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Expecting? Expect to Be Denied Insurance Coverage Through 2014

A recent investigation by the House Committee on Energy and Commerce brought to light several disturbing findings about the inequities expectant parents face in the insurance market. Among them:


(1) Pregnant women are frequently unable to obtain health insurance in the individual market. The four largest for-profit health insurance companies each list pregnancy as a medical condition that results in an automatic denial of individual health insurance coverage; put differently, if a pregnant woman applies for insurance coverage in the individual market, insurers generally consider her pregnancy to constitute a preexisting medical condition and deny her coverage. The investigation also found that, because the law in some states requires insurers to extend coverage to policyholders’ newborn or adopted children, insurers sometimes deny coverage to expectant fathers and those who are in the process of adopting.


(2) Many health insurance plans in the individual market do not provide insurance coverage for medical costs related to pregnancy. A 2009 investigation by the National Women’s Law Center found that only 13 percent—of the more than 3,500 individual health insurance policies reviewed—provide maternity care. And, the costs related to pregnancy add up: as of 2007, the average expenses for maternity care—including nine months of prenatal care and three months of postpartum care for a delivery without complications—were over $10,000.


How can this be? Isn’t coverage for maternity care required under the Pregnancy Discrimination Act? Unfortunately, not—the Pregnancy Discrimination Act does not apply to individual policies. Thankfully, change is coming!


Beginning in 2014, health insurance companies will no longer be allowed to deny coverage to women because they are pregnant or to exclude maternity-related claims. Under the health care reform legislation signed into law by President Obama (the Affordable Care Act), health plans will be prohibited from turning away applicants because of preexisting conditions, including pregnancy. And insurance policies sold through state-based insurance exchanges, as well as new individual and small-group plans sold outside the exchanges, will be required to cover maternity care as an “essential health benefit.”

Denied coverage for expectant fathers???

Really can that even be legitimate, a man denied because he is an expecting father. Apparently so, according to United Healthcare my husband cannot receive coverage until after I give birth! Something just doesn't seem right about that. What risk is he to them if I am pregnant or not? Are they expecting additional costs related to my husband because I am pregnant? Absolutely senseless!!

You are not alone!

I have found the exact same situation in Georgia. I got married and my wife has insurance (luckily), although it is individual health insurance and does not provide maternity coverage. I am a student and have not had health insurance for about two years, since I quit my job to go to grad school (before I met wife). Now, since wifey is pregnant, my insurance guy says I will not be able to get any insurance until the kid is born. You know why? Because state law requires an insurance company to allow an insured to add a newborn child to their policy within 30 days of birth, so they don't want to insure me cuz they fear I may add a child with health problems that they are forced to cover. Doesn't matter to them that she already has insurance. Insurance companies heartless, evil companies, and are in the profit business, not the health care business. Their unending drive is to collect premiums without paying out any more claims than humanly possible. Because they don't want to maybe cover my kid in 9 months, I am totally unable to purchase health insurance for myself. At least until 2014 when new health care regs are implemented. But no, we don't need any reform of health care!!

Not completely true

The above comments are not completely true. In Utah, for example, my husband and other children can be insured under a transition plan or short-term plan. This plan is quite cheap and will cover them all for 6 months while I use Cobra to cover the pregnancy and delivery. The only thing he is required to do is sign a waiver form that says he is aware that nobody else can be added to his plan (the newborn or myself, for example). So for the next 6 months until the baby is born he and the other children will do the transition plan, I will do Cobra and then we will all get onto an individual plan for the family after that. If there are complications in the meantime that is when the HIP program would kick in and anyone who cannot be insured would have to join the stat pool. At that point, however, if it was too expensive we would probably think about getting employment with an employer that has a group plan again.

Same nonsense happing to me in Texas

I am currently in the exact situation. I left my last job in January and started my own graphic design business. I was not aware of this absurd law that men can’t be insured if their wife is expecting, so I didn’t opt for the Cobra coverage from my last employer and instead pursued an individual plan. My wife was a month pregnant when I left my last job and it took me about a month before I got around to applying for new coverage because of the time needed to get everything in place for my company. Then, I discovered this BS loophole the insurance companies are exploiting. My wife has full coverage with maternity and I am still being told that I am uninsurable until a month after the baby is born. How does that make sense? I’m 28 and in perfect health with no pre-existing conditions and no medical record. I’ve been to the doc like 1 time in the past 6 years and I’ve never been to the hospital. I am amazed at how insurance companies are allowed to deny coverage to expecting fathers even when the mother has full coverage maternity insurance. How is this allowed? I just hope nothing happens to me this year in the only time period of my life that I’ve been uninsured.

And, I have checked for a short-term plan or some other solution. I have been told the same thing by a dozen different insurance companies...that there is nothing I can do until a month after the baby is born!! The only solution is to take a position with a company and get on their group insurance plan, which may or may not have some type of qualifying period of time before coverage starts. Either way...I'm basically screwed until November.

Health Care Rip off

I am a new resident of Texas and I was informed about this BS from the insurance company. My wife is covered for maternity from her school health insurance but I as a spouse cannot be added to her plan. I decided to go for the individual insurance plan and got rejected since my wife is pregnant. I couldn't believe that. How insane is that? I just moved here from Canada and I wish I could go back atleast we have universal health care. Unfortunately, I am stuck here without insurance till after the kid is born. This is absolutely insane. I wish these politicians do something about it and I hope these health insurance companies rot in hell.

 

God Bless America !!

Totally insane. I have Kaiser

Totally insane. I have Kaiser NorCal insurance and am 9 mo pregnant. My husband is insured but we wanted to switch from Blue cross to Kaiser because its a better plan. He is in totally good health...been to doc maybe once in 12 years. On the decline letter they said they cannot insure him while I'm pregnant but after delivery its ok. WTF? I have insurance! Why are they denying him insurance??? 

same thing here in VA

This makes me livid.  Im so happy to live in a country driven by money and useless politics.

Adoption Disqualifies Us Too!

My wife and children have been denied insurance because we are in the process of adopting a child. Even though we do not anticipate finalizing the adoption for another year!

Same thing here in IL

I have not-so-great insurance as a teacher in rural Illinois, and I can't afford the extra $750/month to insure the rest of my family. My husband and children are very healthy, but they are being denied private insurance because we're in the process of adoption... that could (and probably will) be years away. Crazy. Don't know what to do. :(

It's True

I just found out that I am pregnant. I work freelance so I don't have insurance. My boyfriends insurance would not let him add me because we are not married. I just found out that I am pregnant and was looking to purchase insurance and Kaiser denied me because I am pregnant.

denied health care because i'm pregnant!!

my husband and i found out we were pregnant in early march 2014 after a birth control failure. we were happy though and do not believe in abortion. however, neither one of us has insurance because we live paycheck to paycheck and just can't afford the high cost that the ACA was quoting. just for me alone, my lowest premium would be $175 a month. ok, not horrible...until we saw that my deductible would be $6,350 and that would only cover 60% of my care!!! WTF!! i can't afford that! i tried applying for state medicaid but living in a state that chose not to extend it's medicaid plan, we were denied because we were over the limit! So we are too poor for Obamacare and too rich for medicaid. I called the health insurance hotline and they pretty much told me that i was out of luck because they only way to get maternity care is to get it through the ACA website and it's not their problem that's it's unaffordable to us! so what can i do?? i was turned away from the doctor i was seeing because i wasn't making big enough payments towards my doctor's bills! it's horrible that this is what our country has come down to and there's nothing we can do about it!

yeah Obama!

Obama is the man! schmuck.

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