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Blue Cross Blue Shield, Aetna: Sorry, Your Pregnancy Is A Pre-Existing Condition

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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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Comments:

413
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Hmm. If you two were to get married soon, would you then be able to enroll on his insurance? (But DO NOT do that if you aren't sure you want to! Doing it just for reasons like insurance/home/etc. isn't wise!)

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I'm leaning toward blaming the victim here.

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My advice? Marry the boyfriend if his health plan will cover you through your pregnancy at a decent cost. A JOP wedding will run under $100 in most states. People have done stranger things for health insurance - I know I considered it when I was uninsured for over a year out of college.

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Is marriage out of the question?

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Weird, I thought that as long as you didn't have a lapse in coverage, the Certificate of Creditable Coverage would have taken care of this. Obviously she became pregnant while covered by another plan...


(oh, and don't cry too much about $400/mo...plenty of people I know, myself included, pay quite a bit more than that just for self and spouse through work plans. Considering there's no employer portion paid here, $400 for COBRA is quite a deal)

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So...the health insurer doesn't want to cover her. Of course they don't. It'll cost them thousands of dollars. What's the problem here?

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Yeah, I'm sure an insurer would like to take your $175/mo in exchange for the tens of thousands of dollars that a pregnancy costs....


Sucks for all of us...I go to the doctor like once a year, but I still spend thousands upon thousands of dollars that line the pockets of these corporations. At least they're trying to save some money buy not writing a bunch of checks to this person's armada of doctors.

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Write your elected representatives. It's an election year, so they'll likely be falling all over themselves to make a big show of negotiation a fix to your problem. If said representatives are Republicans, you might also mention Planned Parenthood and their various family planning services, you know, the ones Republicans love to say they hate in order to pander to certain parts of their constituent base.

It's worth a shot.

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Let's just throw this out there - how about graduating college, then getting a decent job with health coverage, and THEN gettng knocked up? (Marriage optional.)

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@RandoX:

I'll have to agree.

These things happen.

But it's not like it wasn't preventable with proper planning and self control.

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COBRA is good coverage, but it will get expensive quick. Still, given what's going on, it'll probably be better in the long run.

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Having kids isn't something you should just willy nilly decide to do without extensive planning. It's unfair to the kid. Get an abortion, learn some responsibility, try again later in life.

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What a sad comment on our healthcare system. A few thoughts.


If you're unemployed (i.e. low-income), then Medicaid and / or WIC (nutrition assistance) may be options.


Also, if you pay the COBRA, (existing insurance) then transition to a group policy, HIPPA prevents them from considering pregnancy a pre-existing condition.


You could probably get hired at Starbucks tommorow, who offers healthcare for even part time employees. Look into employers and see who has the shortest waiting period for benefits.


Also, most cities or counties have an office that helps people in these situations. Call City Hall and ask!


Best of luck for a happy, health pregnancy and let's hope that our country someday joins every other major country on the planet and makes healthcare a right, not a product purchased only by those that can afford.

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Yeah, I mean, it's not exactly easy to get pregnant. There are steps involved, a few of them even being voluntary.

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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.

You're telling me that no one will hire you because you're pregnant? Because that's what I'm reading.
Get a job at a place like Starbucks that will provide group health insurance. Problem solved?

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@barometer:

It's unfair to the kid. Get an abortion, learn some responsibility, try again later in life.

I really hope you're kidding - an unplanned pregnancy is unfair to the kid, so just kill the kid and try again later?
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@barometer:


um, no. terminating a pregnancy for personal convenience isn't exactly a humane option either.

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"I make too much money to qualify. Fantastic."


Yes, that IS fantastic. That means you're not among the poor, and have the means for pay for insurance.


I mean, you went to college, right? Varsity athelete? I'm not convinced you're so poor you can't afford $400/mo for pregnancy care. It's not like you should be paying all of that, either. The baby-daddy ought to pay half of it.

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Barometer - you are an ass. You are subhuman.


OP - you have an option for health insurance at $400 a month. That's not expensive. You should consider yourself lucky to have an option at all. Also, maybe think about tying the knot so the kid has a father.

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I fail to understand why you think a health insurance company would accept $175 over the next 5 months in exchange for paying for thousands upon thousands of medical care for you.

You are in a poor position but why you expect a random company to foot the bill is beyond me.

