Maternity Coverage

[TXINSURANCE]

Why buy Health Insurance? It is a huge waste of money.

The best thing is to wait until you are about 6 months pregnant and go on Medicaid - I recommend it to everyone.

 

[Crabcake Johnny]

??? Not everyone income qualifies for Medicaid and what's the huge issue when maternity can be added in most states. That couple can get Assurant's Max Plan with a $5,000 maternity deductible for $286 per month - 6 mo. wait on maternity.

*All maternity services are re-priced
*All maternity service count towards the deductible
*The Assurant maternity deductible is separate from the plan deductible

 

[TXINSURANCE]

$286 per month for what amounts to a discount on maternity, what a joke. You can not sell this with a straight face.

I just had two children and cash paid both. The hospital was $3000, doctor (all charges) were $2500 - $5500 total - the Assurant re price I would be willing to bet would be higher than what I did on my own.

I know the hospital portion I paid $3000 for they billed Unicare (denied of course) $5800.

I just got into a huge argument with my Assurant rep about what joke their maternity was and how this is not something worth selling.

I thought BCBS of MS covered maternity? I will have to check...

Update - BCBS OF MS 80/20 on maternity after a 12 month wait, if maternity plan selected covered like all other services. There is your answer.

 

[Crabcake Johnny]

No - $286 a month that protects your client.

A few month's into my wife's pregnancy she was diagnosed with fifths disease. We spent the next 10 week in a row going for weekly testing to make sure water polyps weren't forming on the baby's brain. Then she popped positive for Down's and had to do another battery of tests. Complete nightmare and none of it would have been covered.

Since she wouldn't have had any coverage under your method there's no pre-auth for any of that testing and it would have been "cash on the barrel head."

I will never sell any play to any client who plans on having kids without maternity.

 

[TXINSURANCE]

I wasn't suggesting going uninsured, I have never been uninsured.

I was suggesting getting a non maternity plan and paying for the routine maternity out of pocket - usually this is the best plan (varies by state).

In some states like TX (where most of my sales are) complications are covered as regular medical under ANY plan per state law.

Also in Texas I believe they stopped asking INCOME for Medicaid, I know plenty of people having free babies that could be on the payment plan like the rest of us.

 

[somarco]

Foundation for Health Coverage Education: Eligibility Tool

While I do not suggest using taxpayer money to fund a PREVENTABLE and ANTICIPATED condition, it appears that MS does not have an income requirement to qualify for Medicaid for a pregnant female.

diagnosed with fifths disease . . . none of it would have been covered.

Why not?

 

[Crabcake Johnny]

Would be a toughie. With coverage but no maternity just my wife contracting fifth disease (parvo virus) would absolutely be covered.

However, parvo virus can cause a few severe problem to a fetus including heart problems and hydrops.

I'd say that none of the fetal testing would have been covered since that's pregnancy related. It would be interesting to see if that would have indeed been covered even without it. My guess is no. My wife could have received treatment for her symptoms, but nothing relating to the baby.

 

[somarco]

Can't say about MD, but many states cover complications of pregnancy even if you do not have maternity coverage.

 

[Crabcake Johnny]

Yes, but sometimes the complications are specific. For example this would be a difference between Max and CoreMed. Max covers all complications and CoreMed only covers about 6 specific conditions.

GR, for example, gives a detailed description in their policy of what is and isn't paid for complications - the list of what isn't covered is longer then the list of what is covered.

 

[somarco]

Max covers all complications and CoreMed only covers about 6 specific conditions

Go back to state mandates. If Core Med (or any other policy) violates mandated coverage then fight it.

FWIW, Core Med is only slightly better than Right Start. If you feel right offering limited benefit plans, then fine.

My guess is the situation you describe (Fith disease) would fall in a gray area when it comes to claims. An argument could be made to cover the testing, etc. absent specific policy language.

When it comes to health insurance, there are quite a few claims that can be adjudicated either way depending on the whim of the carrier and the desire of the insured to fight the claim. Few claims are black or white (to paraphrase Bill Clinton . . .)