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Paying the Price for Maternity -- Till Health Reform Kicks In

2 years ago
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Sarah Wildman
Sarah Wildman
Foreign Policy Correspondent
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Maybe, in four years or so, the e-mails will stop coming. Maybe, in four years, women will stop Googling "women + maternity + individual insurance" or "pregnancy + individual market" and then writing to me, telling their stories, plaintively asking for help finding health insurance that covers pregnancy and childbirth on the individual market.

In 2014 insurance reform fully kicks in, and with it the maternity care loophole in the individual insurance market should close.

Until then, I field the messages, commiserate, and see if I can connect these women to resources. I feel I owe it to them; I know how they feel: I was denied coverage for the labor and delivery of my baby in 2009. I fought the system for seven months, and I won -- but only, I believe, because I wrote my story.
In 2014, insurance companies no longer will be allowed to separate out prenatal care, labor and delivery from "normal" women's care, calling the decision to have children a "choice" rather than a "need." No longer will c-sections be considered pre-existing conditions for women of childbearing age. No longer will women go into debt to have a child or be forced to reconcile the astronomical cost of pregnancy and childbirth without the aid of insurance.

What is a medical necessity? What is a choice? Health insurance, in theory, is supposed to cover a wide range of circumstances and diseases, most of which most of us will not encounter. With employer-based health insurance, risk is pooled and women pay for erectile dysfunction and prostate cancer; men pay for maternity benefits. But on the individual market, nothing is a given. "Rice is rice and gasoline is gasoline. When you buy it, you know what it is," Karen Pollitz, a professor at Georgetown University's Health Policy Institute, told Consumer Reports last year. "Health insurance -- who knows what it is? It is some product that's sold by an insurance company. It could be a little bit or a lot of protection. You don't know what is and isn't covered. Nothing can be taken for granted."

Until 2014, if you're a woman on the individual market looking to find maternity care coverage, good luck. Only 12 states require insurance companies on the individual market to provide such coverage. The rest are a hodgepodge, a labyrinth of patchwork care and expensive fees. Many packages require a pricey maternity "rider" -- extra money paid out each month, sometimes with a year or two-year waiting period -- that eventually goes toward paying maternity care, or a percentage of it. But some plans don't even offer that option. Some states don't offer any options at all. Having a baby without employer-based health care coverage is a fast-track path to bankruptcy.

Take Lindsay Williamson, a (married) mom of one, who lives in Nevada, one of the worst states for women's health coverage. "Several years ago my husband started a small business with a partner who resides in London, England," she wrote to me recently. "My husband is the only full-time employee in the U.S so we do not qualify for small business insurance (you need at least 2-3 employees)." With her first pregnancy, her husband was employed by MGM Mirage, so the couple was insured. But then he struck out on his own.

"We have purchased private insurance for over 2 years now," she continued, "paying close to $400.00 a month through United Golden Rule. We have been told there is absolutely no coverage for pregnancy with this insurance. I have met with numerous agents and researched extensively on the Internet. Most companies in Nevada do not offer maternity coverage. Medically, I will need a C-section for the next child, which is apparently a pre-existing condition. We make too much to qualify for Medicaid (but we are not wealthy by any means). I do not have $20,000 in the bank to cover a pregnancy as one agent told me to do. Another agent told me that having a child is a 'lifestyle choice' and not a medical issue. We are so lost with this!"

Lindsay wanted to know if I had any suggestions, noting, "Nevada is highest in foreclosures, and one of the worst states for education and medical care. We are educated responsible people and we are up against a wall. I have been trying to find out if the new healthcare bill in Congress will help us but I have not yet found the answer. Thanks for listening -- any advice would be greatly appreciated!"

Appalled that insurance brokers had called Lindsay's hope to have another child a "lifestyle choice" (a certain selfishness seems to have been implied) and hoping that Lindsay had overlooked something, I turned to the National Women's Law Center for advice. They confirmed what Lindsay had already found: She and her husband work for a company too small to qualify for small-business health insurance and they make too much for Medicaid, Bridget Courtet at NWLC wrote me. And Nevada's individual insurance market is notoriously awful -- riders for maternity care often offer far less than they promise (a story I know well). Bridget suggested one, flawed, option is to negotiate with the hospital, which is what the Williamsons have decided to do.

