Questions to Ask My Health Insurance When Pregnant

Kyle Walton

8 years ago

“To sum it up…”

You need a list of providers your health insurance covers and find out what the plan coverage is for doctor visits, hospital stays and diagnostic testing
High-risk pregnancies can demand special procedures that may require pre-approval
Know how much deductible has to be paid up-front, the percentage your health insurance pays and the remaining amount you will need to pay out-of-pocket
Have the new baby added to your health insurance policy right away
Ask your health insurance provider about all options in choosing where to give birth and whether to use a doctor or midwife

Being pregnant is a happy time for a family, but it can bring about a lot of financial stress if you’re unaware of how much of the expenses will be picked up by your health insurance coverage.

One of the first things you need to do is make a call to your health insurance company and find out what is covered and how much you will be paying out-of-pocket. Below are a few great questions to get you started.

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Can I access a list of family doctors and obstetricians that accept my insurance plan?

Many health insurance companies will give you a list of health care providers in your area, but there are times you need to contact them for updated information or to find specialists such as obstetricians. This can save you time and allow you to assess whether it is the right clinic or doctor’s office to meet your needs.

There are some plans that allow you to choose a provider, but make sure that is the case before scheduling your first appointment.

What if I Choose a Provider Not On My Provider List?

There are some health insurance policies that cover the expenses of the doctor you choose, but many will make you stick with the provided list.

In the event you choose and out-of-list provider for health care services not covered by the policy you will have to pay all expenses. The health insurance company will not reimburse any costs.

The good news is there are typically many good doctors and clinics to choose from.

What types of coverage does my health insurance plan have for pregnancy?

There are numerous required doctor visits during pregnancy, especially during the last trimester. Find out if these are covered completely or there is additional co-pay required per visit. Discuss items such as:

Testing
Medications
Emergency medical services
Labor and Delivery
C-section

Open communication is best when it comes to dealing with health insurance providers and your doctor. It helps if everyone is on the same page when it comes to your healthcare. The goal is to safely deliver a healthy baby.

Are all hospital and doctor visits covered?

Regular health screenings and health care are important when you are pregnant. It is vital in order to detect problems early and as a method of ensuring that both mom and baby are thriving.

Monthly doctor visits are essential up to 28 weeks, twice monthly for weeks 28 through 36, then once a week from 36 weeks to delivery. These are simply the recommended visits.

Women with high-risk pregnancies will require more frequent visits and possibly additional health care treatment.

Unexpected cramping and bleeding are some of the symptoms that signal a potential problem and might require an emergency room visit.

Find out how your particular health coverage helps pay these expenses. Know what to expect in regards to out-of-pocket and co-pay charges.

Are all diagnostic tests covered by my plan?

Testing is a method of assisting the doctor in knowing the health of both mother and unborn child.

Some of them are vital to know if the baby is experiencing life-threatening problems such as lack of oxygen and serious birth defects. Others are necessary for the health of the mother, such as gestational diabetes.

Find out what is covered and what is not. A few of the routine and not-so-routine tests you may be asked to take are:

Urine Samples
Blood Samples
Anemia
Blood sugar levels and gestational diabetes
Amniocentesis
Sonogram
Swabs to detect infections, including STD’s

What procedures require pre-approval?

There are a few basic tests and procedures that are expected with pregnancy care and rarely require any type of pre-approval. It is best to call and discuss what types of procedures require pre-authorization.

Most types of surgery and intensive procedures could require you to make a phone call and inform the health insurance provider that it is recommended by your doctor. It only takes a few minutes and can save you from having to pay the costs on your own.

Can I expect coverage for expenses if there are complications during my pregnancy, or I have a premature birth?

A pregnancy can be considered high-risk for many reasons. Some of the causes for being thrown in this category are:

Under age 18 or over age 35
Pre-existing serious health problems like cancer or HIV
Previous pregnancy complications
Preeclampsia
Underweight or overweight

These can all mean an increase in diagnostic testing and doctor visits. Make sure that your health insurance covers these particular needs.

Having a premature birth could mean a longer hospital stay for the infant and possible medical complications.

It is imperative to follow the procedure in getting the baby added to the policy as quickly as allowed so that you will not have to pay the heavy costs this entails.

Do I have a deductible amount to pay up-front?

Every health insurance policy has an annual deductible amount that has to be paid before they will begin paying for most types of medical services. The amount varies, depending on the company and the amount you are willing to pay monthly for coverage.

Once you have met the deductible, your end of payments will lessen a great deal. Keep receipts for all doctor visits and related expenses. These will apply towards the deductible amount.

What percentage of the bills will I be left to pay?

After the annual deductible is paid you will pay the agreed upon percentage up to the annual limit for out-of-pocket expenses. Use a $100 doctor visit as an example.

If you have a policy that demands $3500 dollars annual deductible, 20 percent self-contribution and an annual out-of-pocket limit of $6500 dollars you will pay:

All expenses until the $3500 dollar deductible is met
20 percent, or $20, of the doctor visits after deductible is met
20 percent of all other related expenses until you have reached the $6500 annual limit
All further expenses that year are paid by the health insurance in full

Will payments be made directly to the provider or will I receive the money as reimbursement?

Most health insurance plans are set up to pay the provider directly for services. It is important to keep accurate records of all payments you make that meet your annual deductible amount.

Check periodically so that you know you are getting credit for everything you pay towards the deductible amount. This will ensure you get the maximum benefits of having health insurance.

When will the new baby be added to the health care plan and what is the exact procedure to have this done?

The great thing about the health insurance marketplace is that pregnant women can enjoy a Special Enrollment Period (SEP) that allows for the new baby to be added to the coverage even after the open enrollment period is past.

Companies that are not in the healthcare marketplace might have additional steps and you should call to find out exactly what you need to do to get health coverage for your new baby. This is one detail you do not want to overlook.

Does my health insurance policy offer coverage for mid-wife, or other types of home-birthing options, if I feel the services are needed?

Deciding where to deliver your baby is important. You want the experience to be special. Many prefer to use the delivery room of a hospital, but others prefer birthing centers.

They are more like home and can comfortably accommodate family and friends that are anxiously awaiting the birth. Some opt to give birth at home using the services of a licensed midwife.

Explore the options available with your health insurance carrier.

Save for the Annual Deductible

The hardest hurdle to overcome in healthcare coverage is to meet the annual deductible.

The first trimester of a pregnancy is the perfect time to save the needed funds to meet the annual deductible. This is when the expenses are at their lowest amounts, barring any unforeseen complications. It will make the rest of the pregnancy less financially stressful.

Having the right information is the best way to plan for a happy and healthy pregnancy. If you are ever in doubt about anything concerning health care coverage it is best to pick up the phone and call.

The answers can alleviate a lot of worry and stress. Most companies are happy to help you in the process of creating or enlarging your family with the birth of a healthy infant. Here’s to a healthy and affordable pregnancy!

Give you and your new baby the brightest, healthiest start with proper health coverage; enter your zip below to get started by comparing health insurance quotes from your state’s best companies!