When we were pregnant with our first, I was fortunate enough to be doubly insured by my job and being on my parents’ health insurance still (because I was 25). I called both companies and basically said, “hey I’m pregnant, and I don’t even know what to ask you.”
I literally knew NOTHING about health insurance. Couldn’t have even differentiated between deductible and copay. Didn’t know what an out of pocket max was.
Since then, we’ve had a few different job changes, including a period where we didn’t have a viable insurance option, so we partook in a Christian medical sharing network which is a legal alternative to health insurance. We ended up paying for the entire second pregnancy with that organization, and because of the way it operates, I had the chance to learn a lot more about pregnancy coverage, insurance questions, how much things cost, etc…
Anyway, this isn’t meant to be a comprehensive guide to all that. Maybe that post will come another day (thrilling, I know)! But I did want to spell out a few questions you can call and ask your insurance provider once you find out you’re pregnant. Just call the number on the back of your card and say you’re newly pregnant and have a few questions. They’ll get you to the right person.
Then, ask away! (and write down the answers)
- What is my copay for the standard appointments during prenatal care? (Usually once every 4 weeks from week 10- 26, then every 2 weeks from week 26-34, then every week. Plus an ultrasound appointment and any other appointment the doctor deems necessary.)
- Is there a copay for extra visits to my OB during prenatal care? (Like, if I feel cramping and need to go in separate from one of my 4 week visits)
- What is my annual deductible?
- Once I reach my deductible this year, what percentage do we each pay? (Often it’s 80% them/20% you)
- What is my individual and family annual out of pocket maximum and how does it work?
- Do costs for the baby in the hospital count towards my individual out of pocket max or family out of pocket max?
- When do I need to call in to add the baby to the policy to make sure his or her medical needs are covered?
- If I need or want testing during the pregnancy, what is covered by insurance and what isn’t?
- Do you reimburse for a breast pump? Which pumps? What is the process?
- Is Doctor So & So in network?
Hopefully these will get you started with the discussion, and hopefully the person you’re talking to is helpful. I’ve generally found that when I’m asking someone these questions, they’re pretty helpful. If you don’t understand something, just keep asking. It’s all so complicated! Also, feel free to ask questions or leave comments below.
Oh, and if you want to download and print these questions, so that you can easily jot down answers, enter your email below and I’ll send it to you right away.
P.s. I originally wrote these questions for people who were using my budgeting-for-baby worksheet to figure out how much it will actually cost to have a baby. You can view and download that worksheet here.