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.

Tags: carefirst bluecross blueshield, health insurance, labor and delivery, maternity care

Sarah Wildman has written on the intersection of culture and politics for the Guardian, the New York Times, and Slate; you can read more at www.sarahwildman.com

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