I love the idea of socialized healthcare. The Affordable Health Care Act is a great way of making health care more affordable for low income people and for a good amount of Americans who sign up for it. That’s not my issue. My issue here is for giving birth as a middle income family, who suddenly qualifies for a tax discount because of the birth of their first child… and trying to get coverage for that new baby for his first month of birth.
It started when we signed up for insurance through the Health Exchange website, way ahead of the deadline. The insurance we had prior was provided by my old employer, via COBRA, and expired in January 2014– we needed to find something quick! My husband and I are both freelancers living in NYC, so buying our own insurance was something we needed to do. I think we were paying about $1100 for the two of us, so we were very excited to see that for about $850 we could have even better coverage through another provider! The due date for our first baby was predicted for December 2013, and since coverage would start on January 2014, we thought it’d be easy to start off the year without any adjustments! Actually, we had also completed the estimate on the Health Exchange website again (to see if we’d qualify for a discount with our newest family member) and we did! But, obviously, we couldn’t apply until his birth, so we waited…
The doctors ended up being a bit off with our calculations, and I ended up giving birth the second week of January, at almost 43 weeks! Two days after, a bit burned out, I went back on the website, went through the all the form pages, and was offered two options. We could add him to Child Health Plus (a government subsidized program) for $30 a month with a nice discount of about $450, OR we could add him to our own insurance for $1250 a month… without any discount. Whaaaaat? Why were we restricted to only two options?
I called into the Health Exchange help line. They notified me that the discount only applied if we signed him up for Child Health Plus… and that was just the way it worked. Another issue, Child Health Plus did not cover retroactively, and took about 30 days to take affect. The Health Exchange rep mentioned the only way to get coverage for the month after his birth would be to sign him up for Medicaid… which we did not qualify for. So that meant, to get the discount, we’d have to let our newborn go without coverage for 30 days after birth??! I was then informed by the representative on the phone, that our current insurance company should cover him for the first 30 days until he had coverage through Child Health Plus, but that I should them call to confirm.
The next seven days were a series of back and fourth calls between the help line at the Health Exchange website and our current insurer to try to figure out who was covering him. There was no way I would feel comfortable letting my baby go without coverage for 30 days. There were too many things that could go wrong the first month after birth, and I needed the ability to bring him to a doctor (or hospital) as needed, without fearing debt.
Using up all the minutes on our family cell phone plan (mostly on hold for an hour at a time, per each call), I received two different responses from our health insurance that he’d be covered for 30 to 60 days after birth. I also received two responses stating that they didn’t know about any such policy and to call the Health Exchange, since they should be covering him. I did also get one response that he would not be covered by our insurance unless he was added to our health plan. Every single time I called the Health Exchange reps, I’d be told that I’d have to work something out with our insurer.
I am mostly upset that there was no written language of how new births would be handled on the Health Exchange. How can you claim to cover everyone, except for those newly born that aren’t very poor or very rich? It seemed that middle class families were left to fend for themselves, while everyone else was covered. Even with the unknowns of our son’s coverage, I still brought our baby to his first checkup. I wanted to make sure everything was okay. He’s turned out to be a healthy, thriving infant, who is doing great!
It’s now May 2014, and those visits have finally made it through our insurer. Guess what? They sent an ugly rejection letter in the mail, stating they would not cover it. The Pediatrician also sent a bill to the tune of $700 for the two visits in his first month and refuses to offer us a self-paying discount. We’re currently waiting on a response from our insurer, since I did not agree with their determination of benefits for non coverage. I’m hoping that it doesn’t take a few more months to resolve this issue, nonetheless I’m sure it will.
Neither the Health Exchange or our insurer was very clear on coverage for a newborn for the first 30 days. There is nowhere in writing that stated anything about how it was supposed to be handled. It seems that the only way of handling it is to have the baby covered by Medicaid, isn’t of use if you’re unqualified. If we had the money (and the power) to go back in time, I would have avoided this mess and added him to our plan. Unfortunately, that wasn’t the case. I hope our story brings to light one of the hidden pitfalls of the Health Exchange website. I still feel that it’s a great option for buying your own insurance, but perhaps we would have been more prepared if we had known of the issues with coverage for newborns in the first 30 days.