Health Insurance for a Newborn/Pre-born?

September 13, 2009 2:38 PM

I'm confused about how to go about providing health insurance for my unborn baby upon it's birth. I am on Medicare, so the child is not covered. I do not qualify for Medicaid/SCHIP, and most individual plans will not cover a newborn from day one.

My job provides medical insurance for me only, not my dependents. And actually, not me, either because it does not provide coverage for those already qualifying for Medicare.

For the record, I am on MEDICARE, not Medicaid. Yes, this is the old people's insurance. No, I am not too old to have a baby. I'm on it because I have a disability. But this precludes me from qualifying for every "family plan" I've ever tried to apply for.

My other two children each have their own individual BCBS plans. Our children are also not covered under their father's plan.

The problem is, I cannot seem to apply for an individual plan for this child until he is born. Then, most individual plans have 1 to 6 month waiting periods before a newborn can be covered. If the baby has some kind of pre-existing condition in that time (even something as simple as prematurity or jaundice) he may not qualify for a plan (or the premiums could be astronomical.)

I can't seem to find any sort of coverage for him from day one. (He is due in three months.) This scares the shit out of me.

For one thing, the hospital wants a name of a pediatrician and I can find no one that will take him without insurance. If I leave the "pediatrician" line blank on the hospital registration will a ped come and see him?

What will the hospital do? Will they take us and care for him if he is uninsured? Will we be charged thousands of dollars for his care? What if something IS wrong with him? Will he be treated or will he be moved to a "public" hospital? (I'm planning on going to a private (Catholic) hospital now because I see a perinatologist (high risk OB) and that is where he practices. I'm supposed to have a C-section so cannot safely just go to any ER when I go into labor.) If he has something wrong with him, will he be uninsurable forever? (or at a very high premium, or with his "something wrong" not covered?)

Is there a way to get an as of now unborn child insured from the get-go? Who knows about this stuff? I can't seem to get any answers.

This is so confusing. I just want to go to the hospital and know that my baby will receive the care he needs and we will not go bankrupt because of it.

posted by anonymous to health & fitness (13 comments total)

Different states have different options. Could you please follow up with one of the mods to let us know which state you're in? It'll help folks determine where to point you.

I'm sorry you're having to worry about this.
posted by ocherdraco at 2:45 PM on September 13

Like ocherdraco said, without knowing your state, it's hard to help. However, this website may be a good resource to get started with.
posted by ishotjr at 3:08 PM on September 13

And just in case you're new here and don't know how to reach the mods, you do it by going to the contact page.
posted by ocherdraco at 3:29 PM on September 13

For pregnant women on MedicAID, I thought that their newborns are covered under Medicaid too. Can you apply for Medicaid for your new baby in his name? If you are required to wait until he is born, if Medicaid is granted it can usually cover up to 3 months backwards in expenses.
posted by IndigoRain at 3:51 PM on September 13

For pregnant women on MedicAID, I thought that their newborns are covered under Medicaid too. Can you apply for Medicaid for your new baby in his name? If you are required to wait until he is born, if Medicaid is granted it can usually cover up to 3 months backwards in expenses.

She's on medicare, not medicaid.
posted by kylej at 4:08 PM on September 13

I think it's likely that your newborn will be eligible for Medicaid since you're on Medicare. As a previous post stated, Medicaid will usually be retroactive, and most (all?) states have public health care for children. My state offers Medicaid to ALL children, regardless of insurance status, up to the age of 12. I guarantee that you aren't the first person in this situation, and your Medicare case worker should be able to tell you how to apply for Medicaid for the baby.

As someone who had to go through the hassle of dealing with insuring a baby with the state, My best advice is this: No matter how annoyed you are by the case workers and no matter how many times you have to leave voice mails before you finally get a call back, be VERY nice to them. Their jobs suck and they don't make much money and they have power to make the system a freaking nightmare for you. The nicer you are, the more they will want to help you.
posted by Lullen at 5:48 PM on September 13

Disclaimer: I am not an insurance professional. That said, as someone who had a child in a similar circumstance (I had insurance, my child did not, she was quite ill when she was born) and has spent altogether too much time trying to sort it all out:

If you have no insurance and you show up at the hospital, they will care for you. Under federal law, any hospital participating in Medicare *must* provide care to you if you arrive with an "emergency medical condition". Active labor is considered to be one of these conditions. While you may not have your choice of physician, obstetrician, or other medical professional, you will be given at least basic care.

