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A Pregnant Woman’s Guide to Health Insurance

When you first find out you’re pregnant, your thoughts may immediately go to picking nursery decorations and the imminent labor pains. But you should also be focused on how your health insurance is going to affect your pregnancy. Having a child is one of the times in your life when your health insurance will become very important. From my experience as a medical biller, I’m going to share with you the top ways to get the most out of your insurance while you are pregnant.

This article gears more towards patients with insurance. For those of you that do not have insurance, call your local State Human Resource Department. ANYONE can file. It doesn’t mean you will always be accepted but filing is the only way to find out. Even if you have insurance but your coverage is low and your finances are high, you may be accepted for state help.

So onto the checklist:

  1. Call your insurance company to confirm your doctors and hospital are listed as an ‘in-network provider.’ An in-network provider is paid at the highest percentage with a low allowance. What this means is the lowest cost for you. If you haven’t picked out a doctor yet, your insurance company can help you find one.
  2. DON’T PAY anything upfront unless it is a co-pay for a doctor’s visits. Pay after your insurance company processes a claim/bill. The insurance company will send a check to the doctors and hospital. You will receive a letter explaining what was billed and paid for each visit or service. This form is called an ?Explanation of Benefits.? It also explains the approved price to the doctor or hospital for payment. (Example: The hospital bills $2000 for an ultrasound but your insurance company only approves $1000.00. Your insurance company pays *80% and you are billed the *20% of $1000.00; not the $2000 originally billed by the hospital.
    *Percentage paid varies on your individual or company plan.
  3. Make sure all treatment and visits are APPROVED. Most contracted ‘in-network’ providers are responsible for approving your treatment or what is called a Prior Authorization. It is permission granted by the insurance company to your healthcare provider to perform his treatment. I have witnessed patients charged because the doctor or hospital didn’t get your services approved. You can always make sure this is completed by calling your insurance company.
  4. Use what’s available to you. Most insurance companies now have a special unit for any pregnant patient in the Prior Authorization Department. They also assign a Case Manager or Nurse Unit that oversees ALL your care. Get to know them! Obtain the direct number and make sure they are up-to-date on any procedures or visits.
  5. Keep track of everything! File all your bills, receipts, explanation of benefits and letters received by any of those mentioned above. Combine them according to the date of service and keep them handy. Take notes of every conversation including who you spoke to on what day. All of this may prevent you from being billed inappropriately. Make sure you only pay what your Explanation of Benefits shows under ‘patient portion’. And last but not least, don’t pay until you receive both a bill from the doctor/hospital AND the Explanation of Benefits.

This is not only a checklist to follow your healthcare needs during and after your pregnancy but it is a guide to follow for any healthcare procedure you may undergo in the future. Feel free to comment any additional questions or insurance horror stories you may have and I will see what I can do to help.

Written by: Kelli Swift


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