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My GF is in a similar situation, she went through the state for coverage. She has a job but still qualified.

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Pay up the $400 a month - it will be worth it.

If it makes the OP feel any better I thought about using COBRA for my health insurance (also BCBS) but it was $981 a month.... so I think she is getting a bargain!

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Does Katlyn's boyfriend's work provide for "partner" benefits?


Before my boyfriend got a new job with health insurance, we were going to add him to my benefits by registering as domestic partners with the city so my health insurance would allow me to change my plan and cover him as my partner. Of course, I live and work in Minneapolis for a large company based out of San Francisco- so there's a lot of gay-friendly policies in play that also cover straight people.

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I believe you need to pay the Cobra rates.

My last baby...2 years ago, nothing special delivery...was $15,000. Luckily, I had insurance, but still ended up paying about 2k out of pocket after deductibles.

My DH's company switched insurance carriers in the middle of the pregnancy and we were worried that we would not have coverage, but because we had insurance already on the pre-existing condition, they could not block us on that issue.

Cobra rates or a marriage you aren't necessarily ready for, I vote for Cobra...it will be cheaper in the long run.

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Now just a cotton pickin' minute here...

The OP is by her own admission,um, heavy with child. I wouldn't cover her either-and I hate these companies practices more than she ever will. She should be damn glad that she can get COBRA coverage for $400 (split it with the boyfriend), but sweet Jesus, this is NOT evidence that the health care system is fucked.(It is,but not because of stuff like this)...

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An employer who doesn't hire you because your pregnant would be in violation of Federal Law. Of course its relatively hard to prove.


And to those suggesting abortion, because pregnancy without insurance is expensive, we can also kill older people. Since they tend to have a lot of medical expenses, it will help bring down healthcare expenses and eliminate the donor-organ shortage.


This should help make health insurance premiums more affordable for all of us.

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I never thought I'd say this, but I've got to side with the insurance companies here.

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I'd check to see if the pregnancy is covered under your boyfriend's insurance even if you're not. Some plans do allow this. It's his baby just as much as it's yours. Certainly once the baby is born he/she will be eligible to be covered. Make sure your boyfriend does the paperwork immediately so that everything is ready to go. It may not help you up to the birth, but it may help after the birth. Baby check-ups--even well-baby ones--are expensive. You're looking at probably a dozen times a doctor will need to see your little one from the time of the birth through its third month.

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$400 a month is expensive. Mine costs $75, and I think thats too much. Get married, buy the insurance, have the baby, get a divorce and take his money like a good American. I'm not very good at giving advise btw.

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@barometer: FAIL. Can a moderator remove this troll's comments?

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>Have any of our readers been in a similar situation? How did you get through it?

I peed on the stick and it turned blue around the same time my husband started his new job - one with great benefits, but I was worried that because I was pregnant beforehand, pre-existing, yadayada. Then I realized that there was no official diagnosis to get reported to anyone. Why should the insurance folks think I'm pregnant without a doctor's report? So I waited the thirty days for the insurance to kick in, then went to an OB, took a pregnancy test and at that point the condition started to exist.

That was eleven years ago and most of it isn't analogous to the OP (congratulations though!), but that's how I dealt with it. Has OP's pregnancy actually been confirmed by someone official?

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I was hired for an awesome job when I was eight months pregnant (I wasn't showing too terribly). I came right out and told the HR representative that I was pregnant and asked if I should mention it right away to my potential boss during the interview. She said NOT to mention it. Twenty minutes into the interview, I was offered the position and, before I accepted, I said that I couldn't, in good faith, accept the job if I didn't mention that I was eight months pregnant and would obviously be out on maternity leave. His only question to me was, "Are you coming back to work after your maternity leave?" My answer: "Of course, I wouldn't be wasting your time or mine interviewing for a job that I'm only going to be at for a month!" In hindsight, I was SHOCKED that there are people who would actually do that!


To make a long story longer...my point is that there ARE places out there that will hire you if you are pregnant!

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make the boyfriend pay half of the 400 bucks per month. Thats the price you pay sweetheart. Next time. condoms. The moment you agree to have sex is the moment you need to be willing to accept the results of your actions.


I dont mean to preach but just stay with the 400 bucks a month or like other said, get a job. I cant see someone denying you a job because they THINK your prego.


