Keep It In Your Pants Until You Double-Check Your Insurance

Maybe someday you’ll sit your future child on your knee and reassure him he was created with budgetary responsibility in mind. Those who check out the quirks of their health insurance policies beforehand and babymake accordingly will be able to do just that.

As Girls Just Wanna Have Funds points out, health plans are all over the map when it comes to what they will and won’t insure during pregnancy and birth.

Chief among considerations prospective parents should make is whether or not their insurer will hit you up twice to make them max out their deductible before full coverage kicks in. Example: A currently expecting mom may have had to pay out of pocket to reach the deductible on prenatal appointments throughout the year, only to have to do the same in 2012 when her baby arrives, bringing along a host of new expenses. Timing a pregnancy to take place entirely in one calendar year will save you the worries of being double-billed.

Other things to check are to what extent epidurals and pain prescriptions are covered.

Most importantly, don’t forget to negotiate medical bills after the fact. A phone call can save you 25 percent of your costs, leading to hundreds of dollars or more in savings.

Planning For Baby? Check Your Health Insurance First! [Girls Just Wanna Have Funds]

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  1. MutantMonkey says:

    Put the dick down!

    • Cat says:

      “Now, step away from the dick!”

      (I can’t tell you how many women I’ve told to do this when they complain about their “Dick” of a boyfriend)

  2. Cat says:

    A real nightmare for insurance deductibles would be giving birth to a New Year’s Day baby.

    Full deductible in the hospital the day before the birth, and full deductible AGAIN starting at midnight.

    And now, I will insert the obligatory “Single Payer!” comment here.

    • hansolo247 says:

      Yes, but before you can just go to a single-payer system, you have to attack the problem.

      COST.

      Our country can’t just magically go to a Medicare-for-all program without attacking it. The solvency outlook of medicare and social security is grim already.

      • FiorellaMajumdar says:

        Agreed, we have to manage cost, but how are you going to do that when the GOP is fighting the medical cost ratio requirements of Health Reform? There are a lot of health executives who’d have to go without their seven-figure stock bonuses and salaries if you make insurers show they’re paying for what they’re supposed to. If you want to knock down cost, then you also have to tell people they can’t smoke, drink or eat fatty foods because most of the cost of health care is related to heart disease and cancer, both of which would be dramatically reduced if you change lifestyles–but the GOP doesn’t believe in telling people how to live. And, finally, most of Medicare’s funds go toward the last two years of life, so are you going to kill Grandma so her terminal illness doesn’t drag on? Insurance depends on spreading the risk, and removing the individual mandate only concentrates risk making any attempt at reform too expensive, but any attempt to continue our broken system even more costly.

    • Nigerian prince looking for business partner says:

      That’s exactly why those with early January due dates plead with their doctors to induce at the end of December.

    • AllanG54 says:

      Sorry, you’re wrong on that…it goes by policy year NOT calendar year so if your policy starts in July you’re not responsible for a new deductible until NEXT July.

      • msbask says:

        Cat’s not wrong, just change the date.

        If my policy starts July 1, I’d pay a full deductible in the hospital the day before the birth (June 30th), and full deductible AGAIN starting at midnight (July 1st).

  3. Applekid ┬──┬ ノ( ゜-゜ノ) says:

    Is that why there are so many birthdays in September?
    And here I thought it was “Happy New Year” and “Happy Valentine’s Day” sex.

    • Evil_Otto would rather pay taxes than make someone else rich says:

      Our son was conceived before Christmas and was born on September 11. I don’t think you can do the deed as late as you think. Pregnancy is 40 weeks, not 9 months.

    • Oranges w/ Cheese says:

      My parents made me on Christmas eve and I was born in August, but I was premature by about 3 weeks, since my ears were still folded up.

  4. Dallas_shopper says:

    Or you could just support a single-payer system and hopefully, someday, we won’t have to worry about this stupid shit.

    • prizgrizbiz says:

      No, your elected officials will worry about it, as they figure out ways to give you less and less healthcare so they can ‘cover’ everybody and everything, or institute triage and delay that treatment until granny dies and doesn’t cost THE SYSTEM an inordinate amount of resources, and will publicize how if you really care about your comrades, the other citizens, you would rather die than be a burden. Then every political campaign until the end of time will be about which candidate will promise to spend more money on healthcare and shorten wait times, until we can afford nothing other than healthcare.

