Insurance won't cover my pregnancy!?

Question

Hi all,

I just wanted a few opinions from everyone on this site. I currently have health insurance through a company called GoldenRule. I've been active with them for about 11 months. I added a maternity package to my health insurance at the end of June and the rider took effect on July 28th. On July 30th, I found out I was 8 weeks pregnant. On my pregnancy rider, it gives me this nice inclusion:

"Exclusions and Limitations

No Payments will be made under this rider for expenses:

Resulting from a pregnancy which is found by a doctor to have begun prior to the date the covered person's insurance under this rider took effect."

I have applied for Medicaid as well but I have yet to be approved. I know that insurance companies do not consider pregnancy a "pre-exisiting condition." Does anyone know if i were to change insurance companies, if I would be covered? If so, I might just ditch this GoldenRule!

Answer 1

Group insurance (through an employer) cannot consider pregnancy a pre-existing condition. Individual policies can.The rider exclusion you quoted is the standard exclusion for this type of coverage. (Which you should have known prior to accepting and paying for it).

If you do not qualify for medicaid, most OB's and hospitals have a cash discount "package" rate for maternity and delivery. Look into it. You might be suprized at how reasonably priced it is. It would be a good idea to keep your insurance in place though because you will need coverage for any complications that arise and to cover the baby after it is born.

Answer 2

It is incorrect to say that insurance companies don't consider pregnancy to be a pre-existing condition.  Group insurance policies through an employer can't consider a pregnancy pre-existing.  However, any insurance company can (and will) consider a pregnancy pre-existing if you're purchasing a policy that's not through an employer group.

This is why its very important to purchase that maternity rider months in advance of when you plan to start trying to have a baby.  Most maternity riders have a "waiting period," where you can't have coverage for a pregnancy.  (Too late now, but if you knew trying for a baby was in your future, you should have added the maternity rider at the time you started your policy 11 months ago.)

You have 3 options at this point...

1)  Qualify for Medicaid and have them cover the birth/prenatal care.

2)  Either you or your husband gets a new job that comes with insurance and maternity coverage through the employer.

3)  Start saving to pay for everything out of pocket...set aside as much as you can every month, so you don't get hit with a huge bill at the end.  (And negotiate a cash price with the doctors and hospital, if possible!)

Congratulations on the pregnancy, by the way.

Answer 3

You won't find ANY insurer who is going to pick up your pregnancy and birth related costs, unless you happen to find a job quickly with group health insurance offered.

What you are looking for is similar to asking an insurer to pay for a car accident which occurred before you had coverage.

Answer 4

It is SO important to read everything and be careful about planning (or not planning) for a child. There is nothing you can do, hopefully Medicaid picks you up. I would start saving!