When health insurance won’t cover your pregnancy

Consumer Reports News: August 20, 2008 02:33 PM

A few weeks after my first prenatal exam, I got a letter from my health-insurance company. It informed me that my pregnancy would not be covered because I wasn’t insured at the time of conception. The fact that I did not know that I was pregnant at the time of conception was irrelevant. I had a complicated pregnancy with preeclampsia, which raised my blood pressure and caused my kidneys to function poorly. Because I required a month of hospitalization and numerous tests, the costs were exorbitant. But I was fortunate. My baby was healthy and my previous insurance company paid the initial bills through the waiting period.

For Tina (right), in Pittsburgh, the solution was not so easy. She, too, developed preeclampsia, as well as gestational diabetes, another high-risk condition. About five months into her pregnancy, she began receiving doctors’ bills and was informed that her individual insurance policy did not cover maternity care. In addition to the mounting financial stress, her mother was diagnosed with cancer, and she had a death in the family. The emotional toll did not help her medical condition. But a newspaper reporter took on her story, and, in the end, the insurance company agreed to cover her bills.

But what about all the women who are not as lucky as Tina and I am?

According to the 2007 report out of the Henry J. Kaiser Family Foundation, the cost of having a baby—even with a routine pregnancy—comes to about $10,000, and a pregnancy like Tina’s can cost as much as $300,000. Amanda from Weiser, Idaho, discovered this firsthand. It would have cost almost $800 a month to add her and her son to her husband’s health policy (he’s a teacher), so she purchased an individual policy instead. But with the insurance’s premium and childbirth deductible and the upcoming birth of their second child, they’ll end up spending 50 percent of the family’s net annual income on healthcare.

In 1978 the Pregnancy Discrimination Act mandated that employers of 15 or more workers provide health insurance with maternity coverage. Unfortunately, that doesn’t include individual policies such as Tina’s and Amanda’s, and it doesn’t cover smaller businesses. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits discriminating against pre-existing conditions, so that women like me, who switch health plans while pregnant, have it easier. But HIPAA mainly applies to those who have had prior group health coverage. If you move from an individual to a group plan, you may be subject to a pre-existing condition waiting period. Or if you move from one individual health plan to another, you may not get pregnancy coverage at all.

We try hard to promote the value of prenatal health care in this country, but when pregnancy costs can wipe out savings, women will invariably be placed in the position of once again making impossible choices.

Orly Avitzur, M.D., medical adviser to Consumers Union

Read more on individual health insurance, and visit Cover America Tour to see more videos of the people we're talking to across America, and to share your own health care story.

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