Pregnant in New York: foreign, partly insured, need prenatal care help

January 4, 2017 9:53 AM

My unmarried partner and I are pregnant for the first time, while on a six-month working trip to NYC (four months left). We found out on the weekend and in order to be (partly) covered by our insurance for prenatal care, we need to provide a LOT of information to the insurance company: chosen providers, required tests, costs, etc. We don’t have a clue where to start with this: not just because this is our first pregnancy, but also because the American health care system is so foreign to us. We need help on how to start choosing a temporary care provider and… well… everything else! Can you help?

Specifically: How can we choose a provider? How do we determine what tests are needed and their costs without a multitude of expensive exploratory appointments? What ballpark figures can we expect to pay? Is there an organisation who can help us (we thought of Planned Parenthood, but is that primarily for people in severe financial and emotions distress)?


Many, many extra details to ensure I’m covering most concerns:

Our Situation in America
- We’re both from a Western EU country that provides high quality care. We’re fully insured at home.
- I’m here on an L1 visa. My company’s policy is that assignments less than a year in length are individual: there is no support provided for dependents.
- My registered partner (unmarried), was able to take a six month sabbatical from work (still formally employed), and is with me here on an L2 visa.
- Leaving the job in NY is not easy, but possible. This would be our last resort. We’re determined to try and do this here, and then return to our jobs in our home country in four months’ time.
- We can’t easily just go home, because we don’t have anywhere to live.

Our Insurance / Finances
- I’m fully insured both here and at home, but this does not cover a partner’s pregnancy because she is formally employed with her own health care insurance.
- My partner is fully insured at home and partly insured here: we’re covered up to the prenatal care costs that would be expected in our home country (so probably not much).
- To obtain this part coverage, we need to obtain pre-approval from the insurance company after providing information on our chosen prenatal healthcare provider, the required tests and their costs.
- If we can’t be covered, we can spend ~$5000 on this to make the next four months as stress- and pain-free as possible. Or even to increase the level of care we obtain. Is this a tiny sum for what’s needed?

The Pregnancy
- A few days ago, we discovered that she’s/we’re pregnant… about five weeks along.
- This is our first pregnancy.
- We’re both 35, so classed as ‘high risk’.
- While not a complete surprise, we did not expect this now for a multitude of snowflakey reasons.
- We definitely want to continue with the pregnancy.

posted by anonymous to Health & Fitness (8 answers total)

Congratulations! I'm not able to speak to specific providers, but may be able to ease your mind a bit in terms of tests. I was 35 or over for both of my pregnancies and both were uncomplicated and at no point was I considered "high risk." In the first and second trimester I was checking in once a month or so and the tests performed in the doctor's office were usually just a urine dip to check for protein that was carried out in office, so nothing terribly high cost. There are various genetic screens you can opt in or out of to screen for genetic or other congenital conditions in the fetus. For me this included a blood draw at about 12 weeks and more detailed ultrasounds at 14 and at 20 weeks. There were options to forgo these, though they are useful in terms of planning medical care if there is a concern for the baby.

Once you have identified a provider, contact them prior to your first appointment to ask what their standard care looks like. They should be able to provide a letter that outlines the common tests they would expect to carry out during their care of your partner
as well as how often they would expect to see you for routine care. You can ask what would be required vs. recommended as well. That should give you a starting point for figuring out costs. From there you may have some ability to negotiate costs if you are able to pay up front for some services.

Best of luck to you on this adventure! Parenthood is amazing.
posted by goggie at 10:06 AM on January 4, 2017

Planned Parenthood does offer prenatal care! It doesn't matter how much or how little money you have, or your emotional state; it's offered at some locations. Given the size of NYC, you'll have to figure out if a PP near you offers prenatal care if that's the direction you want to go. It wouldn't be a bad idea to just make an appointment anyway, even if you decide to go to an OB-GYN practice or whatever, to get an idea of what is considered standard obstetric care in the US in general, and in NYC in particular. That way you'll be armed with more information for your partner's insurance company and you can make a more informed decision as to who you want to do your care with.
posted by cooker girl at 10:08 AM on January 4, 2017 [6 favorites]

Go to www.healthcare.gov; you should be eligible for Obamacare. In order to get the tax credits though you'd need to file 2017 taxes (and also make below 400% of the US federal poverty line) and I'm not sure how that works from abroad, but it may be possible. Since the insurance you have now is only partial, you should qualify as not having minimum coverage and therefore be eligible for Obamacare.

I'm not completely sure how it would work with the taxes, but it's easy enough to go on the site to apply to see if you can do it.
posted by bearette at 10:20 AM on January 4, 2017

You can also try contacting the OB departments at the major medical centers such as NYU, Columbia and Mt Sinai. They often deal with fellows or exchange faculty who need time-limited services with varying insurance/payment issues.
posted by beaning at 11:11 AM on January 4, 2017

Here are some basics on beginning-of-pregnancy care. First you have a checkup with a GYN or OB-GYN to confirm officially that you are pregnant. This will be billed and treated as a regular checkup. Ask your friends for referrals to their docs--this is how people find doctors in New York. Once you get a list of recommended names, you can look up these doctors to see if they are accepted by your partner's insurance. But in order to get the ball rolling, it might be easier to pay out of pocket for this initial checkup and confirmation.

During this checkup, you can explain your needs (only prenatal care for a few months, need to have a list of likely tests and costs) and hopefully the doctor will be able to provide what you need.

Congratulations on the pregnancy, and you will be SO HAPPY to get back to your home country to finish up the pregnancy!
posted by Liesl at 11:35 AM on January 4, 2017 [1 favorite]

Much if not all of American healthcare is structured through corporations/hospitals rather than individual providers. For example, my OB/Gyn of many years worked for a University Hospitals with many branches but had an office of 6 Drs. All prenatal visits were with him but when it came time to delivery the Dr. on call did the baby catch while nurses, practitioners and such were with us most of the way. I think this is typical for insurance-covered deliveries. I would focus on a good "group" rather than a specific Dr. The practice will do the rest of the paperwork you need to figure out. Ask around for recommendations from colleagues for a Dr or office is the best bet if you don't have a Dr now. Not to sound crass but if you have a normalish pregnancy (mine was high risk due to me being 42 with first baby) it's like a factory, but in a good way. A lot of people would disagree with that and opt for natural non-hospital based deliveries. I can't comment on that. The bottom line is that the Dr.'s practice will get you going in the right direction. I have a lot of faith in our system as far as the compassion of the care givers based on experience, but YMMV.
posted by waving at 12:17 PM on January 4, 2017

A community health center will be a good place to get your early care at a manageable cost, if it turns out that the insurance coverage you're able to apply to this still leaves you with too much of a financial burden. They are used to helping people who aren't familiar with the US health care system.
posted by lakeroon at 1:21 PM on January 4, 2017

There is an MetaFilter-originated Facebook group for parents / expecting parents started recently that you may find helpful. I imagine you'll have a lot more questions big and small in the coming months, and we have some folks in the group who've dealt with getting prenatal care in several different countries and can speak to the differences, as well as New Yorkers who might have some specific local suggestions for you. Memail me, anon (and others who are reading this!) if you'd like to join and I'll add you - it's a secret group for now so no one has to out themselves to their networks.
posted by sestaaak at 1:30 PM on January 4, 2017