Questions you should as your insurance provider as soon as you find out you are pregnant
Insurance was always such a confusing aspect for me prior to having a family.
However, at my first doctor’s appointment with Emmy, at just 7 weeks pregnant, I was presented with a contract for my OBGYN. It included a pay schedule and deductible amount and all sorts of numbers that really confused me.
After MANY phone calls to my provider and 3 dozen questions texted to my mom, I finally started to understand. I knew what needed to be done now and after baby arrived.
Here’s all the information I recommend gathering and questions you need to ask. Be sure you have a pen and paper handy when you call!
-Is Doctor “ABC” an In-network provider? First and foremost, before you start establishing a relationship with an OB, you want to make sure they are in-network. In-network means that your insurance covers that doctor and will pay for any visits within your plan parameters.
-What is my annual deductible? Your deductible is the total amount you will pay out-of-pocket. Some insurance providers have different deductibles for medical services and prescriptions. If you are on a family plan, you will want to see if it is individual deductibles or family deductible.
-What will my insurance cover once I meet my deductible? Once you reach this deductible amount, your insurance will begin paying based on what your plan says. For example, let’s say you have a $1,000 deductible and once you meet it, your insurance covers 100%. After 2 medical procedures that cost $500 each, your insurance will cover everything (that is in-network). However, some plans do not cover the full 100%. Some insurance plans will only pay a certain percentage once the deductible is met. For example, 80% once the deductible is met, meaning you will still pay 20%.
-What is my max out-of-pocket expense? While you still may be responsible for covering 20% (give or take) once your deductible is met, you will eventually meet your max out-of-pocket limit, meaning insurance will cover 100% after this point. In 2017, I had Nora in October and came down with appendicitis on December 23rd. Because we had met our $6,000 max out-of-pocket for the year, 100% of my surgery and hospital stay was covered. My body had great timing! Two more weeks and I would have had to pay all of those expenses out-of-pocket since my deductible would have reset!
-How will my pre-natal visits work? Is there a co-pay or do I pay all out of pocket until the deductible is met? Are ultrasounds included in a visit co-pay or will they be paid out-of-pocket? Some insurance plans will have a set amount you pay for a doctor’s visit. My co-pay is $25 per doctor’s visit. Be aware that in most cases, co-pays do not go towards your deductible.
-Is “ABC” test covered? In the case that you are doing any sort of extra testing for you or baby due to health risks or concerns, you want to run those by your insurance first. Sometimes these test required what is called “pre-authorization” which simply means that want to know why you need the test prior to giving you the ok to get it.
-What is the process for adding the baby to my insurance once he/she arrives? If your insurance is provided through your employer, the answer will most likely be that you will need to contact them to add your baby.
-Do you cover or reimburse for a breast pump? I have experienced two different setups when it came to getting my breast pump covered. One had an online website I ordered from and the total was $0. The other had me purchase it on my own and send in a receipt to be reimbursed. Both situations worked great. I would suggest asking about this before you hit your third trimester. When I ordered from the website it took quite a long time to arrive.
-Do you reimburse for a birth class? The classes that help you prepare for labor and delivery may be covered! Ask what the process is to get reimbursed. You can also sign up for a free online prenatal class from a Labor and Delivery Nurse here.
-Online Access. This is just a side note and a personal preference, but I figured I would share. Calling insurance companies is a pain in the butt. I have online access to see all of our claims, where we sit with our deductible, etc. in an online portal and it saves so much time (and sanity!) versus calling into the company. Ask your provider if this is an option for you!
Hope this helps! Be sure to read more of our pregnancy-related posts below!