Since you actually have insurance, though, that's not going to be an issue for you. Pretty much any hospital that takes your insurance will take you, regardless of if your child has insurance or not.

It's been my experience that the hospital will provide care for your child regardless of their insurance status. You may well be charged thousands upon thousands (and if there are complications, tens of thousands or hundreds of thousands) of dollars for said care, but care will be provided. Unless there are severe complications that necessitate transfer (to a place with a level III or IV NICU, for example) they're not going to force you into a transfer or onto the streets. This is especially true because you have insurance--they'll probably let you stay for however long your insurance dictates the appropriate stay for a C-section is, and they're not going to send your child home without you.

A pediatrician will see your child. Maybe, again, not your pediatrician of choice, but someone will see your child and ensure that they seem okay. If something is horribly wrong, the hospital will quite probably call in whomever they feel needs to be called in.

Medicaid--which is available to people in a variety of circumstances--will pay expenses back several months from when you apply. At the hospital, when they discover your child doesn't have insurance and you're on a state plan, they will probably offer you a Medicaid case worker. Take them up on it--even if it turns out that you're not eligible, it's a good place to start.

Assuming that you're unable to get Medicaid for your child, I would suggest phoning the hospital as soon as your bills start coming due. Explain to them that while you had insurance, your child does not, and the bills that they've sent you are way beyond your ability to pay. You're going to a Catholic hospital, which is fortunate--it's been my experience that private hospitals are often very willing to work with you on this sort of thing and often have funds that will allow them to minister to their community in this way. They may offer to waive a portion of your bill, they may offer you a payment plan of some sort. Hospitals rarely charge interest, and the payments can be quite minimal, sometimes as little as $5-$10 a month.

The trick to all of that, though, is phoning as soon as a bill shows up. Don't sit on it or ignore it. If you're in the process of getting insurance, tell them that, and tell them that you expect the insurance will cover some of the bill, and can you delay making payments until that's settled? If you're not in the process of getting insurance, just call right away and say that you're really sorry, that you'd expected to be able to get insurance, and that you're unable to make the full payment/suggested payment. It starts getting scary when things go to collections--don't let that happen. (I say this as someone who let it happen. It was bad times all around.)

Regarding the chances that your child will be able to get insurance, I'd say that it varies dramatically from place to place and instance to instance. If you're able to put the child on your work insurance, my understanding is that generally they'll refuse to cover a pre-existing condition or anything related to said condition, but they'll allow you to insure the child. If you're buying a plan on the open market, you'll probably not have problems if there's nothing wrong. If something catastrophic happens during the birth, you're probably out of luck for purchasing an insurance plan, but may have better luck getting them on a state-funded plan. All of this varies, of course, by where you are, what insurance companies you're dealing with, what sort of pre-existing conditions may be present, whether or not you sacrificed a chicken at the last full moon...Insurance is sort of like magic, really.

I'd also like to second what Lullen said about dealing with the state--leave as many voicemails as you need, but sound nice about it. Be polite. Even when they say no, thank them for their time, and then try again the next day. Even when they're nasty to you, thank them and try again the next day. Keep being nice, even when you want to scream and cry and throttle someone. Apologize for bothering them, thank them for helping you. I'm not going to lie--it really, really sucks to have to play nice like this, but this is one of those times you have to do it anyhow.

In writing this, I've made several assumptions: that you're not going to an overcrowded, underfunded hospital (for which you can likely read "inner city or very rural hospital"), that you're capable of advocating for yourself (that is, if you feel you're not getting the care you need, speak up--sometimes it won't be provided unless you ask), and, most contentious of all, that you come off as more or less middle class. I'm certainly not saying that it's right, but it's fairly well-documented that minorities and the poor (just the first hits, not an exhaustive search for documentation) receive health care that's of a lesser quality than non-minorities and people who are more affluent. While in theory, you'll receive the care described above regardless of your ethnicity or social class, you're probably going to have to fight harder for it if you're non-white and/or can't present yourself as middle-class.