      • Dallas_shopper says:

        I lived in a country with a single-payer system for six years, so I’m familiar with how they work and their consequences. I still support it here.

        • Browsing says:

          I live in one now and even though our fees are going “up” on Jan 1st, I 100% support it!

          • Nigerian prince looking for business partner says:

            Just out of curiosity… Would a middle class resident in your country pay anywhere close to $15,000 to $20,000/year in taxes to cover his family’s health care and then another $2,500 – $5,000/year in out-of-pocket expenses?

            • Evil_Otto would rather pay taxes than make someone else rich says:

              I pay that now, under private insurance. (Well, to be fair, my employer pays 80% of it, but if it didn’t, that would be more money to pay me. Which would get eaten up by the additional taxes necessary to pay for a single payer system, so it’s a wash financially. Except for that whole ‘universal coverage’ benefit.)

      • BurtReynolds says:

        Death panels! Rationing by “stupid bureaucrats”! Less advantages for the wealthy! Removing a burden from business owners! Oh no!!!

  5. chiieddy says:

    Actually right now is a good time to conceive. You’re guaranteed the child will arrive in a single calendar year. That said, anytime between Sept and March would keep most of the expenses in a year since most plans have a single copay for office visits and majority of the expensive tests are after the first trimester.

  6. TheMansfieldMauler says:

    At least they pay something. Unless you’ve got some kind of magic insurance by working at a very good company, your insurance won’t pay a penny for a vasectomy (which is something that would SAVE them money in the long run).

    Doesn’t make any sense. I was getting insurance quotes once and they were higher because I had had an overnight stay in a hospital within the previous 2 years. But the hospital stay was for my appendix, which was now gone – meaning there was no way the new company would ever have to pay for an appendix operation. The risk had gone to zero for that ailment, but because I had been in a hospital overnight the rates were higher.

    • Cat says:

      I have sucky and expensive insurance, but they paid 80% of my vasectomy.

      [Well, It WAS done by a veterinarian. I am a Cat, after all.]

    • sponica says:

      as far as I know “voluntary sterilization” for both sexes is fully covered by my mother’s insurance plan….

    • Rebecca K-S says:

      My insurance blows, but they’ll definitely pay for vasectomy.

    • caradrake says:

      My old insurance would pay part of a vasectomy, but would not pay anything for a tubal. It did not make sense to me. Yes, vasectomies are cheaper, but a tubal is a little more directly likely to prevent a pregnancy.

      For that matter, my husband’s insurance was the same.

    • giax says:

      My other half got his vasectomy covered by his ex-wife’s insurance. Something to be grateful every time I have sex :D

      I would love to see a wider variety of health insurance policies with differences for breeder policies. If I’m never gonna have kids (other than maybe goat kids one day if I’ll live in the countryside), wouldn’t it make sense to offer an insurance plan without the added cost of the average women popping out 2+ kids in their lifetime? Cover the sterilization instead.

      • Shrew2u says:

        in California, we have exactly that – plans with AND without maternity coverage, just like we have plans with and without Rx coverage.

        My employer is awesome, so they offer both HMO and PPO plans. Before I was done breeding, I opted for the HMO plan (maternity coverage the only option). Each of my children cost $200 apiece from prenatal to hospital discharge: $100 for the doctor’s office including all visits and testing, $100 for labor, delivery and hospital stay. No other out-of-pocket costs involved.

        Now that I’m done breeding, I’m switching to PPO in January, so my husband can get a vasectomy with the best urologist in town (no HMO plans accepted) and see his regular dermatologist, chiropractor and other preferred specialists (also non-HMO-accepting providers).

    • Raanne says:

      nope – our insurance covers a vasectomy, and we don’t even have that great of insurance. We have looked into it. Its on the agenda next year. I can say that with the birth of the kiddo this year, we are hitting the elusive 7.5%AGI where we can actually deduct some medical expenses.

  7. iblamehistory says:

    It would be nice to be able to time pregnancy to whenever we want it to happen. Just don’t suggest that to my husband and I who tried 7 times before I finally got that positive HPT (with temperature charting, ovulation prediction tests–not just sex whenever we guessed I was fertile). And at only 7 tries, our journey was microscopic compared to what some people struggle with.