Any consolation, I had to pay 450 bucks a month for car insurance before i got married. A result of my 360 horsepower habit. I got what i deserved.

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@RINO-Marty: Tying the knot so that the kid has a father is not a good reason to get married. Bringing the kid up in a family that is full of resentment is not a healthy way to go.

They should get married if they would do it anyway, if they want to do it, if they really genuinely love each other. They shouldn't get married for the opportunity to raise the kid in a dysfunctional home.

The father had half the fun and should pay half the expenses. That includes COBRA, which is cheap. I'm healthy and a year ago when I was paying COBRA it cost me $750.

$400/month for COBRA is a hell of a lot cheaper than divorce.

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@nsv: Agreed. The father should shoulder half of the financial burden here.

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Or she has a new one. Either way. I understand life is complicated and I'm going over the line here a little, but this person sounds like she has reasonable options and highly unrealistic expectations. I say this as a certified despiser of health insurance companies, who should all be nationalized. ;)

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@hi: $400 a month is expensive. Mine costs $75


Your plan through work? Like it or not, your salary is reduced by a commensurate amount (just like people who brag "work pays for my healthcare!"). It's all about how the company chooses to divy up the cost.


Since (as I understand) COBRA means the insured person is paying 100% of the premium, $400 is an absolute steal for a low-deductible policy.

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I'm not exactly siding with the insurance companies, but I shed no tears for a girl who leads her life like this--makes poor choices--and then expects the world to accommodate her.

It's time for the world to show her some tough love. I'm sick and tired of people bending over backwards for others who have made just plain poor choices. Save the tears for those who are truly unfortunate through no fault or poor decision making on their own.

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Hey - welcome to the world of consequences. She had the right priorities - they were just in the wrong order. She made the bed; now she has to lie in it - literally.

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@Snarkysnake: A pregnant woman going without healthcare is NOT proof of our healthcare system being f'd up?


Assuming the mother and baby both live through the pregancy (if she were to go without healthcare), she will likely end up in the emergency room several times during her pregancy which costs more that scheduled non-emergency treatments. The baby will be far more likely to have life long problems in a pregnancy without full and proper care.


We pay these costs either way. When the uninsured go to a hospital, the cost of treatment is simply covered by the higher charges for everything we all pay directly, or via high insurance premiums. There's a reason a single aspirin in a hospital is a $15.00 charge. If she gets $175.00 a month insurance for a $15,000 pregnancy, we pay, via our premiums.


All the more reason national healthcare makes sense. Let the money we pay (whether premiums, taxes, etc.) go for actual health services and not large percent of healthcare dollars spent on administration of claims.

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Planned Parenthood has a $300 solution.

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I'm curious about what the Royal Exalted Republican Dick Armey would say about the situation. Would he invoke his "personal liberties" argument? What would he say if she did contemplate a termination?

Oh nevermind, he would tell the "whore" to "keep her legs closed!"

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This is pretty standard in health insurance (I'm in the insurance business) and it's not fair to blame the company entirely.

Pregnancy and childbirth is extraordinarily expensive medically, and if an insurer knows you're pregnant, they can't charge you enough in premium to begin to make up for their outlay, nor should you expect them to. It's just like if you had a disease that was extremely expensive to treat like cancer or AIDS--they won't insure you then, either.

I'm in favor of new insurance policies for these situations that charge a premium and co-insurance, maybe 70/30 or something like that...but health insurers aren't Medicare, and they're not just going to pay for your exorbitant medical expenses without blinking an eye.

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@MissPeacock: Apparently it's "Be mean to pregnant women day" on the Consumerist. See you tomorrow.

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@elmo3: Who said she made a poor choice? She seems to be happy about it.

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Get your graduate degree! Your college demands you have health insurance to attend there, and if you do not, they will give you a pretty cheap option for coverage. Already have one grad degree? Get another.

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@Snarkysnake:

"Damn glad" doesn't even BEGIN to describe how happy the OP should be to know that she has a COBRA option. Even if she got a new job, if I were her employer I would not be happy putting her on my employee-group health plan, as next year premiums for the entire group will increase due to the new employee's pregnancy.

I would be even less happy to be her co-worker and know that her pregnancy is taking money out of my pocket (if I am paying some of the monthly premium).

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My campus gave out free birth control. This chick was reckless and now faces the consequences. Tough shit.

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stop working and apply for medicaid