Health insurance is very complicated and it is mainly because there are so many factors that effect it. There is no single solution for everyone so it is very important to do your own research for your specific needs before you jump into it so you can avoid surprises and plan ahead. Here are some quick tips that may work for you.
Having a baby usually involves 3 phases from the insurance and doctor visit standpoint:
Phase 1 —- monthly prenatal checkup for mom (which get more frequent as the due date approaches)
Phase 2 —- labor & delivery (includes maternity care and newborn care for 48 or 72 hours after birth),
Phase 3 —- postnatal checkup for mom (6 weeks after birth)
Note: If you are planning to get an IUD or any other form of birth control implanted, it is separate and independent of your pregnancy. It is usually implanted after 10 weeks post-birth. See my other post about what to expect when you go for an IUD implantation.
If you are planning a hospital birth, here’s what you can try:
1. If your insurance company allows it, the first step is to register online with your insurance company so you can login and utilize all the resources on its website.
2. Search for in network and out of network doctors and hospitals in your area. In-network is usually cheaper. Check with your insurance company.
3. Do you research about each hospital. Once you like a hospital or doctor, you can Google him or her for more details, reviews, etc., which might help you compare and choose the best one for your specific needs.
4. Finalize two or three hospitals and clinics.
5. Some insurance websites have approximate cost calculator that gives you a heads up about what how much to expect on your hospital bill after the insurance company pays for it partially, based on your plan. Try to get an estimate of expenses (for both vaginal and c-section if you don’t know what you’ll have) for all 3 phases.
6. Call each hospital and confirm if they accept your insurance.
7. Ask if insurance company has a contractual rate with the hospital.
Other important questions for the insurance company:
1. Are all 3 phases a single package?
Can we choose different clinics/hospitals for each phase ?
2. What happens if we change insurance companies during or between these stages (voluntarily or due to loss of coverage)? How does it effect my insurance charges ? Will my old charges be reassessed according to new rate?
3. How do you deal with emergency visits during pregnancy?
4. What’s my copay for each service – blood work, ultrasound, urine test, etc.
5. When do we report birth? Within 24-48 hours? 30 days? 60 days? 90 days?
6. How do we report birth?
7. If I have an existing insurance coverage on my name and add my baby’s name to it, what is the effective date of insurance coverage for the baby ? Same as date of birth? Can we request a different effective date of coverage?
8. After my 6-week post natal visit, if I would like to get an IUD implanted during a visit that is scheduled for a date 10 weeks from birth, would that be covered by this insurance plan? What is my cost for it?
9. I would like to rent a breast pump from the hospital for a few months. Will this be covered ? How much do I pay?
10. I would like to get a FREE breast pump. Do I qualify ?