to posting. No less than 50 posts, including my own, said, and I’m paraphrasing, “TAKE THE COBRA.”
Now, I reserve the right to judge and be judged. You can take the feminist, women-is-always-right approach, as you did, or you can ask yourself why this is even an issue. Here are the facts:
1) She can’t get individual health insurance on her own.
2) She’s unable or unwilling to retain employment with group insurance. Several have suggested employment as places such as Starbucks. There COULD be a bit of a bias, since before she mentioned being pregnant she mentioned being a recent grad, against taking such menial employment. Beggars can’t be chosers.
3) She has a (relatively expensive when compared to group rates such as BCBS through an employer) viable option through her father.
4) She didn’t even address the possibility of marriage with her co-procreator.
We’re talking about a life for which the two of them are completely responsible. Regardless of religious affiliation they have the MORAL responsibility to make EVERY decision framed by the fact that they have created a life and now must make appropriate decisions. They’ve already chosen poorly. Yes. They have. There are no such things as accidental pregnancies, only NEGLIGENT pregnancies. We are defined by the choices we make, right or wrong.
I feel for her and I feel for her child. Growing up in a single parent household, statistically, stacks the deck against him/her. I only hope her decision making improves. This one is a no brainer.
@RandoX: i agree with randox too.
it isn’t fair to ask a company to start spending thousands on your pregnancy when you jumped right in for coverage after the fact. just because you’re pregnant doesn’t mean the world needs to jump in and take care of you. i’m sure this sounds harsh but it isn’t everyone’s place to eat costs because you didn’t make a wise decision.
@AndyRogers: i couldn’t have said that better.
this isn’t a case of the world is against the female. this is a case of negligent behavior and the effects of such.
You might try setting up a small business and joining the local
chamber of commerce. in NYC, that is a “group plan” and thus you get
out of the embargo. I have done this successfully myself.
You should seriously consider a midwife as should most insurance companies. Birth at a hospital can regularly run in the $15-30k range. Birth at a birthing center or at home with a certified nurse midwife is approximately $4k and its a much healthier experience. The OP sounds like a wonderful candidate for a midwife being in excellent health.
Go see “The Business of Being Born” and you’ll see why more women are going the midwife route!
Some helpful links:
Q&A w/ Midwife
[thebusinessofbeingborn.com]
Find a Midwife/Doula
[thebusinessofbeingborn.com]
This is why more girls should take Tina Fey’s advice: Your mouth can’t get pregnant…
I was about to refute this woman’s claim because I have BCBS and it clearly states that pregnancy isn’t a pre-existing. However, I scanned to the end and read the reason her situation is different. Yeah, I get BCBS through work which is a group plan.
Amazing at the number of comments that make it sound like there will be death involved if heaven forbid she doesn’t see a doctor. I’m not saying that there isn’t, but in a majority of the world women do not see a doctor when they’re pregnant. Yes, they die more than in the U.S., but that’s not the majority. Otherwise the world would not be overpopulated. Talk about exaggerating.
If you can’t afford the $400 COBRA, look into home birth. There may be state/federal programs that can help, or you might be able to find a midwife who works cheap/gratis in situations like yours, or will work with you on extended payment. You don’t need a hospital and millions of dollars of medical equipment to do something mammals have done for millions of years.
Oh, and countries like Finland have a much lower infanct mortality rate than the US, largely due to home birth.
My sister and her boyfriend found out that they could legally register as Domestic Partners in their state which allowed my sister to be added to her boyfriend’s insurance without them having to get married first. Maybe that’s a possibility for Katlyn and her boyfriend.
It’s just a suggestion, but Planned Parenthood doesn’t only offer abortions, but also discount prenatal care, and since you’re pregnant….
@jscott73: “My wife and I used midwives with our fist child”
I didn’t know you could get pregnant that way.
OP: “First and foremost, I am 15 weeks pregnant, unmarried, and I just graduated from college.”
That should tell you all you need to know about whether the OP has a “good head on her shoulders.” F’in breeders.
@smartmuffin: Obviously not the right forum to enter into this discussion but my medications helped me get through college a graduate instead of kicked out because I didn’t have the strength to even get out of bed in the morning. For your sake, I hope you’re not a Scientologist.
I completely support health care reforms and a socialized medicine program. However, since no one I vote for ever gets elected and the majority has spoken, that’s not the way it is.
I wonder why this young woman didn’t seek out health care coverage before she got pregnant. It sounds like she only asked for it when she needed it because she didn’t want to pay monthly fees when she was healthy and unlikely to use the coverage. Insurance doesn’t work that way. You don’t get to sign up at the 11th hour and benefit from the premiums of others who have been forking over their money every month for years when they didn’t need it.
