Wednesday, December 29, 2010

Having a Baby Without Maternity Insurance

The exciting news is we are expecting our fourth child in August. The not so exciting news is we don't have maternity coverage, and the company our policy is with (Insurers Administrative Corporation) will not cover any complications to me or the baby if they arise, since we do not have the maternity rider. So what is the point of paying hundreds of dollars a month to have insurance? (Plus, we have had so many problems with this company that I have ethical problems with paying them).

Through prayer and lots of discussion, my husband and I decided to cancel my insurance policy altogether. At least that way we will be able to save the money we were paying for my premium. His employer generously agreed to pay my husband the other half of premium they paid for me, so that will allow us to save quite a bit each month to use toward our medical expenses.

Here are some of the other ways we will be saving up to pay cash for baby #4:
  • We are already on a bare-bones budget, so the only way I know to trim expenses further is to reduce our grocery expenses. That is why I have started posting the "Healthy $10 a Day Menus," and I will continue to do this.
  • We received some Christmas cash, which will go into the baby fund.
  • I know it would be less expensive to use a midwife and have a home birth. However, during my last pregnancy, I had a problem with my placenta and bled quite a bit at delivery, so it's just too risky for me. My husband and I prefer to use a hospital for safety reasons.
  • I plan to call the hospital and see what I can do, or bring on my own, to reduce fees. Also, if there are not any complications, and we can leave a few hours after delivery, it is likely that we can save dramatically on room and board. (As a side note, hospital costs can seem so excessive. Each of my boys roomed in with me, yet the hospital charged two room and board fees of more than $2,500 each--one for me and one for the baby. I called once and asked if, since we shared a room, the hospital would be willing to reduce one of the fees. Nope.  Same with the circumcision: my doctor charged $400 for the procedure, the hospital charged $400 simply because the procedure was done at their hospital and the doctor used a tray of their instruments. Whether one has insurance or pays cash, these charges illustrate the problems with the medical system). Plus, the honest truth is many times hospitals are more willing to negotiate with those who do not have insurance, than those who have insurance but it won't cover their services, or have a high deductible (over $5,000).
Sure, it's a little unsettling to not have insurance, but again, this company will not cover anything related to the pregnancy or birth, so it is a waste of money from my perspective. Plus, medical insurance is a relatively new concept. Prior to the 19th century, people paid a fee for services. Here is a bit of interesting information about the start of health insurance as we know it, from the article "A Short History of Health Care" and the book Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price:
What we recognize as modern medicine, Cohn writes, began in the 1920s. That's when doctors and hospitals, having only during the previous decade learned enough about disease that they could be reliably helpful in treating sick people, began charging more than most individuals could easily pay. To close this gap, which worsened with the advent of the Great Depression, the administrator of Baylor Hospital in Dallas created a system that caught on elsewhere and eventually evolved into Blue Cross. The Blues were essentially nonprofit health insurers who served local community organizations like the Elks. In exchange for a tax break, Blue Cross organizations kept premiums reasonably low.
The success of the Blues persuaded commercial insurers, who initially considered medicine an unpromising market, to enter the field. Private insurers accelerated these efforts in the 1940s when businesses, seeking ways to get around wartime wage controls, began to compete for labor by offering health insurance. If government regulators had thought to freeze fringe benefits along with wages, we might have avoided making the workplace primarily responsible for supplying health insurance, a role that most people now agree was ill-advised. Instead, the government jumped on the bandwagon by exempting from the income tax company expenses associated with health care...

The Blues, in their early days, charged everyone the same premium, regardless of age, sex, or pre-existing conditions. This was partly because the Blues were quasi-philanthropic organizations, Cohn explains, and partly because the Blues were created by hospitals and therefore interested mainly in signing up potential hospital patients. They were sufficiently benevolent that when Harry Truman proposed a national health-care scheme, opponents were able to defeat it by arguing that the nonprofit sector had the problem well in hand. As private insurers entered the market, however, they rejiggered premiums by calculating relative risk, and avoided the riskiest potential customers altogether. To survive, the Blues followed suit; today, they no longer enjoy a tax advantage and are virtually indistinguishable from other health insurers. Meanwhile, large companies, which tend to employ significantly more young people than old people, began to self-insure. The combined result was that people who really needed health care had an increasingly difficult time affording, or even getting, health-care insurance.
So that's where we're at today. People are paying more for fewer services. I don't know what the solution is, but for me, it's to pull out of the system altogether right now. I don't want fear of what could happen to dictate my life (and force me to shell out hundreds of dollars a month that I could be saving). Also, in what, or in whom, am I trusting? Am I trusting a system to provide my needs, or my God? I choose to trust in God. I choose to make responsible choices to do what I can to save the needed money, and I choose to trust that God will keep us safe and provide for all our needs.

Have you ever had a baby without insurance, and how did you make it work?


  1. If we found ourselves blessed with a fourth, we would seriously consider a midwife and birthing center. I would travel across state lines if necessary, because the hospitals and insurance companies make it a ripoff when you don't buy insurance.

