Pregnant? Do You Understand Your Health Insurance?

Shortly after the birth of our first son, my husband and I experienced an incredible shock. We thought we had prepared for the diapers, the late night feedings, and the complete lack of sleep. However, the cost of family health insurance shocked us more than anything else.

There we were in our late twenties, both perfectly healthy. We had finished our undergraduate degrees and were both continuing to take additional courses as we needed to. We were both working and finally enjoying the satisfaction of being able to pay our bills completely on our own. We had group health insurance through my husband's employer, as I did not have insurance available to me through my employer.

The group coverage for employee and spouse was not cheap, but it was do-able for us. I chose my medical care providers throughout my pregnancy and I was really happy with the care I received. We spent approximately $3,000 out-of-pocket for maternity and pregnancy related expenses. A huge dip into our meager savings, but again, it was still do-able.

When our son was born and we added him to our insurance however, the cost of our family policy skyrocketed to more than double the cost of our total monthly living expenses! With an infant to care for and our closest relatives more than three hours away, I was staying at home during the day with our son and working part-time in the evenings when my husband came home from work.

I was also exclusively breastfeeding, washing cloth diapers, and making all my son's baby food to help offset the costs of my not working full-time. Still, when the annual enrollment window came around, we knew we had to make some changes if we were going to continue to pay our bills and our student loans.

We decided on the employee and one group plan for my husband and son, and then chose an Aetna Advantage High Deductible PPO Plan for me. For a little over a hundred dollars a month, I had some sort of basic health insurance coverage which we felt would be okay temporarily until we could afford to work something else out when our son was a little older.

I was young, healthy, and I only ever went to the doctor for my annual physical because I hated doctors and generally avoided them. Also, since I was exclusively breast-feeding and on the pill, I wasn't planning a second pregnancy anytime soon and the likelihood of that occurring was about 99.9% unlikely.

However, part of the reason we choose an Aetna policy was due to the fact that it was the only plan we researched that offered immediate maternity coverage for women in my position. In comparison, other policies we considered offered maternity coverage only if the policy had been in effect for at least a year. I thought I was making an educated and researched decision.

For the first six months of breastfeeding, I was prescribed a mini-pill. When my son started solid foods, my prescription switched to a regular strength pill, which immediately made me terribly sick. I continued to take it yet made an appointment with my OB/GYN to see if there was a different medication I could try. You cannot imagine my shock when she informed me that I was already 10 weeks pregnant! I cried all the way home as I thought I had been doing everything within my power to be an educated, responsible, and loving mother.

I cried even harder a few weeks later when the first pregnancy related bills started to arrive in our mailbox. The only insurance policy that was supposed to offer maternity coverage paid literally nothing. So, I called and talked to a very nice and understanding customer service representative who explained everything to me in detail and enlightened me to my complete and total ignorance.

I understood that a high deductible PPO plan meant that I had a high deductible. I had braced myself for being responsible for the $3,000 deductible before the policy would be of any benefit. However, what I had not anticipated was that the deductible year was from January 1 - December 31, regardless of my pregnancy related expenses.

Let me explain.

I found out I was pregnant in August 2006. Since I had not been to the doctor at all that year, I still had the full $3,000 deductible until the plan would pay a dime of my maternity care. Not only that, on January 1, 2007, my deductible would go right back up to another $3,000 for the 2007 year. Also, as soon as my baby was born, he would have his own $3,000 deductible.

A bit bewildered, I recall asking the kind customer service lady, "So, what you're saying is this pregnancy is going to cost me $9,000 before this policy will even cover anything at all, so I'm paying more than a hundred dollars a month for pretty much absolutely nothing?" The customer service representative very quietly squeaked "yes," and that she was sorry but there was nothing else she could do to help me. She added that most all other policies are this same way and that probably my only other option, if I qualified, was to check into Medicaid.

Somehow, the individual who originally sold me this policy completely failed to mention to me how pregnancy coverage really worked. Then, since it wasn't something I was planning on needing I also didn't think to ask. I knew the coverage I had wasn't exceptional, but I felt secure that having something was better than nothing, right? I couldn't have been more wrong.

I sincerely hope other women can learn from my mistake. If you are thinking about getting pregnant, wanting to get pregnant, or even afraid of having a little surprise, please make sure you really understand your health insurance coverage so you are more prepared. If your insurance coverage deductible runs from January 1-December 31, my suggestion would be to try and get pregnant between mid-November and the end of February. In that instance, your 9-month pregnancy will be confined to one deductible year. This can potentially save you a bundle of money, as your little bundle of joy should definitely not be a bundle of financial woe.

As I cried and tried to explain to my OB/GYN that she was mistaken, I recall her assuring me that I indeed was going to have another baby whether I had planned it or not. She said this little baby just somehow must have really wanted to be here. Obviously, this little baby knew absolutely nothing about health insurance.

My husband and I have always worked hard, and we have always strived to be independent and self-sufficient individuals. Though we have never had everything we ever wanted, we have always made do, and we have had everything we always really needed. It was an incredible blow to both our ego and our pride to face the realization that we needed some help in our situation.

In the America that we live in today, I am quite appalled that the right to life is so unreasonably expensive for the working middle class. I love my two boys dearly, and there is nothing I wouldn't do for either of them. My pride has fallen, yes, but my dignity is intact, and I will recover. I also never want my youngest child to know that the $500 alternative was not an option, because I was already too far along when we realized the direness of our situation. No mother should have to be able to admit that to her child. Nor should any mother anywhere have to even remotely consider that possibility.