News & Politics
Health Insurance Woes: My $22,000 Bill for Having a Baby
And I had coverage for maternity care!
Our six-month-old daughter cost over $22,000.
You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.
Nope. Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.
About 63 percent of Americans receive medical care through their employer and nearly 20 percent are uninsured. 16 percent receive some insurance through a federal program like Medicaid or Medicare. The rest of us—between 5 and 7 percent—pay for insurance out of pocket. That’s a small share of the total at any one time, yes. But it amounts to at least ten million people (the American Medical Association says it’s more like 27 million; that number would be even higher if premiums weren’t out of reach for many.) Over the course of our lives, roughly one in four Americans will buy their own health insurance. We’re the freelancers, the newly unemployed, the entrepreneurs, the people who are transitioning out of college or grad school or between jobs, or the ones who work for employers with fewer than 20 employees. Our numbers are growing. An estimated 14,000 Americans lose their job-based health insurance every day.
The individual insurance market is like that old joke about the food being terrible and the portions too small; it’s expensive, shoddy, and deeply unsatisfying. Those of us who buy into it are not protected by the federal and state laws that govern employer-based health care. In fact, there’s no one looking out for us at all.
I didn’t know any of this 20 months ago, when my partner and I began hunting for health care. After several years in Europe—where coverage was, as goes the cliché, comprehensive and nearly free—we came back and searched for policies that provided maternity benefits. We found that health insurance purchased on the individual market hardly ever extends to pregnancy. A few policies offer the opportunity to buy additional coverage—known as a “rider”—to tack a maternity benefit onto your plan. It’s almost always only available in anticipation; if you try to buy the rider once you’re already pregnant, the fetus becomes a “pre-existing condition.”
Last fall, the National Women’s Law Center issued a report detailing exactly how women who want to bear children are derailed when searching for out-of-pocket health care. Only 14 states require maternity coverage to be included in insurance sold on the individual market, according to the Kaiser Family Foundation. In contrast, the Pregnancy Discrimination Act of 1978 requires employers with more than 15 employees to include maternity benefits in their health insurance packages. “We looked at 3,500 individual insurance policies and only 12 percent included comprehensive maternity coverage,” said Lisa Codispoti, Senior Advisor at the National Women’s Law Center. Another 20 percent offered a rider that was astronomically expensive or skimpy or both. One charged $1,100 a month; others required a two-year waiting period.
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Comments
Thanks so much for sharing your story!
By: cmhmom | Wed, 12/30/2009 - 14:38
Your story was familiar. I carry my own PPO. Our 15 month old cost a little over $14,000 including monthly premiums, prescriptions and ultrasound. My $10,000 deductible was voided because the cap does not apply to pregnancy. Thank you for bringing attention to this reality.
Maternity insurance requires high premiums!
By: golf7 | Mon, 12/07/2009 - 18:09
Insurance companies fully know that the average child birth along with prenatal care, etc will cost in the neighborhood of $15k-$20k per child! And that any woman getting a maternity rider has about a 50% chance of using it in the first year, and 75% chance by the second year. So when they crunch the numbers it requires a maternity premium ADD ON of $625/month (if they didn't have a coverage limit). This is in addition to the basic health insurance policy with might cost $250/month, so you're looking at a total monthly cost of almost $900/month. The reason unlimited coverage maternity costs so much is that the probability of it being used is very high (50% to 75%). Compare that to a basic health insuance policy, where the probability of the insurance company having to pay out a $15k-$20k claim in any particular year would be less than 1%. This is the rub folks, no way around it! The chance of the insurance company having to pay a big maternity care bill is virtually a sure thing, so it is not actually insurance. The way to attack the expense problem is to get competition in the marketplace, something that birthing centers and midwives address and why they are a growing option for many people.
What courses/qualification is
By: jhonplayer | Thu, 11/26/2009 - 05:45
What courses/qualification is required for globe-trotting travel industry related jobs ?
cheap travel insurance
Individual insurance
By: jb1966 | Wed, 11/11/2009 - 21:11
The most I've gotten out of individual health insurance is motivation to eat right and exercise.
My insurance boat sank
By: encelia | Thu, 09/17/2009 - 22:00
I read your article with great interest, as it echoes what I am currently going through. Two years ago my son was delivered via emergency c-section at 32 weeks because I developed severe preeclampsia and HELLP syndrome. At the time, I was covered by my employer's health insurance policy and had to pay only $500.00 out of a total of $275,000.00.
I am now self employed and would like to get pregnant again. However, because of my history with my first pregnancy I am completely shut out of the maternity care insurance market. To make matters worse, because of my history I need extensive testing before conceiving and my insurance company refuses to cover any of it, as they only cover catastrophic care and some preventative care.
Right now, it feels like I have been sterilized by the insurance companies. They simply won't cover me. Even if I carried my next baby to term and had a completely healthy pregnancy (which is unlikely) it would cost a minimum of $25,000 PLUS an additional $7,000 for preconception testing. I'm just so sickened and saddened over all of this.