    We have had good sucess giving birth in other countries, where health care costs are not so exhorbitant. Though we did have insurance, we were reimbursed later. For all my prenatal checkups and a normal delivery plus a 2 day stay in the hospital, the cost was less than $2000. So, if we found ourselves needing to pay cash, we would honestly consider going abroad. Even staying in an extended stay apartment for 6 weeks was way cheaper having a baby in the U.S.

    However, with three other children now, that might be a tad complicated, even if it was significantly less expensive. We had our third child in the U.S. and the prices would have been ridiculous if we weren't insured. Giving birth at a hospital in Chicago cost about $10,000 for all the fees and just a 1-night stay!

    Obviously, I have very strong feelings on these matters. =) Our three kids were born in 3 different countries, and after comparing experiences, I'm not a fan of the American health care system.

  2. As a Canadian, I am glad we didn't have to deal with this. I was charged like $15 each time (or something like that) to pay for hygiene supplies and diapers -- and I had two C-Sections! My son's circumcision was $58, paid directly to the dr. as it was a matter of personal choice and not medically required. What do woman who can't afford it do?? When the life of your child is hanging in the balance it isn't good to have to be worrying about the financial side of things... I would be more likely to skip appointments or drugs if it was just me in the equation, but while pregnant, that isn't something you want to do... And I thought it was bad enough paying for stuff when I had to use insulin for gestational diabetes. Sorry you have this worry on your plate but I trust that God will provide... How much do you think you'll need to save? (Ballpark) -- I am an August baby and so is my daughter!? Congratulations!
    Denise in Saskatchewan

  3. I don't know your feelings on receiving government help, but you could apply for medicaid through the state. They want a lot of information - utility bills, look at your income, family size, whether you have insurance or not etc. If you do not have your children covered with insurance they could also qualify for the Kid Care Chip. Contact your local department of family services for more info. Just a thought... and also apply for WIC (Women Infant and Children) program if you haven't already. Your children under 5 will qualify also. I think they look at your income as well. They provide you with milk, cheese, fruit, vegetables to help promote a healthy pregnancy and help promote healthy childhood development. Again, not sure what your feelings are on programs such as these, but worth the look.

  4. My husband and I can't afford insurance. So we went with a midwife. I can't say enough good about midwife care!! But unfortunately, the story doesn't end there. At the very end of the pregnancy, I developed some serious health problems, which led to an induction at the hospital, and ultimately, a C-section. THEN my little boy "had" to be in the NICU for twelve days.

    When I was admitted to the hospital, as soon as they found out we didn't have insurance, they sent someone over right away to sign me up for Medicaid. They actually had an employee for that! I haaated to take state help, but there was no way we could afford the medical bills.

    It was a double-edged sword: yes, we didn't have to pay for the birth, but I also think that it led to an unnecessarily long hospitalization of our boy. I'm pretty sure that the hospital was trying to milk the state for money, so they kept making up reasons to keep our baby in the NICU. Finally, around Day 10, absolutely exhausted by running back and forth from house to hospital to fast food and back again, while recovering from the C-section, my husband and I started making a huge stink about getting our baby out. And wouldn't you know, a couple days later, he magically got better.

    So, that's just a cautionary tale about going the State route. I don't know how we would have paid the bills without it, but it was traumatizing in its own way.

  5. We just had our 4th. I used a CNM in a hospital and had a fabulous experience, and she costs less! We also found that by calling around, many places were willing to work with us, especially if we were paying in cash. Also, after our 2nd, the hospital "forgave" much of our bill because we didn't have insurance (they offered us the service)! We still paid the CNM and some other fees, but they weren't too bad! The Lord provides for the blessings He gives. Congratulations!

  6. Congratulations! What a blessing! Both of my births, we had insurance. Currently, we don't have insurance (for about 2 years now.) Co-pays, deductibles and premiums were so high with both births that we felt like we paid for the births out of pocket anyways!

  7. It sounds like you are doing your best to be wise with your finances while trusting God to provide for what is "lacking." In my husband's and my experience, God honors that kind of heart! We have seen God provide for us, especially in the area of providing for our children. My first pregnancy, which ended in miscarriage / D&C, was not covered by insurance. Even though the D&C was not as expensive as having the baby, paying those bills was a big deal to us (and a source of stress in addition to the miscarriage). God used that experience to stretch our faith early in our marriage and to prove his provision to us. Since then, he has blessed us with three children and has never ceased to so kindly provide for us. We serve a benevolent God. Congratulations and looking forward to seeing how God will bless your family!

  8. I delivered all five of my children at home with a CNM. She is fantastic, and since I had precipitous labors (average 1 hour, 20 mins) I would not have made it to a hospital anyhow. For my first few births she allowed me to pay in installments, and it was around $2k each. For the last two I had medicaid coverage, which I did struggle with some. We do not have insurance and prefer to trust God to provide our needs (and He has!). Like another comment said, it's a two-edged sword. We needed the financial aid at the time, but didn't want to "use" a system unfairly. BUT, we, as taxpayers, have paid into the system all our working years. I think using it for a temporary time of need (as opposed to living off it) is acceptable when there are no other options. But, as with many situations in our walk with the Lord, each decision each time is based on where we are in our faith at that time. God has never failed to meet our needs or meet us where we are/were - and grow us in the process.

