News & Politics
Health Insurance Woes: My $22,000 Bill for Having a Baby
And I had coverage for maternity care!
And as unsatisfying as individual-market coverage is, it’s also easily taken away. After 36 hours of labor, I ended up having a cesarean section. Now I’m considered at risk of having a second; the c-section is a pre-existing condition. As a result, unless I’ve been sterilized, I may have a hard time switching policies within the individual market.
In both the House and Senate, proposals have been floated to deem maternity care essential for everyone, not just those with employer based insurance, to do away with pre-existing conditions as a means to deny coverage, and also to end the rampant practice of gender rating, or charging women more than men for insurance, on the premise that we go to the doctor more. Sign me up. In the meantime, I’ve been stuck on the phone with hospital administrators.
In early June, our billing disaster came to a head. A hospital administrator told us that because CareFirst had never bothered to let Shady Grove know our claim was under review, we had to pay, in full, in the next 90 days. Otherwise, the bill would be sent to collections. He cheerfully suggested we just “put it on a credit card;" the hospital had run a credit check on us and said we could afford it. He noted “upon arrival in the hospital you agreed to cover all costs regardless of insurance reimbursement.” Of course we had. After 12 hours of laboring at home, who wouldn’t sign a form to ensure proper medical treatment for mother and child? Plus, we thought we were covered.
To my own amazement, this story has a happy ending—but only, I think, because you’re reading it. In early June I called CareFirst’s press reps and told them I was writing about their “crappy” maternity policy. That day, I got kicked up the food chain. With a top Customer Service manager at our service, our claim went back under review. Last week, she called to tell me the policy had been reviewed and changed after feedback from customers; “members were really unhappy with the benefit,” she said.
This change, she said, applies to CareFirst clients throughout the District of Columbia. We will no longer have a $3,000 cap per pregnancy. In fact, the manager continued, this change should have been in effect since fall 2008, but due to poor “internal communication” no one “on the front lines” knew. CareFirst has now paid 90 percent of our hospital fee. And the company, the rep promised, was about to adjust the claims paid to all women denied coverage since the change went into effect.
When I asked if this had come about because I’m a journalist, the rep demurred. The timing suggests otherwise, but it’s possible, at least, that we might have won because we put up a fight in the first place. Karen Pollitz, the project director at Georgetown’s Health Policy Institute, says insurance companies assume most people won’t challenge a denial of coverage even if they’re entitled for a review. “The individual market stinks,” Pollitz told me. “It’s terrible. It’s broken as can be. Coverage is unsubsidized, largely unregulated. You are at the mercy of the insurance company and if they think you will make a claim they will avoid you.”
Six months of calls, anxiety and aggravation prove the point. For us, healthcare reform can't come fast enough. God forbid we need our insurance before then. Who knows what else we aren’t covered for.
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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.