Pregnancy: Basics of Insurance for New Dads

By Mathew Miller, Sharon Perkins

The better new dads understand how your insurance covers pregnancy, the less likely you are to receive an unexpected (and unexpectedly large) hospital bill upon your return home. The second trimester is a perfect time to dive into your insurance benefits so you can make sure you have a crystal-clear picture of what’s covered and what’s not prior to delivering your bundle of joy.

Although navigating your insurance plan may sound as impossible as understanding your income taxes, it’s an important predelivery step for couples. Talk with someone from your human resources department at work, as well as with your insurance company to fully understand your coverage.

Unites States law says that pregnancy can’t be deemed a preexisting condition by insurance companies, so if you or your partner switched jobs or insurance plans in the middle of pregnancy, you’re probably still covered. However, the law is limited to group policies, not individual policies, and it has multiple loopholes, so be sure to carefully research your coverage.

Also, if you’ve recently changed insurance plans or signed up for coverage through the Affordable Care Act, understanding what your plan covers is of utmost importance and ultimately spells out how much you’ll owe when all is said and done.

Your personal insurance plan dictates the following factors:

  • Elective procedures: Whether it’s a scheduled Cesarean or a circumcision, not all insurance companies cover procedures that can be deemed as elective.

  • Length of stay in the hospital: The Newborns’ and Mothers’ Health Protection Act is a U.S. federal law that requires all insurance companies to cover the hospital stay for 48 hours after a standard delivery and 96 hours after a cesarean. It does not, however, require that insurance companies cover any or all of the birth itself.

  • Percentage of total cost: 80 percent coverage may seem like an awesome deal, until you realize your entire stay cost $10,000, and you’re now on the hook for two grand. Knowing what to expect allows you to save ahead so that when the bills start arriving, you don’t have to scramble.

  • What drugs are covered: It may seem like your insurance is obligated to fully cover any drug or medicine your doctor provides your partner, but that’s not always the case. Find out how much of the total cost of an epidural is covered because they’re quite expensive, and you may need to plan ahead for the costs you may incur.

  • Where your partner can give birth: Unless you want to get stuck footing a huge portion of the bill, make sure the hospital or birthing center of your choice is on your insurance company’s list of approved facilities. You’ve hopefully done this well before the third trimester, but it never hurts to double-check and make sure your policy hasn’t changed.

  • Who can attend the birth: Not all medical practitioners are covered by your insurance, so make sure yours is early in pregnancy, and recheck with your insurance company as the date approaches. If you’re opting for a midwife, investigate the coverage your insurance provides and make sure your midwife is willing to work with your insurance company. In rare cases, some insurance plans cover part of a doula’s fees.

Midwives are generally less expensive to employ than a doctor, and if your insurance covers the cost of a midwife, you’ll likely save money going that route. Many midwives even deliver in hospitals and partner with a doctor to ensure emergency care when needed.

Home births are the cheapest option of all but are generally recommended only for women who fall into the low-risk pregnancy category. However, if you and your partner are opting for a home birth, check with your insurance provider to find out how it handles such situations and what’s covered in case of an emergency.

In the case of multiples, the cost will increase by a great deal because the babies are more likely to stay in the neonatal intensive care unit. Again, assuming 80 percent coverage, you could be responsible for 20 percent of a bill that quickly escalates into the six figures.

Also, keep in mind that after mom is discharged, the costs of travel and staying at or near the hospital while your baby/babies are in the NICU are up to you.

Here are some other important questions to ask your health insurance provider:

  • Do you need to notify the provider upon admission into the hospital?

  • Are childbirth classes covered by your plan?

  • Will any portion of a doula’s services be covered?

  • Is lactation consultation covered?

  • What newborn care is covered in case of emergency?

  • Are any prescriptions or medications not covered?

  • Are any procedures (circumcision, scheduled C-section) or prenatal tests (amniocentesis) not covered? Are there exceptions?

During open benefits season at your work, which usually occurs sometime around the end of the year, check into the labor and delivery coverage of any alternative insurance plans that your company offers and consider switching plans or providers to one that best suits your needs. Doing so may save you thousands of dollars in hospital bills.