The system sucks, that’s true. But, this isn’t a case where you can blame the insurance companies. If everyone did as this woman is attempting to do, there wouldn’t even be the weak system in place that we currently have as you’d have all sorts of people expecting thousands of dollars of care for only several months of payments.
How can anyone in the US still not be in favor of universal health care administered by government, given situations like this?
In Australia i am covered (as all citizens and people with residency are) by medicare, it’s not a perfect system but here your pregnancy care is free and excellent.
I also choose to pay for health insurance (as this cuts down wait times and our medicare doesn’t cover dental, and you don’t have to pay part of the medicare fee in your tax) and i pay about $85 a month and thats with top cover that means my first 8 nights in a private hospital are $50 a night! and if i call an ambulance it’s covered by the plan.
Also the rules on conditions that are excluded are less strict, however there are waiting times before you can claim pregnancy related expanses like private obstets etc, however you are fully covered by the public system with a choice of obstetric led units, midwifery birth centers (with obstetric cover) and even hospital supported home birth in some places.
So i still can’t fathom the argument that you will be stuck with shit doctors in a system of universal healthcare, if you know and understand the system you actually have quite a few choices for quality health care, and you can still whip out your cheque book if you don’t want to wait or want a particular doctor to care for you in a private hospital. Also most GP visits are free under medicare! (this is however under threat, you still have to fight to keep the universal healthcare once you get it unfortunately).
ALSO: If i were in this situation i would definitely go with a midwife (we are excellent at caring for woman and newborns) midwives have far better outcomes than obstetricians in the care of normal healthy women. If i lived in the US and i were a millionaire i would still go with a midwife, speaking as someone who has done the research (for a living).
I’m willing to give the OP the benefit of the doubt. Just because she’s unmarried doesn’t mean her relationship is unstable. There’s no reason to automatically assume that this is unplanned. Even if it is, maybe her birth control failed. You’re a fool if you think that doesn’t happen ALL THE TIME. Finally, I think the decision to have an abortion is something you can’t begin to appreciate until you’ve been there. It’s all well and good to say you’d get one, but it’s entirely different when you have to make the decision to kill that little blob of protohuman.
I’m also guessing most of the asshats making comments about how she should have waited until X, Y and Z either don’t have kids and don’t understand how the world works, or they’re really bitter about how their kids have changed their lives.
There’s NO GOOD TIME TO DO IT. Right out of college with no job? Just started a job? Oh now THAT’s career suicide. Been in the same job for two years? Now it’s time for graduate school. Ok, now you’re 27, in a new job, and oops, you’re still living in a crappy apartment and getting knocked up now is still career suicide. Pretty soon, you’re over 30 and oh by the way, your chances of having a baby with Down Syndrome or being infertile are going up.
There’s no time when having kids is a ‘smart’ decision. Period. Daycare for our 1-yo son is a thousand bucks a month. Non-parent friends kind of make this sucking “ooomph” sound when they hear that, and that’s probably below average here in my midwestern city. Frankly, that’s nothing compared to the physical and psychological torture that is parenting. Don’t get me wrong, it worth it many times over, but anyone who thinks insurance is her biggest worry has never had kids.
IMO, as soon as you’re mature enough to know you want a kid and able to care for it, the time is as good as any, because it doesn’t get easier as you get older. People have a way of rising to the occasion, anyway.
That said, the OP should probably have gotten the insurance thing squared away sooner. She NEEDS to get it or she’ll wind up broker than broke. The father needs to pay for half of it. The insurance companies aren’t in the wrong (they’re businesses and this is a losing proposition for them). And although she has a ‘cheap’ ($400*7mo=$2800) option, the fact that a pregnant woman can get into a situation where no one will cover her medical bills in a sign that health care is broken. The societal costs of uninsured mothers are vastly higher than the cost of providing free care.
We pay more per person and live shorter lives than most of the western world. That’s the only fact that matters in the private-vs-public insurance debate, IMO.
“But it’s not like it wasn’t preventable with proper planning and self control.”
There is no such thing as 100% effective birth control.
For 100,000 years of human history and evolution, women’s childbearing age has been in their teens and twenties, and by the time you get to thirties, you’re eggs are becoming defective and by the time you’re over 35, you still have another 35 years to have a career but you’ve pretty much blown your natural childbearing years. For thousands of years of recorded human history, it has been the norm for teens to get married, have children, and become productive members of society. Feminazis think they can wave their magic college diplomas and make history and biology go away, but in real life it doesn’t work all that well. And telling girls to wait until after they have a college degree and are settled into a career (ie, AFTER their natural child-bearing years are OVER) to get married and have sex is just a stupid plan from the get-go. It’s the feminist pro-materialism pro-commercialism anti-family paradigm that treats younger women as if it’s some strange thing for them to get pregnant, and the completely greedy and irresponsible insurance industry that denies people their basic human right to health care that is the problem, not her pregnancy. She is the one behaving normally here, and her rights are being trampled on by greed-mongers who are only interested in taking advantage of her for a profit and don’t give a rats rear end about her health or her baby’s health.