    Not that I have any huge issues with this post; I just get a little bothered when it’s suggested that you time pregnancy, or when someone says they want to avoid a certain birth day/time/month/season/whatever. It doesn’t always work out that when you decide you want to get pregnant, it happens instantly (unless you’re 16, in which case it seems to happen as soon as you look at a male).

    • Rebecca K-S says:

      No kidding. I have friends who were open to pregnancy and used no prevention for the first ten years of their marriage – nothing! – and then took nearly a year to get pregnant once they started actively trying.

      • jrwn says:

        It took my wife and I 7 years, after doing everything and giving up. We started fostercare and a few months before adopting our oldest daughter, it happened. So we have 2 daughters 2 years apart now.

    • kalaratri says:

      Why would you get annoyed when someone else wants to time their pregnancy? Some people have no issues getting pregnant or have a longer time table are willing to wait a few months before trying again.

      I refuse to be heavily pregnant in the summer and I choose that because of my own health issues (postural tachycardia syndrome for one) and yes, we timed my daughter’s conception to match my needs.

      • iblamehistory says:

        I never said I was annoyed when people decide what to do with their own bodies. I said it bothers me when other people casually suggest “oh, just time it!” just as it bothers me when someone says “just have sex 2 weeks after your period, that’s when you can get pregnant! Stop trying and it’ll happen!”

        My frustration with people who want to eliminate certain times/birthdays/etc stems from my time on pregnancy forums. People come in and say, “I’m going to get pregnant this month because if I wait until next month, my baby will have a Christmas birthday.” And then they come crying to the internet when they fail to conceive on the first try. Of course many people who want to time it are aware that it usually takes a while. There’s just so much facepalming involved with the masses who DO think it’s always as easy as “I’m going to get pregnant this month.”

  8. Quixiotic... Yea it's a typo (╯°□°)╯彡┻━┻ says:

    Good thing to know last thing I got out of the military before getting the boot was a vasectomy, thank you taxpayers. :D

    • Emerald4me says:

      You are welcome. And my wonderful husband got one of those too. He called it my Christmas present 10 years ago. It was what I had been asking for.

  9. John Gage says:

    You should also check and see if your plan has “deductible carryover.” Some plans will carryover any deductible met in the last three months of the calendar year. So if you meet your whole deductible in Oct., Nov., or Dec., you have then also met it for the next year.

  10. Snoofin says:

    I dont think health insurance should pay for anything related to having a baby. It makes insurance rates for us single childless people go up. (Using the same rationale people use for fat people and smokers). Why should I pay more for my health insurance to subsidize someone else having a baby. Having a baby is a choice and if you want to have one, you should be responsible for the costs involved.

    • Rebecca K-S says:

      I’m not sure that’s entirely true, since my understanding is it’s common for insurance companies to require a pregnancy rider, which you pay extra for, and sometimes have a separate pregnancy deductible you have to meet in addition to your regular deductible.

      • sponica says:

        depends on the plan….my plan requires a maternity rider.

        my mother’s plan covers the unborn from the moment the egg is fertilized….

      • Nigerian prince looking for business partner says:

        Virtually every individual (non-group) policy requires a maternity rider if you want to be covered for pre-natal care and delivery. In our case (Highmark BC/BS), the rider would cost us an extra $250/month.

    • somedaysomehow says:

      Like.

    • Chiclet says:

      I might never get cancer, but it doesn’t bother me one bit that other people’s cancer treatments are driving up my premium.

    • hymie! says:

      Why should I pay more for my health insurance to subsidize someone else having a baby.

      Because that’s how insurance plans work.

    • Awesome McAwesomeness says:

      Well, I never get sick. Why should I have to subsidize people who get strep throat, bronchitis and everything else 10 times a year? That’s not fair either.

      See what I did there? We can all bitch about something that isn’t fair with insurance. All of us.

    • Nigerian prince looking for business partner says:

      Then opt out of the maternity rider and save yourself a few hundred a month. Problem solved.

    • qualia says:

      Too bad. That’s how health insurance works. It spreads risk over a large pool of people who don’t all carry that risk. If people start excluding conditions they aren’t likely to get or aren’t sympathetic to (bigots may not be kind to, say, AIDS or Tay-Sachs sufferers), it defeats the purpose of insurance.