Good luck. MeMail me if you think there's anything I can answer for you.
posted by MeghanC at 7:24 PM on September 13 [1 favorite has favorites]

followup:

I'm in the state of Oregon. I have already been denied Medicaid and SCHIP (the requirements are poverty line for those programs in my state, I am above poverty level, but within around 133% of poverty level.)

Medicare is a Federally funded program, not based on income and has nothing to do with state insurance.I have tried www.insurekidsnow.org, but have found nothing but outdated information and dead links.

I hope that information helps. Thanks to all who are responding and I appreciate any ideas, personal experiences and help you can provide.

posted by mathowie at 8:36 PM on September 13

kylej: "She's on medicare, not medicaid."

Yes, I know, that's why I emphasized MedicAID to show it was on purpose. I thought that since mothers on Medicaid often have coverage for their newborns, maybe a mother on Medicare could too.
posted by IndigoRain at 9:08 PM on September 13

I had a similar issue when expecting my last child. I had been laid off of work and was on cobra insurance. My insurance company, Blue Cross of Rochester told me that the baby would be covered under my policy until he was discharged from the hospital. This would apply whether he stayed 24 hours or many months.

Upon his discharge, we had to purchase insurance for him through Blue Cross of our home state.
posted by JujuB at 9:49 PM on September 13

Not knowing your income, might this program apply? http://www.oregonhealthykids.gov/

TODAY - Children in families with income up to 185% of the Federal Poverty Level (FPL) ($40,792.50 for a family of four) can enroll.

BEGINNING OCTOBER 2009 - Coverage will extend to children in families up to 200% FPL ($44,100 for a family of four).

BEGINNING JANUARY 2010 - Children in families between 200% and 300% FPL ($44,100 to 66,150 for a family of four) will be ableto enroll in coverage with premium assistance and children in families above 300% FPL will be able to buy into the program at full cost.
posted by cmgonzalez at 10:07 PM on September 13 [2 favorites has favorites]

"I'm in the state of Oregon. I have already been denied Medicaid and SCHIP (the requirements are poverty line for those programs in my state, I am above poverty level, but within around 133% of poverty level.)"

OP, have you checked on the qualifications in light of your new, larger family size? In other words, if your family of 3 has grown to a family of 4, the amount of income you could have and still be making less than the federal poverty guidelines has increased 20%. If you've applied for SCHIP/Medicaid for this baby, they probably took that into account.

This site states that the SCHIP (and pregnancy coverage, for that matter) guidelines in OR covers kids in families up to 185% of the federal poverty guidelines, and that Medicaid covers kids aged 0-5 if you make up to 133%. If you previously applied for your older children, I'd go ahead and reapply for this one, as the poverty guidelines will take into account your larger family size if you are seeking coverage for a new baby (some states will count the baby even when determining coverage for Medicaid and WIC during pregnancy).
posted by Cricket at 7:38 AM on September 14

Agreed with the comments about contacting the Oregon networks - keep phoning, keep emailing, keep speaking in person. Keep a diary annotated for quick reference.

This is especially true because you have insurance--they'll probably let you stay for however long your insurance dictates the appropriate stay for a C-section is, and they're not going to send your child home without you.

Slight nitpick - unless she develops severe complications herself necessitating an extraordinarily long hospital stay; it might be in the best interests of a healthy child to go home if the mother is too ill post-partum to be out of the hospital. Not very likely, but possible.

Make sure your spouse and other caregivers find that reference diary readable.

http://www.coverageforall.org/pdf/matrix/OR_Matrix.pdf

This, while only tangentially related, seems to indicate you can apply for MedicAID for this child.

http://www.thenationalcouncil.org/cs/public_policy/medicaid_newborns

Good luck!
posted by tilde at 6:04 PM on September 14