How can I have a baby in NYC without health insurance?
November 14, 2009 9:12 AM   Subscribe

We are having a baby! We are super excited, except that we are in NYC without health insurance and really scared. What are our options?

To further complicate things we are both non US citizens (Swedish and Australian), freelancers, young and broke, and live here on non-immigratant visas. My fiance and I want to stay in NYC, but only if we can find a way that is best for mother and baby. One option is to return to our home country and benefit from free health care, but this is our home now. We will do this though if there isn't any alternative, but we hope to find a solution here.

I have called around to some OBGYN offices, but they quoted around $10k, and that doesn't include tests or complications. It seems too expensive, especially considering if there are potential problems. We would get her health insurance if possible, but from reading around it seems that pregnancy is considered a pre-existing condition and wouldn't be covered? Either of us can't be employed because of our visa status and so company health care isn't an option either.

My fiance is 6 weeks pregnant and we are eager to see a doctor immediately, but we haven't had much luck so far. Have you been in this situation? How can we see a doctor immediately without a huge financial burden? Can we get health insurance in NYC even when pregnant? Thanks so much for any advice, leads or suggestions.
posted by anonymous to Health & Fitness (33 answers total)
If you make less than $36,000 a year, it looks like you might qualify for this.
posted by craichead at 9:28 AM on November 14, 2009

10K sounds high -- my OB charges $2800 total for a vaginal delivery, including all prenatal visits -- but it's really not the half of it. You'll have tests -- blood tests, ultrasound -- throughout the pregnancy. You'll see doctors other than your OB at the hospital -- an anesthesiologist, a pediatrician after baby's born -- for your delivery, and each one will charge a fee. The hospital itself will charge for your room, for tests, for the fetal monitor, for the food. If you have to have a c-section, things will get more expensive -- just the anesthesiologist's fee will be huge. If you have any more exotic complications -- I hope you won't, of course! -- things could get stratospheric.

You can probably pay out-of-pocket for a first prenatal visit, maybe at a clinic, just in these next couple of weeks, to make sure the baby is in the uterus (the doctor can confirm this just through a physical exam). But other than that, as soon as you can make arrangements ... just go home for the next year.

If someone offered to pay you at least 15K, with the chance of getting 50K, to go home for a year, you'd do it, right?
posted by palliser at 9:43 AM on November 14, 2009

Planned Parenthood could be a great resource right now. They do offer prenatal care, but could probably give you some area referrals if you need them.
posted by so_gracefully at 9:46 AM on November 14, 2009

Sorry to call your home country "home" -- should have noted that you specifically said you consider NYC your home now.

Anyway, do check out the possibility of public assistance, but if you're really looking at paying out-of-pocket, my advice still stands that the OB fee is nowhere near what the total cost would be.

And congratulations!
posted by palliser at 9:49 AM on November 14, 2009

Consider choosing a homebirth. If I were pregnant in NYC, a CPM would be my first choice, and a CNM would be my second choice. CPM's are not yet legal in NYC, but it looks like there are some good homebirth CNM's. I read that Miriam charges $4500, which should include her prenatal care charges too. Research it all yourselves, but my research and experience has shown that homebirth is very safe for low risk women. Good luck.
posted by skjønn at 9:49 AM on November 14, 2009 [2 favorites]

Homebirth is two to three times more dangerous that hospital delivery. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.
posted by Rhomboid at 10:04 AM on November 14, 2009 [1 favorite]

Honestly, if you've got comprehensive coverage for mom and baby elsewhere, I wouldn't risk it here, especially if you're paying out of pocket. If anything at all goes wrong--for kid or mother--you could end up with a staggering bill that even a couple that isn't self-described as "broke freelancers" would have issues with. I'd head back to where your coverage is, give it 3-6 months post birth to make sure that everyone's checking out OK, and then look into coming back "home" to the US.

(Also, services for indigent mothers and children aren't always great....and as more and more citizens become eligible for them due to the economic crash, you'll want to consider whether or not you want to deal with the increased paper work and wait time.)
posted by availablelight at 10:06 AM on November 14, 2009 [2 favorites]

PS-- "anything at all" doesn't have to mean worst case scenerio stuff like a birth injury or maternal crisis....even just infected c-section stitches, milk duct issues, etc. will pile on hundreds of extra dollars if you're not insured.
posted by availablelight at 10:13 AM on November 14, 2009

I have to point out to those who are saying "go to where your coverage is", that doing so would mean that the child would not be a US citizen, and dual (or in this case, possibly triple) citizenship has it's benefits, especially in adulthood. Of course, one would have to weigh that against everything else being discussed here, but it is a factor.
posted by deadmessenger at 10:33 AM on November 14, 2009

Check out medical school clinics. I had one of my children at Cornell Medical School/New York Hospital. I got excellent care. It was a long time ago but I remember they had some kind of sliding fee based on income.
posted by mareli at 10:49 AM on November 14, 2009

[comment removed - this is not the place for birth horror stories.]
posted by jessamyn (staff) at 11:03 AM on November 14, 2009

Do you qualify for Healthy NY (discounted/free insurance provided by NYS)?
posted by meta_eli at 11:08 AM on November 14, 2009

I have to point out to those who are saying "go to where your coverage is", that doing so would mean that the child would not be a US citizen, and dual (or in this case, possibly triple) citizenship has it's benefits, especially in adulthood. Of course, one would have to weigh that against everything else being discussed here, but it is a factor.