Doing the right thing
By: jeanniez | Wed, 09/02/2009 - 14:58
What gets me is that she really tried to do the right thing.
If you have normal insurance, having a baby is more or less covered.
She knew she needed coverage before she was pregnant to cover herself so she was paying higher premiums before she was even sure she could get pregnant.
The insurance company sold her the policy knowing she was looking for maternity coverage.
If they had been upfront about the $3000 cap she might have said "no thanks" and researched how she might pay for the baby otherwise.
We need a clear and accountable way for insurance companies to lay their coverages out so people can see what they are really getting. Having a cap for services printed in the footnotes is no way for important information to be relayed to customers.
BCBS is UN surance
By: drmom | Tue, 09/01/2009 - 09:50
I have the same situation, but my BCBS Unsurance is "provided" by my employer, a medical university/hospital system at which I am a faculty member...supposedly a prime position with prime benefits. I also pay premiums for no care. I also pay fully for every visit, every test, everything. BCBS pays nothing. Never has. I, too, called the representative and asked EXACTLY what my mandated deducted premium (from my check) covers. She said, "Your premiums cover my paycheck for working for BCBS...you are stupid to think we have enough money to cover your health care!"
So, please don't feel that it is just for those who buy policies on their own. We, too (10,000 employees) are being screwed by BCBS. Oh, lest I forget, the CEO of BCBS bought the most expensive lot on Sullivan's Island, SC (we are in Charleston) in the history of the island. Yes. He paid millions for DIRT. He has not built his home yet. So, this is where our premiums go, to the pockets of the CEO of BCBS, the source for UN insurance. You can report this company for insurance fraud. I have. I will do it monthly until they get tired of hearing from me and do something about it.
I am considered to "have" insurance and care. What a crock of crap!
Really!
Public Health Insurance
By: florida health ... | Mon, 08/31/2009 - 14:49
As the public option for Health Insurance slowly starts to disappear I'm beginning to become more convinced that I needed to revisit my health insurance policy. I contacted a company called East Coast Health Insurance Florida health insurance and they informed that regardless of whether a public plan came to fruition they would continue to represent and deliever all our health needs. I currently have BC/BS with a new plan called Dade Blue which is extremely affordable. I think their number is 888-803-5917.
Why it's "insurance"
By: joss | Sat, 08/29/2009 - 19:26
The first ridiculous category of comments is the "insurance is not for routine stuff, only for catastrophes"
1. Here's why you get health insurance for "routine" maternal care: because no one can know if it's going to be routine until after it's over. If there was the possibility of an oil change going horribly wrong, it probably would be covered by car insurance. Her policy would never have covered premature labor, time in the NICU, PROM, placenta problems, miscarriage, D&C, hypertension, gestational diabetes, hemorrhaging, or what-have-you with its ridiculous $3,000 cap. Anyone who thinks that you can go into pregnancy knowing exactly what will happen and how much it will cost doesn't know what they're talking about.
2. When I didn't have dental insurance, I still made sure to get my teeth cleaned twice a year, paying for it myself. Now that I have dental insurance, it covers dental cleanings even though that is a predictable, routine cost. For whatever reason, health and dental insurance aren't like flood insurance and car insurance. They just aren't. They cover routine care and up. You can argue that they shouldn't in the future, but that doesn't make this woman irresponsible for expecting them to now.
The second is the focus on the what is perceived to be her lack of responsibility (for not being prepared to pay for a birth out of pocket) instead of the obscene fraud perpetrated by the insurance company. The company presented a service to her that it had no intention of ever performing. If I had never heard of health insurance covering a birth before, I might think "well, if it sounds too good to be true, it probably is." But that's not the case. That's why the headline is what it is: the expectation, even without this particular company selling the idea, is that if you have researched and purchased health insurance you HAVE done what you are supposed to do, what is responsible.
What you needed was financing
By: jimmy_w | Fri, 08/28/2009 - 16:13
Sarah,
What your story illustrates, is that financing, not insurance, was your primary problem.
You may not be able to afford $22,000 at one time. However, you could have afforded an installment payment program to pay back the $22,000 over a few years.
As you described in the insurance market, pregnancy and delivery is more of a known cost than an insurance-type risk event. We know pretty much how much it will be, and most people know when they want to make it happen.
You said you want to make maternity coverage a requirement for all medical insurance. But what about all of the people who do not want kids (and some of whom hate kids)? Is it really fair to make them contribute to your happy life event? Or would you be willing to subsidize a family that chooses to have 8 kids, by paying for part of their hospital bills?
As I detailed in my blog article, http://americanmohist.blogspot.com/2009/06/health-financing-alternative-... , a financing program (or medical loan in England) can make healthcare more affordable to many people, while still keeping some accountability. It looks like it would have made a difference in your case, too.