"After extensive research I have found that my only viable option is to negotiate with the hospital and doctors," Lindsay wrote me this week. "I contacted the hospital where I delivered previously and that quoted me $5,400.00 for the C-section, and $2,000 for prenatal care. So we have to save up for approximately $8,000 dollars to have a baby. Still not great, but at least I have a number to work with, no hidden fees or denials of coverage."

Think that haggling with a hospital to have a baby sounds ridiculous or improbable? In the midst of my battle with CareFirst BlueCross BlueShield, when the hospital creditors were calling about the bill for my hospital stay, I was told I should have negotiated a "$3,000 flat fee" with the hospital -- an option, the administrator on the phone confided to me, that is offered to the uninsured (if I could promise to give birth and be out of the hospital within 24 hours). But we weren't uninsured! I protested. He said that for maternity, basically, you were uninsured. (And who can promise 24 hours, anyway?)

As the National Women's Law Center reported in 2008, "Individual market insurers may consider a pregnancy as grounds for denying a women's application, or as a 'pre-existing condition' for which coverage can be excluded. . . .The vast majority of individual market health insurance policies that NWLC found do not cover pregnancy at all." Just 12 percent of the 3,500 plans NWLC reviewed nationally offered maternity benefits, and 9 percent offered less-than-full coverage. Most involve astronomically expensive riders that may be pricier than remaining uninsured. Pregnant already? Don't even try to find coverage.

Women write to me because I found this out the hard way. After spending a few years in Europe I came back to the states and looked for insurance that would provide maternity coverage. We wanted to start a family; we wanted to be smart about it. We talked to insurance brokers; we talked to friends. We settled on CareFirst BlueCross BlueShield and began paying a $126 per month maternity rider on top of the approximately $500-a-month cost for general care. And we paid that extra fee for the six months before, and the nine months during, my pregnancy. With co-pays and other expenses, we spent $12,000 buying -- we thought -- coverage for birth. Trouble was, buried in all the paperwork was a clause capping the fees to be paid for prenatal care, labor and delivery at $3,000. There isn't a pregnancy in America to be had for that small sum. And CareFirst knew it. When we left the hospital we received a bill for over $10,000.

First we tried the normal way, through calls to customer service. Agent after agent. Month after month. They never even bothered to tell the hospital they were reviewing our claim, which began to sound like a we say/they say argument. So I decided to write a story about it -- the frustrations, the humiliations, the anxiety and the path that a seemingly educated couple can follow and still go wrong. When I told the insurer's press department I was writing about the fraudulent maternity policy I'd been sold, doors began to open. Eventually they paid 90 percent of the fees, saying the benefit had just changed, we simply hadn't been notified. House Speaker Nancy Pelosi's office invited me to tell our story on Capitol Hill (you can watch my testimony here, starting at minute 2:26). We were the poster children for a flawed health policy, and we had fought back.

And so, I had won. Sort of.

The craziest thing is we're still, like the Williamsons, stuck. Neither my partner nor I have employer-based insurance. We now pay more than $800 a month for coverage. With CareFirst. Our daughter is on it as well. And we still pay for the maternity rider because, if I get pregnant again before 2014, we don't know what else to do. In four years, there will be high-risk pools we can enter into. But until then, we're hemorrhaging money for a policy that barely pays the medical bills. Still, we fear changing it till 2014. At least it's something -- $38,400 worth of something, if you add up these next 48 months. But that's too scary to do.
Filed Under: Woman Up
Tagged: babies, feminism, health in, health insurance, health insurance reform, HealthIn, HealthInsurance, HealthInsuranceReform, maternity, national womens law center, NationalWomensLawCenter, pregnancy, women, womens health, WomensHealth
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mermaid757

Thank you for vocalizing this issue. It baffles me that, because I quit my corporate job to pursue my highly successful freelance job, and my husband is currently in school, I cannot get adequate maternity coverage. I "fortunately" could get a premium coverage with my insurance for pregnancy, but it is $700+ per month more than what I have, which, doing the math, ends up being close to if not more than if I just paid out of pocket for expenses. As such we have put off having another child until we can save $10,000+ aside for hospital bills. So much for saving to have a home.

2014?! That is very far away and we can't wait until then with our family.

What troubles me most is that low-income people can get in and out of the hospital with pregnancy almost for free, but those that are making a decent living and paying tons of taxes cannot get adequate help for coverage to deliver children.

I have already had one child and it went pretty smoothly. Home birth, though I would have never considered it, is sounding pretty good right now.

August 04 2010 at 2:56 PM Report abuse rate up rate down Reply

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