    We have had two other non-pregnancy related circumstances that required hospital stays/procedures that were billed at over $10k. Because we were uninsured the hospitals worked with us and reduced our bills (over 70%!!) and set up payment plans with us. So be sure to ask the financial departments what types of assistance or plans may be available to you.

    And, congratulations!

  9. The right home birth midwife is very good with complications. I know of someone who just gave birth at home this month and her placenta detached and the midwife saved the baby. Even if she had been delivering at the hospital they would not have gotten a c-section done quick enough. So I'm not really sure what "complications" have to do with not having a home birth. And just because you had complications with one does not mean you'll have them again. I had an ectopic pregnancy for my last miscarriage, but didn't have one this time. If you really wanted to save money going the home birth route, you could. I'm not sure why people don't think it's just as safe or safer than the hospital...I've had three of them, and there have been "complications" with two of those. Midwives HAVE had training for that sort of thing.

    I would also suggest the Medicaid route because sometimes you can get it JUST for pregnancy and that's it.

    About circumcision...if you do have a little boy, don't get the circ done at the hospital, get it done a few days later at your baby's pediatrician. That will save the hospitals fee. I had home births and so I couldn't get the circ done at birth anyway. It's cheaper to get it done later, and we wait till the 8th day when the vitamin K is highest, and it will heal quicker.

  10. Congratulations! I don't have any advice/info on the insurance issues, but I like your attitude and trust in God. It sounds like you and your husband are prepared and doing the right thing.

    P.S. I'm an August baby....we turn out great ;)

  11. All of your medical expenses will be tax deductible. The amounts over 7.5% of your adjusted gross income can be deducted from your taxes. If your expenses are not high enough to meet that hurdle consider putting money into your flexible spending account(s). You will get tax savings on the first dollar, and avoid paying FICA taxes on those dollars as well.

  12. Hi everyone,
    Thanks for the comments! It was encouraging to me to know that I am not the only one who has dealt with this, and to hear your experiences of not having insurance and God providing.
    To answer a few specific questions,
    Denise--the OB fee is $4100 (yikes!), and I estimate the hospital will be about $6,000 assuming a clean bill of health for me and the baby. (I am going to see if it would be less if we don't stay overnight). Saving up this much money seems difficult, but with God all things are possible! Plus, I keep reminding myself that people frequently go 10-20,000 in debt for a vehicle and make car payments. How much better is a baby! :)
    Anon-I am not opposed to getting help for a season :) I think we are just a teeny over the limit if they consider us a family of five, but if they count the baby as a person now, we may qualify. I'll have to check into it.
    Thanks, Julie (and others!), for the encouragement!
    Katy-Anne, unfortunately certified nurse midwifery is not currently legal in our state (although there is a bill before the legislature to make it legal). So many who are certified will not deliver for fear of prosecution. My friend's mom is a CNM, but she will only deliver her daughter's babies at this point. As I mentioned in the post, I am not opposed to homebirths and I support the decisions of those who have them. Why I said my husband and I feel the hospital is safer for us is because we are right down the hall from ICU, and if anything happens (a friend of mine hemorraged, one of my babies lost oxygen), you don't lose any time in getting emergency help. That's all I meant. :)
    Kevin H, yes, we will be taking those deductions and putting as much as we're allowed into an HSA.

  13. You have to do what you believe is best. I had a lay midwife, not a CNM. A CNM is really just a fancy word for "medical midwife" rather than "natural midwife". But you do have to make extra sure with lay midwives what kind of training they have had. Mine actually had OB training but she was far more natural minded, so it worked out well.

    Hope it works out well for you. :)

  14. Congratulations on your pregnancy! I am expecting baby #2 in early May and am dealing with a slightly different insurance situation this time around, too (although nothing as drastic as yours, of course).

    Two things:
    - God is, of course, in control. My prayers (and other readers' prayers are with you, the baby, your husband, and your family.
    - As another commenter mentioned, getting a circ done at the pediatrician's office instead of in the hospital saves a bunch of money. That's what we did with my son as we weren't sure how much (if any) insurance would cover the procedure.

    Blessings to you and yours!

  15. Congrats! How exciting!!! With God all things are possible!!! I also know from family experience if you tell the hospital you don't have insurance, but that you would be willing to pay for your bills in full they will take as much as 50% off your bill. You politely as them for a discount and many are willing to help. As far as WIC and KidChip, Yes, the services do count the baby you are carrying as part of your family size. These serives will help cover your children and the new born by providing medical and grocery assistance. I would totally take the time to look into it through the health department.

  16. Here is a link:

  17. Congrats! Totally missed this post.

  18. You may already know about this, but I remember reading at Life in a Shoe about an alternative to traditional health insurance, Samaritan Ministries.

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  20. Glad to know there are several options to find maternity insurance once you are already pregnant.

  21. If you end up paying out of pocket, negotiate discount rates in advance and set up payment plans. Frequently, hospitals have a rack rate, a self-pay discount rate, and an even lower charity rate. If you don’t ask about the charity rate, they might not volunteer it.