I was well aware of that when answering. And also aware of how a single medical crisis or mishap can spiral even middle class folks into a financial nightmare....and how sub-optimal (and strained to the breaking point) charity care can be right now major urban areas. I wouldn't gamble with a kid.
posted by availablelight at 11:10 AM on November 14, 2009

Rhomboid linked to Amy Tuteur, who is someone who has made a career of hit and run postings against homebirth. I disagree with her conclusions on homebirth. She neglects to account for homebirth parents who have babies with congenital defects, comparing studies where congenital defects are corrected for, and the Johnson and Daviss study, where they are not. She also is working with extremely small numbers that are bordering on (if not) statistically insignificant.

I agree that this thread is not for a homebirth safety debate. If the question asker is so inclined, I encourage her to research all available perspectives for herself.
posted by skjønn at 11:22 AM on November 14, 2009 [2 favorites]

I think Healthy NY has a pre-existing condition clause, meta_eli. It might be a good longterm option, though. It's one thing to be uninsured when it's just you, but I think I'd want more stability if there were a kid in the picture.

And actually, I don't know if this is OT, but I'd just throw that out there. Once you have a kid, you have pretty epic responsibilities. It's one thing to be young, broke, and semi-legal when you don't have kids, but I'm wondering if it's going to feel the same way when there's someone else's whole future on the line. Are you going to feel secure with your work/ visa/ health insurance situation when you have a kid? I'm sort of wondering if you don't want to move back to a country where you can live and work legally and try to figure out a longterm plan to return to NY with a more stability-conducive immigration status.
posted by craichead at 11:22 AM on November 14, 2009

Also, for a better idea of Amy Tuteur, you might want to look at the reaction in the comments to her latest diatribe against homebirth.
posted by skjønn at 11:23 AM on November 14, 2009

Are you 100% certain that the medical coverage (I assume Universal care or some such thing) doesn't cover you while you're in the US? You should double check with your embassies about this. Many countries do provide coverage to their citizens while abroad, especially if you are explicitly on a non-citizenship track visa.
posted by anastasiav at 11:34 AM on November 14, 2009

I work as a physician at a large public hospital in Brooklyn where we have a real commitment to providing prenatal care. Let me suggest you go to the HHC website and find the hospital nearest you, call and make an appointment with their prenatal clinic. In the meantime go to the pharmacy and get some prenatal vitamins, stop smoking and drinking, etc. If you have any problems you can contact me at the email listed in my profile.
posted by mert at 11:40 AM on November 14, 2009

The situation in NYC is not great. Although I'm sure you can find public and charitable resources here, they really are stretched to the limit. The care you get will be sub-optimal, and you will be taking from an already limited pool of funds, so you might consider the ethical implications of using these resources.
posted by kathrineg at 11:46 AM on November 14, 2009 [1 favorite]

FYI, Planned Parenthood does not offer prenatal care in New York City, but yes, they can refer you elsewhere.
posted by keever at 11:54 AM on November 14, 2009

Check out Freelancer's Union for insurance coverage. Several types of freelancers are eligible for coverage; you'll need to go through their little form and figure out if you fit in to that. It says specifically that pregnancy is not subject to pre-existing condition limitations. It doesn't say anything about citizenship requirements, so you may need to call and talk to them, once you know if you meet the other conditions. Fwiw, I had insurance through them several years ago, and it was fine for basic care, and it looks like it's improved significantly since then.
posted by min at 12:22 PM on November 14, 2009

Many countries do provide coverage to their citizens while abroad, especially if you are explicitly on a non-citizenship track visa.

No idea about Australia, but from what I can tell, Sweden only covers it if it's an unexpected condition, and you still have residency in Sweden (there are some exceptions for au pair-work, but that's about it).
posted by effbot at 12:34 PM on November 14, 2009

I have called around to some OBGYN offices, but they quoted around $10k, and that doesn't include tests or complications

I gave birth in NYC six weeks ago and the bills have finally all trickled in; prenatal care, testing, delivery, hospitalization, and the baby's first pediatric care in the hospital added up to just over $50,000. I had a completely normal, problem-free pregnancy that ended in an unexpected and unavoidable C-section.

This is just to say that doing this without insurance would have been financially disastrous.
posted by agent99 at 12:49 PM on November 14, 2009

(but if the mother is swedish, call försakringskassan and check with them directly. there might be some rule or agreement that applies to your specific case, depending on how long you've been away, residency, etc.)
posted by effbot at 1:05 PM on November 14, 2009

Data point: my wife and I elected for home birth and paid out of pocket (wtf? insurance will cover $10,000+ hospital stay but not a $3,000 home birth).