    • BurtReynolds says:

      Because there are benefits to society of at least some of us having children. Read up on countries who aren’t having enough kids to replace the population that passes on. China/India style growth isn’t preferable, but contraction doesn’t help anything either.

      Of course, folks who complain about things like this typically aren’t concerned about the well being of society as a whole. Me, me, me, me right?

    • Conformist138 says:

      I don’t have asthma, so my insurance shouldn’t cover inhalers. I am a woman, so men with testicular cancer are not my concern- throw them out. I have no kids, so nothing should be covered for anyone under 18. Anyone with an extra pound of fat is clearly unworthy due to their own gross laziness, so they should be blocked for coverage.

      Because this world is MY world, you just have temporary permission to live in it (until you do something different from me, then you’re out, because my world is only populated by clones of my own narcissism).

  11. Alliance to Restore the Republic of the United States of America says:

    There’s something wrong in the world when human beings have to plan new life around bureaucratic bullsh*t and corporate greed.

    • Evil_Otto would rather pay taxes than make someone else rich says:

      You must be new here. Welcome to the United States of Corporate Personhood.

  12. SporadicBlah says:

    This article hits home. We are due in March. The OB office my wife picked just so happens to be the most expensive in town and they space out their tests to one a visit so they have to see you every 2 weeks. Ive tried to creatively complain about the cost but Im not the one carrying the child. 26 visits, 2 deductibles and a $625 fee “just to be their client”. What really sickens me is all the Medicaid moms that use this office and dont pay one cent! A simple checkup usually takes 2+ hours with around 100 women in queue spread among 5 different waiting rooms. Im glad I dont have a vagina.

    • Shrew2u says:

      With my last pregnancy, I had 27 visits total because I turned 35 right before my due date (ergo, high risk). Regular visits (14 total: monthly, bi-weekly, then weekly), two ultrasounds, three blood draws for various tests, then twice-weekly visits to one of the nurses during the final month because one of my tests came back a bit outside of the norm and my OB wanted me to get fetal monitoring. The pregnancy before that was similar, because I had gestational diabetes. My first was the only low-visit one: I was 21, healthy as a horse and had a fairly boring pregnancy.

      I guess the wifey-pooh is in charge of choosing her OB, but I’d take the lead in choosing the pediatrician if I were you. Try to get one who DOESN’T accept Medicaid patients. My first pediatrician was outstanding (head of pediatrics at the local hospital yada yada), but his practice served everybody and it showed: always crowded with sick kids, small, dirty waiting room that looked like a prison reception room, ghetto parents, waited forever for a 15 minute visit, the whole nine.

      When I had my last child, I liked the pediatrician who saw him in the hospital so much that I checked out her practice and ended up switching all of the kids over. No Medicaid patients, separate waiting rooms for sick kids and well kids, very quiet and uncrowded office, we were always seen within 15 minutes of the appointment time or 30 minutes on a walk-in and I could always get a call-back, email or phone consult from my regular pediatrician on the same day (saving a number of office visits). It really is a world of difference.

  13. Laughing says:

    Now if someone is counting their pennies so that they can’t afford to max out their deductible two years running then they probably can’t afford a baby in the first place. Even after the baby is born they’ll have all the office visits for checkups and vaccinations and colds and other baby health problems. (Let’s not even get into the expenses of clothes, food, and education.) As such, the notion of timing a pregnancy to try to avoid this circus seems pretty silly, unless we’re talking a deductible of $10k or something.

    No, in reality, most people don’t time their babies and if they did time them then it would not pertain to health care expenses but practical things like “do I want to be waddling about in 90 degree weather this summer?”

    • Raanne says:

      deductible + 20% coinsurance, i’m easily at the $3000 personal max-out-of-pocket, plus you can add on $3000 in insurance premiums that i paid. And that doesn’t even count any of the bills that were for my son instead of for me.

  14. HogwartsProfessor says:

    If people waited to have babies when everything was perfect, no one would ever be born.

  15. Nigerian prince looking for business partner says:

    We learned these lessons the hard way with our last child.

    We had a $5,000 deductible and due to a reverted vasectomy, we had an unplanned pregnancy at the end of March (two years ago). That resulted in all of the prenatal care falling in one year’s deductible and the birth in another and about $10,000 in out-of-pocket expenses, in addition to close to $24,000 in premiums over two years.

