Questions to Ask Your Health Insurance Company When You're Pregnant

Published on: Sep 13, 2021fb-roundtwitter-roundemail-round
Questions to Ask Your Insurance when pregnant Lindsay Lange
The Story 

Pregnancy comes with a LOT of questions about the future, like this one: Who’s paying for all of it? 

Yeah. Who’s gonna chip in? 

You’re on your own for a stroller and college fund. But maternity and newborn care — services offered before and when your child is born — are what insurance companies consider “essential health benefits”. You’ll want to pay attention to your in-network options (more on that later). Having a baby qualifies you for a special enrollment period, meaning you can add your baby to your insurance plan if you’re already covered, or apply for marketplace coverage up to 60 days after the baby’s birth if you don’t have an insurance plan. If you have a qualified individual or small group plan (whether it’s a marketplace or an employer-sponsored plan) you’re covered for things like…

  • ​​Outpatient services. Meaning prenatal and postnatal doctor visits, gestational diabetes screenings, and medications.

  • Hospitalization and emergency services. This includes overnight stays and childbirth.

  • Newborn baby care. Meaning doc appointments and immunizations. 

  • Breastfeeding support and counseling (think: how to get your baby to latch and establish a feeding schedule) and breast pump costs (which, depending on your plan, might cover a manual or electric rental pump for a certain length of time or a new pump). 

Are some plans better than others for pregnancy? 

In general, plans with a lower deductible and higher premiums are better for expecting moms. Reminder: a deductible is the amount you need to pay towards your covered medical costs before your insurance company starts picking up part of the bill. A premium is the monthly fee you pay for coverage. Having a baby is an expensive health care event, so a low deductible plan makes sure that insurance kicks in for most of it. 

What about in-network vs. out-of-network coverage? 

If you’re choosing a new insurance plan, make sure to get to know your plan’s in-network providers (and check out our guide all about choosing the right insurance plan). Because in is better than out. You’ll usually pay way less for each appointment. Ask your OB-GYN or midwife for recommendations and try to find specialists within your network. Parents-to-be should try to pick a plan where the OB-GYN, midwife, hospital or birthing center, anesthesiologist, and the closest NICU are all in-network. Tip: Just because you’re seeing a specialist in the same hospital as your OB-GYN, doesn’t mean they’ll be in the same network. Many hospitals have providers that may or may not participate in-network for your plan. Andddd surprise — you’ve got (bills in the) mail. 

Tell me how to deal. 

Hold the surprise party champagne. One recent study found that about one in five families received one or more surprise charges, averaging $744, after their baby was born. If you think you’ve been charged for something unexpected, ask for an itemized bill, then call your insurance provider and explain the situation. They’ll probably then contact your health care provider on your behalf if there was a mistake. Be prepared for a game of telephone as you fight the charges.

What about health savings accounts? 

Health savings accounts (HSAs) and flexible spending accounts (FSAs) are accounts where you can save pre-tax dollars to pay for certain medical expenses. Lots of staples are eligible (see: prenatal vitamins and breast pumps). One of the biggest differences between an HSA and a FSA is that any money you don’t use in an HSA account rolls over into the next year, while an FSA is generally a use it or lose it situation. But you can only qualify for an HSA if you have a health plan with a high deductible. And since lower deductibles are generally recommended for expecting moms, it may make most sense to go with an FSA. 

OK, time to pick my plan. What questions should I ask? 

Ready, set, raise your hand. To avoid surprises, research or ask your provider lots of Qs up front, such as...

  • Which prenatal screenings are covered?

  • Does my plan cover breast pumps, childbirth classes, or doula/midwife care? 

  • Do I have to contact the health insurance company when I'm admitted to the hospital for labor and delivery (Some plans will make you pay if you don’t do this.)?

  • What kind of coverage do I have if I experience complications during the pregnancy?

  • What kind of coverage do I have if I deliver a premature baby?

  • Do I have coverage if my baby needs to stay in the hospital?

  • Do I need a referral from my primary care doctor to see a specialist in the event of complications?

  • How long of a hospital stay will the plan cover after delivery? Will the plan cover an extended stay if medically necessary?

  • What is my copay for the standard appointments during prenatal care?

  • Is there a copay for any extra visits to my doctor during prenatal care?

  • Can I add my baby to my health care plan?

  • If you don't have this noted before delivery, you will have to call the day the baby is born, otherwise all expenses related to infant care up to the time you make the phone call will not be covered. 

  • Do costs for the baby in the hospital count towards my individual out-of-pocket max or family out-of-pocket max?

  • Are the expenses of an at-home birth, water birth, midwife, or doula covered under my policy?

  • Is circumcision covered? 

  • Is late-term miscarriage covered? 

  • How does vaginal birth coverage differ from C-section coverage? 

theSkimm

No one *wants* to deal with insurance but everyone wants to save money. Finding a good plan is the best way to start a baby's life off on the right foot and cut down on surprise bills.

This content is for informational and educational purposes only. It does not constitute a medical opinion, medical advice, or diagnosis or treatment of any particular condition. 


Avery Carpenter Forrey, Becky Murray, & Jane Ackermann


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