We paid $3,000 in a few installments, got bi-monthly appointments with our midwife up until the third trimester, where they then switched to weekly appointments. Each appointment lasted approximately an hour. That's an hour of face-to-face time with the person who's going to be sticking their hands in your body. Our friends complained of OBGYN visits where they'd see a different nurse each checkup, and the doctor would come in for only five minutes. MeFi mail me if you'd like more homebirth resources in your area.

smooth pregnancy, labor, and delivery (albeit a long labor). every birth story is different. hospitals in the US love to encourage C-sections, which can be very expensive without insurance.
posted by spikeleemajortomdickandharryconnickjrmints at 1:22 PM on November 14, 2009 [3 favorites]

Rhomboid doesn't know what he or she is talking about at all, and the author of that particular article retired from medicine more than 15 years ago. She no longer practices medicine, hasn't published anything at all in peer reviewed journals, and is only known for one book on birth --- published, coincidentally enough, the year she retired from obstetrics. She's also not considered that highly in the field of obstetrics. Just throwing this out there because in that particular piece, she misrepresents the statistics on homebirth. I'm not encouraging you either way, but I want to strongly express that you need to do your own research on homebirth if that is the treatment model you would consider.

That aside, I do think you should be aware of the Emergency Medical Treatment and Labor Act, which applies to anyone regardless of ability to pay. If your girlfriend shows up at the hospital in labor, the hospital cannot turn her away and will have to treat her. After which, the hospital will more than likely work with you on reduced payment because they won't really have a choice otherwise if they want some of the costs covered. This doesn't assist with the prenatal care component, of course, but I think the suggestions of seeking out Planned Parenthood and/or a clinic in NYC are good ones.
posted by zizzle at 1:36 PM on November 14, 2009 [2 favorites]

It might help to know what category of visa you are under, as they have different restrictions.
posted by jacalata at 4:29 PM on November 14, 2009

I would suggest a midwife as their professional focus is solely on childbirth and woman's health and they are used to helping out with persons in tough financial situations. I would strongly advise against a home birth, there are a huge number of variables even in healthy pregnancies that even a skilled practitioner will not have the facilities to deal with in your residence. Also you should be aware that CPM's are not certified to international standards and while many of them are skilled I would advise against using their services. If you are interested in seeking care at a midwifery practice you have a many options.
posted by BobbyDigital at 5:59 PM on November 14, 2009

In response to BobbyDigital, here are the educational requirements for CPM's. It's true, situations do arise in homebirth that require transfer. And things happen in the hospital (like unnecessary C-sections) that can also result in the death of the mother. In my opinion, the evidence shows homebirth is safe for low risk pregnancies. But please, rather than take the word of any strangers from the internet, find out for yourself from any care provider in New York you might choose what their education consisted of, how many births they have attended, what their cesarean rate is, etc. The midwives I know have completed a college degree, had extensive clinical training, and passed a national exam, and are licensed by the state we live in, with some states providing medicaid reimbursement.
posted by skjønn at 6:54 PM on November 14, 2009

I can't offer a direct answer to the poster's question, but I can respond to anastasiav's comment regarding your home countries' medical coverage being applicable in the U.S.: I have just applied for and received an Australian Medicare card, and I read all the fine print. While Australia's Medicare coverage does have reciprocal agreements with several countries, the U.S. is not one of them. (Source.)
posted by po at 8:55 PM on November 14, 2009

By law, public hospitals in the US cannot turn away a woman who is in labor and about to give birth. However, an expectant mother needs prenatal care as well. From my understanding, a non-immigrant visa is used for temporary visits to the US, whether for business, pleasure or medical treatment. IANAL, but until you apply to change your immigration status with the USCIS you won't be able to take advantage of the medical services available for low-income US residents. Even if you have a home birth with a midwife, she will have to fill out paperwork to register your baby's birth and that paperwork will ask for the Social Security Number of either or both parents. In the meantime, should you decide to apply for a different type of visa or citizenship, any assistance you receive from WIC (which provides certain foods and medical referrals to low-income pregnant women) will not count as a "public charge" and cannot effect any visa/citizenship applications.
posted by Oriole Adams at 10:58 AM on November 15, 2009

I would like to second mert's suggestion of HHC. Both for prenatal care and for labor (please don't just show up for labor). And I strongly yet humbly disagree with katherineg that your care will be suboptimal, or that there is some kind of ethical implication of taking advantage of a program designed to help people like you.
posted by deliquescent at 3:18 PM on November 15, 2009

My friends tell me a typical hospital birth costs $40-$50k. If something goes wrong, you're probably looking at double or triple that.

It sucks that your kid might not have American citizenship, but turning down free, first-world healthcare while lacking U.S. insurance seems kinda silly.
posted by exhilaration at 12:58 PM on November 16, 2009

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