Archive for October, 2010

Maternity/Pregnancy Insurance for Self Employed

Are you self employed and have Individual health insurance coverage?


Are you planning to start a family by getting pregnant and having baby?


If you answered yes to both of the above questions, you can almost forget about having a baby without losing all your savings. Yes, I say that with lots of frustration and sigh after going through the hassle ourselves during our pregnancy period this year for our second baby.  It is hard to find a reasonable insurance coverage with maternity these days. You might be lucky to find some in certain states or cities but 75% of the time you will never see an insurance company covering maternity or pregnancy. That’s one of the biggest exclusion item.

I have spent number of hours googling and asking my friends and collegues around to finally got hold of one and only company which covered pregnancy in Texas(Assurant Health) with a reasonable deductible and major medical coverage for hefty price tag. But getting the insurance wasn’t hard part, getting them pay for the claims is the hardest of all. After you paid premiums every month for a year or so, you will shock to hear that they won’t cover certain claims.  

Like any industry, there are lot of loop holes associated with the medical codes system where insurance companies easily find ways to get you pay as much as possible before they pay their share. I am just talking about for normal delivery and you can imagine how difficult and hard it would be for C section or delivery with complication. In this post and next posts, I plan to share the real experience of going through the hassle of finding a insurance carrier, how to get the coverage abiding with their restrictions and how it all turned out during the delivery time.

How much it cost?

First and foremost, lets share the maternity bill for my wife’s delivery which is normal delivery and no complications to get some perspective. These are aproximate figures closer to the billing charges. I got bills from almost 5-10 different providers. I thought I will only get bills from Hospital and Doctors but I was surprised by providers which are billed seperately and not included in the Hospital charges  like pathologist, anesthesiologist , lab work, and so forth.

Hospital charges  – $13500,  $3000 (Baby)
Doctor’s Charges – $3500
Anesthesiologist – $$3800 (epideral medicine)
Pathologist –  $200
Pediatrician – $1000

Total    –  $25000  (before insurance insurace discount)

With the insurance discount, it all came down to $15,000 or so. The charges are only for the delivery period. There are bills during the pregnancy period for lab work, scans and different pregnancy tests. Our mail box was always filled a bill or two every day.

According to the some reports, the pregnancy cost have gone so much and it ranges anywhere from $15000 – $25000 for normal delivery and cost more around $35000 or up for other types depending on the complications. That’s the main reason, I wanted to have maternity insurance. You should have one too. Baby delivery is so  unpredictable and anything can happen for the mother and the baby and you better have coverage to cover otherwise don’t be shocked to see the Himalayan bill at a later point. To avoid heart attack and save your life savings, you should have a pregnancy/maternity insurance. I highly recommend it if you can find one in your state or city.

How to get Pregnancy/Maternity Coverage?


1. Easiest and cheapest solution, get a job in  a company which offers group health insurance. I only paid $500 for my first kid when I was working for big company with good insurance 5 years ago, now I paid more than $5000.  Even if your spouse can get a part time job in an organization and get health coverage, that would save your money if she/he doesn’t earn a lot. That would be best choice.

2. If self employed or own a company with employees, sponsor for group insuarnce for all and get maternity coverage. There are many insurance carriers like Aetna, BCBS, United Healthcare which offers good coverage for small business companies.

3. If you weren’t able to get any group coverage, then your last resort is to find a individual insurance with maternity coverage.  You might be able to find coverage from companies like Cigna, Assurant Health(bought by Cigna now) and few others.

4. If you can’t get insurance coverage, atleast talk to your gynogolist and hospital where you planning to have a baby and workout a deal. Many providers/hospital are willing to work out a payment plan and give discounts which might work better. Because they are better off getting money from you than from insurance companies which only pays discounted/adjusted charges.

With the recent Health care Act changes gone effect on Sept 23, 2010, Kids can be covered under parents plan upto 26 years. If your parents have good health coverage and you are below that age range, you might have a chance to get covera but please check the insurance carrier.

In the next post, we will see some important things to consider while getting the Maternity/Pregnancy insurance coverage and after delivery.

5 Tips to choose a Right Healthcare Plan

In the last post, we saw the recent Health Act law changes went effect from Sept 23,2010 and more such changes are going happen for the year to come. Whether full health care bill takes effect in 2014 or not, these small changes really helps many families to maintain their health insurance coverage.  If you are individual who don’t work for any big companies that offers group health coverage and been contemplating about taking individual coverage, this may be right time before the premiums go up as many expects.

For the household which has group insurance coverage, open enrollment is right around the corner. That mean’s it’s time to start thinking about choosing your health plan for next year. Some of you might have option to select from different providers and plans but some might not have lot of wiggle room except choosing from two different plans. It all depends on your employer. But if you are individual/family without an option for getting group plan and looking to carry individual insurance you have all the options in the world.