    According to our OB, it’s very common for people to induce the last week in December, simply because they can’t afford to pay for the delivery on top of their pre-natal care bills.

    If the same thing were to happen again, I truly don’t know what we would do. We’re definitely uncomfortable with abortion and would love to have another child but there’s no way we could afford another $20,000 or $30,000 in health insurance and doctor’s bills. The options would essentially be to have an abortion or get a divorce and let the state pay for the birth.

  16. Cat says:

    What I can’t understand is why a normal human bodily function like giving birth costs so much.

    My dad paid the doctor out of pocket when I was born, under $100. Now it’s about $10,000 for a NORMAL birth, no complications. Now, that’s some SERIOUS inflation in 50 years…

    • azgirl says:

      It is because it CAN cost that much.. although if you are lucky, you can use a birth center and cut out all that crap..for 4K I am getting all of my prenatal care, and the delivery at the center (assuming the kid complies, and doesn’t go breach or something nutty.)

      My insurance may or may not pay for any of that.. but if I go to a hospital, they will gladly pay the 60% of the 30k a c-section will cost…after my 10K deductible of course..

    • Jevia says:

      Unfortunately, a significant amount of that increase is due to lawsuits. Something goes wrong during birth (or immediately before) and the parents sue the hospital and doctors involved, which increases their malpractice insurance, which causes an increase in their billing rates, which then causes an increase in the parent’s medical insurance. In fact, OB doctors have one of the highest premiums for malpractice insurance because when a baby is injured (whether there is really negligence or not), the lawsuit damages tend to be astronomical.

  17. bdgbill says:

    If people gave the slightest thought to their finances before making children we would all have a lot less problems and a lot more money.

    • azgirl says:

      Agreed.. I waited a long time before I chose to do this. I saved up an insane amount of money to do it.. although I have to admit feeling like an idiot when I get to pay all this money, and I see others doing it on the state’s dime.. or my dime really– so I get to pay for their births and mine.. bonus!

      I guess its that damn college education and years of hard work finally paybing off.. wait.. ummm..

  18. FiorellaMajumdar says:

    Let’s give a cheer for Corporate Medicine and Survival of the Richest! It’s certainly better than the socialistic “everyone gets care” government health programs in every single other industrialized nation. No wonder our infant mortality numbers are so bad that America is a Third-World Nation for newborns…I wonder how that stacks up with the “Save the Babies” blather from the “pro-life” rightwing?

  19. chatterboxwriting says:

    My insurance plan ticks me off. I was told I should not ever get pregnant because 1) I have so much scarring from previous pelvic surgery that they don’t even know if I could carry safely; 2) I had bladder augmentation surgery in 1987, which displaced my pelvic organs — so again, they don’t know if I could grow a little chatterbox and 3) I have kidney disease and hypertension, so I am a huge stroke risk. My OB/GYN said if I absolutely insisted on having kids, I would have to spend 6 to 7 months of the pregnancy in the hospital. So, trying to be responsible, I decided to get my tubes tied. Turns out, my insurance won’t pay for it because it’s a contraceptive procedure. So they’ll gladly pay like half a million dollars or more for me to lie in the hospital for six months, but they won’t pay for a one-time procedure.

  20. Vincent says:

    +1

    My wife and I would have already conceived by now if I weren’t so concerned about the rising cost of healthcare. I’m pretty sure if we continue down the same path, many middle-class Americans will simply not have children due to the cost.

  21. tiz says:

    be Canadian

  22. missminimonster says:

    My insurance company was so backward about the entire thing. I have an individual policy and a pre-existing condition, so basically my coverage is catastrophic. They wouldn’t cover my pregnancy unless there was some kind of emergency with the birth. So, I found a birthing center and paid out of pocket (it was affordable) and planned to have the baby there.

    Well, it didn’t turn out that way and I did end up having a c-section due to how the baby was positioned and also the fact that his heart rate was worrisome (and I hadn’t been induced or anything). Apparently whoever did insurance work with the hospital was able to put a good spin on it because when I got home there was a letter from the company saying that they’ve approved my hospital stay. Hopefully they will take the edge off of this impending bill. I’m dreading it already.