It does not cost “$118,000″ to raise a child to age 18 – that’s a load of bologna. That more than my husband makes in two years of full time employment, and we have four natural born children and one legal ward – and the mortgage takes 1/3 of his take-home pay. We live comfortably on the rest. That’s just another scare-tactic they’re using to try and social-engineer the “lower classes.”
@juniper: Well, and I don’t mean to be a dick here, but that’s called insurance fraud. Insurance companies don’t have the resources to investigate if you knew before hand. If they did, they’d turn your friend over for fraud. Now, I’m more compassionate than to say she should go to jail, but she shouldn’t get coverage if she knew about it and lied. It’s just screwing the rest of us. Same with auto insurance fraud.
@AndyRogers: I’m so calling my wife “Teh co-procreator” from this point forward. Especially when we hang out with my daughter’s two godfathers.
You may want to look into your state medicaid, many states will provide healthcare to pregnant single mothers for the term of their pregnancy and a little while later as others have mentioned.
there is a possibility OP could qualify for state assistance for pregnancy
So, the rest of us should pick up the cost of her irresponsibility? Nice!
She is the one behaving normally here, and her rights are being trampled on by greed-mongers who are only interested in taking advantage of her for a profit and don’t give a rats rear end about her health or her baby’s health.
I pay for my health care, and I waited until I was 35 to get a dog so I could be sure I could pay for any possible medical catastrophe it would have. It’s a now-rare thing called “personal responsibility.”
Oh, but now that I’m reading your comment above, I’m wondering, what about my “right” to have you pay for my health care for free? Don’t you give a rat’s “rear end” about my health?
What age bodies typically got pregnant is not the question here. Since she isn’t going to be squatting under a tree to have the thing, she should have taken some responsibility here. But, no, here we have a college girl who has little ability with logic or economics. Fantastic. What are they teaching them in college these days? How to throw back Jell-O shooters?
One thing is the OP legally pregnant as far as the insurance companies go. This is something that comes in to place as well. Has she been to a physician or other practitioner and been officially declared pregnant or is she just by her own admission.
My step daughter had an issue with a miscarriage last fall where it occur just as she got a job, got insurance. She was about 9 weeks along but since she had not seen a doctor- when here most will not see you until you are 3 month in any way you are not legally pregnant and hence it was not a pre-existing condition.
I don’t mean to be a stick in the mud, but in order to qualify for medical insurance at a place like Starbucks, don’t you have to work there for a period of time, something like 90-120 days before you qualify for insurance?
Here is another option, that seems to be a solution to what the OP is looking for. I have no idea what it is or how it works, but I recall looking at it at one point for my wife, and it seems to be legit and could help our friend Kaitlyn. It’s called the Maternity Card (I have no relation to the people that do this, I just remembered looking at it).
[www.maternitycard.com]
Cheers!
I switched jobs while the DW was pregnant. We had to carry the COBRA (which was more expensive than mentioned in the OP) until the new insurance kicked in.
I’m in agreement that if she had health insurance while at school (either on her parents or through the college) and if her boyfriend’s employer will extend benefits to her as his domestic partner, that’s the way to go, even if they (including papa here) have to pay for COBRA to bridge the gap.
As an aside, COBRA isn’t as easy as you’d think. There’s a series of forms, notifications from previous employers and payments that have to be done just right before your coverage starts. While the coverage is retroactive to when your previous coverage expired, you can find yourself having to pay for everything in the mean time and filing claims later when your coverage is active.
I suppose there are problems with the Canadian system, chiefly brain drain to the states, but we haven’t had to pay a dime to have our kids delivered, get myself an mri on my knee, take the kids to the doctors, etc. etc. My work also gave me an option for additional coverage at $10 per month that paid for the upgrade to a private birthing room, too.
@SinisterMatt: She just needs to make sure that there are providers in her area that actually take that discount plan before she invests her $$ in it. Their BBB report is a bit dodgy.
Find a non-profit hospital, and settle on a payment plan BEFORE you go into labor. Also, don’t let them give you any extras: bring in your own kleenex, ibuprofen, diapers, baby wipes, etc. If you can think of it, bring it in. They can and will charge you WAY TOO MUCH for each and everything you use during your hospital stay. Make sure they aren’t sneeking anything onto your bill without your approval – read it before you commit, so you can contest any unapproved charges.
Not all bills are unmanagable. With my local hospital, as long as you stay in communication with them about how much you are able to pay, and then give them a little something each month, they are very understanding. I’ve even had a friend have one of her two foot surgery bills completely forgiven by them, because of her low income!
Yes, the health care system in our country is SICK. But with a little planning, you may be able to pull through.