Is prenatal care covered under my health insurance?

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• Prenatal care is not always covered by health insurance
• The average pregnancy costs thousands of dollars even before the baby is delivered
• Prenatal care usually begins at eight weeks of pregnancy

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Most people assume that prenatal care would be covered by health insurance. Unfortunately, that is not always the case.  Not all health insurance policies cover prenatal care  anymore.

The number of health insurance companies that choose not to cover prenatal care is steadily increasing these days. In California, more than 800,000 people have policies that do not cover prenatal care, and that number has been rising for years. Since 2004, the number of policies that don’t cover prenatal care has quadrupled in California.

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Why isn’t prenatal care covered by my insurance plan?

The reason that health insurance companies are starting to move away from prenatal care is simple – pregnancy is very expensive. Prenatal visits start at about the eighth week of pregnancy and become more and more frequent as the pregnancy continues.

Each pregnancy could cost an insurance company thousands of dollars before the mother-to-be even reaches the delivery room when you add in the cost of:

• Tests
• Ultrasounds
• Any special concerns or doctor visits
• and more

How much prenatal care does my health insurance cover?

Even if your health insurance covers prenatal care, there’s no guarantee that the coverage will be good enough. You should especially keep an eye on the cap on expenses related to pregnancy.

There have been reports of some insurance policies capping benefit amounts as low as $3,000, even though an average pregnancy costs closer to $10,000 and with complications, it could be considerably higher.

You should also watch your claims carefully during prenatal care. Health insurance companies make mistakes just like everybody else, and sometimes a clerical error or a form improperly filled out by a physician can result in a mistakenly denied claim.

In one case, a claim was denied because it was submitted by the nurse practitioner in the OB/GYN office, rather than the doctor herself, and the insurance company didn’t have the nurse practitioner’s name on file, even though the office and the doctor were in their network.

How can I get prenatal insurance if I can’t get it through my employer?

If you have recently left a job, most employers are required by law to offer COBRA coverage for up to 18 months. As you’ve probably heard, COBRA coverage can be very expensive, but it is still usually less expensive than buying insurance off the street.

With the cost of prenatal care and the possibility of huge expenses related to complications in pregnancy, it is worthwhile to have insurance, whatever the cost.

If you were self-employed, it would be a good idea to check and see if you can get insurance through a union or other professional organization.

Failing that, check with any other clubs or organizations you belong to and see if they can get you a group rate on insurance.

If you are unemployed, you may want to see if your state offers any special insurance programs for pregnancy and prenatal care.

If all else fails, you can check around and see what various insurance companies have to offer. There are many health insurance companies out there, so there will be plenty of opportunities to shop around and find the best deal. In this age, it’s much easier than it used to be – you can just go online and compare offers.

Is there a way to get supplemental prenatal or maternity insurance?

If your health insurance doesn’t cover prenatal care or doesn’t provide enough coverage for your comfort, supplemental coverage may be the way to go.

Most health insurance companies offer supplemental prenatal or maternity insurance, but you usually have to ask. See your benefits manager and ask them what they offer in terms of maternity insurance and they can usually give you what you’re looking for.

If you don’t have health insurance, you can still get maternity insurance from most major health care insurance providers. When talking to them about maternity insurance, it would be a good idea to ask about coverage for the newborn baby, as well.

There are hundreds of reasons a baby may need extra medical care after birth, and those expenses add up quickly without insurance.

Another thing to keep in mind when looking for health insurance or supplemental maternity insurance is whether your doctor is covered in their network.

Most women have a preferred choice of OB/GYN and it would be really inconvenient to have to change for insurance reasons during a pregnancy.

When is the right time to check on prenatal coverage?

You’ll want to check on prenatal coverage early – preferably long before you need it. Many insurance companies consider pregnancy a pre-existing condition and they can require you to be insured with them for as long as six months before you become pregnant if you want the insurance to cover your pregnancy.

With this in mind, you’ll obviously want to know if your health insurance lacks prenatal coverage early so that you have plenty of time to be established with a new insurance policy before becoming pregnant.

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[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

1. https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuati…
2. https://www.healthcare.gov/preventive-care-women/
3. https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/coverage_examples_calculat…
4. http://www.webmd.com/health-insurance/aca-pregnancy-fa

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