1. What’s your status?

First, think about your current status. Are you single or married? Do you have dependents in your household who needs medical help. It matters because it determines whether you need a plan for one or a family member. Also the status will affect your cost and your health coverage. So be careful to see which plan options best suit your situation.



2. What’s the cost?

Secondly comes the cost. There are a few big things to consider about cost. Do you or your family go to the doctor often? Then you might want a plan with a lower deductible and out-of-pocket cost and a higher monthly premium. If don’t use your health plan or go to the doctor much? It might be better to choose a plan with a lower monthly premium and higher deductible. I like to categorize them as, Pay first Plans and Pay later plans.

You either pay ahead as premiums if you need lot of medical help and save money on deductibles or pay later when things happen and save money on paying high premiums.  It depends on your situation. I prefer to go with Pay later plans that way you have more flexibility but you need to plan for those expenses and put away the money aside for deductibles/coninsurances.

If you’re not sure what might be best, look at what you spent last year and how often you or your family went to the doctor. By doing your analysis and then you can choose a plan that fits your needs.



3. Who’s in the Provider network?

Third comes the provider network. Check out whether your favorite doctor is “in network” for the plans you are looking. How about specialists and hospitals nearby your area? Some don’t want to lose their favorite doctors or pediatricians while changing the plans but most of the PPO plans from different providers are pretty flexible and coverages well know doctors and clinics. But it is always better to make sure by calling the doctors office before you deciding on a particular plan.



4. Are there other benefits?


Many providers offers plan with paid preventive coverages with certain limitation and also offers wellness programs like reimbursing for fitness clubs memberships, covering certain weight loss programs. This will be the fourth step in your plan selection process.  It is common belief that one lives healthier avoids getting sick often and will have less medical problems, that reduces number of visits to hospitals and doctors and insurance companies can reduce their cost. At the same time, as a person it is important to get support to lose weight, eat healthier or stay fit. It is a win win for both insurance companies and individuals. So make sure you take a look at the wellness options.



5. Is a healthcare fund (FSA/HSA) right for you?


Finally comes some many saving options. If you currently have healthcare insurance through your employer, you might have heard about FSA cafeteria plan(FSA). This plan is offered seperately apart from your Health insurance. If you have the option to enroll in this funds, please consider it. It could help you save by paying for care with pretax dollars. Similary, HSA (Health Savings Account) also helps save money by paying premiums and deductibles from Health Saving account where the contributions to them are tax deductible and also has flexibility to earn some interest which can be withdrawan tax free when used for medical expenses. You can learn more about these plans at planforyourhealth.com.

Health problems/issues can be devastating at times and has the power to wipe out your full assets in matter of months. It is wise to have a Health insurance with reasonsable coverage to cover you and your family both for the physical and financial well being.

Some content courtesy: Aetna Newsletter

Health Care Act Update: Good Changes are in effect

Around 10-15 million Americans are without job and around 45 millions don’t have any Health Insurance coverage as per reports. So we cannot be sure about how the new Health Care Act is going to help achieve its set goal of making the not insured count go down when it takes effect starting in 2014. With Mr. President opponents(republicans) grapling about Health Care Bill and doing everything possible to repeal the act. It is not sure whether major changes of health care act will ever effect. So it is encouraging and good news to hear some part of the act is taking effect as of Sept 23rd, 2010.

Being self employed and carrying Individual Health insurance, I always look out for changes in health care to see whether it makes our life easier and save some money. The changes which took effect on Sept 23, 2010, seems to really add value to the consumer and makes good sense.  Here are the details about changes so you can apppreciate it. If you are group health plan holder, you won’t be thrilled about since everything is covered in group coverage.


What Insurance companies can’t do anymore:

  • Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma. This is a big blessing for many parents who already suffereing because of their kids pre-existing conditions. Now Insurance companies have to cover them. It might be expensive but alteast coverage gives discounted price on the services provided.

  • Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer. With medical cost skyrocketing these days, any person with serious medical condition, this is big bonus so they don’t have pay from their pocket after lifetime benefits are finished. 

  • Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most – solely because you or your employer made an honest mistake on your insurance application.

  • Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer. This makes sense because you have the right to appeal or review which many times helps to get the cliams paid. Many insurance carriers already provide this opportunity but making it a compulsory in the agreement would force them to do proper claim service.

What consumers get when they renew or buy new Health Plans:

  • Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you. Many insurance carriers already provide this option with limitation on the expense like $300/year. I am not sure whether the new law changes and takes away the limitation or not.

  • Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job.  This might e a burden to many parents but kids without insurance is bad compared to having them in your plan until they can financially support themselves.

  • Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.

  • Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services.  This change is a big plus for many elderly and many with serious medical conditions who use emergency a lot.


Overall, these new changes seems to add value to the insurance policy but Insurance carrier are sure to shove the expenses related to these changes to the consumer. Because of that, you are going to see some big jumps in the insurance cost in coming years. Check out more details and webcasts about this change from healthcare.gov

Source: healthcare.gov

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