Personal Health|September 16, 2009 9:55 PM

Uninsured and pregnant doesn’t mean financial disaster

babysidebar_refPregnancy is a difficult time as it is, without being faced with the additional worry of having no insurance. But there are more options than you may realize for having your baby with quality medical care. It also pays to shop around.

The most critical thing to understand is that you need prenatal care, for both health and financial reasons. Prenatal care increases the chances of having a healthy pregnancy and a normal delivery, which is far less expensive than one with complications.

As you sort your options for getting care, don’t wait to start taking care of yourself. There are many web sites that can provide you with information on what you should be doing to ensure a healthy pregnancy. These sites also provide information that can help guide your decisions about prenatal care and delivery options. A few trustworthy sites are:

Paying for Pregnancy Care

Because prenatal care has been proven to reduce the risks — and expenses — of premature births and unhealthy babies, the government has focused on helping women find care in a number of ways. Here’s a guide to help you find care:

Do you qualify for insurance under a former employer? If you or your husband were laid off or quit a job in the past few months where you had health insurance, you may still be eligible. The question is whether you already refused to extend your employer’s insurance under a law called COBRA, says Chris Miller, director of large group underwriting for Anthem Blue Cross Blue Shield. Contact your former employer immediately to get information. Even if you became pregnant after leaving the job — but if you’re still within 60 days of the time you were notified of your COBRA benefits — you are eligible, Miller says. The federal government is paying up to 65 percent of the cost of COBRA coverage for employees who are laid off.  The federal government has a guide to COBRA.

Can you or your husband find a job? If you or your spouse can find a job that offers healthcare benefits and you enroll as soon as you are eligible, your pregnancy will be covered. Under Colorado law, insurance companies can’t consider pregnancy a pre-existing condition and exclude it, according to Miller. This applies throughout your pregnancy, so it is never too late to get coverage.

Do you have a low family income? You may qualify for Medicaid or the Colorado Child Health Plan Plus. These state programs provide insurance coverage for prenatal care, delivery care and infant care. When you are pregnant, you can make more money and still qualify for help. For instance, a single pregnant woman is counted as two people, and can earn up to $29,880 a year and still qualify for care. (That figure is after certain expenses are deducted.) If you want to apply for both programs online, you can fill out a “joint application.” (Applications are available in English and Spanish.)  Pregnant women also can apply in person for immediate care at one of 120 locations statewide and request presumptive eligibility.

Is your income too high to qualify for Medicaid/CHP? You may still qualify for help. The Colorado Indigent Care Program, despite the name, provides discounted healthcare services to women with incomes that are low, but too high for Medicaid or the Child Health Plan Plus. Women can apply for this program at the same “presumptive eligibility” sites provided above.

Are you ineligible for any governmental help or private insurance? If so, you are now considered a “self-pay” patient. Although having a baby is expensive, there are programs that will help reduce the cost while also ensuring that you and your baby get the care that you need to have the healthiest pregnancy possible.

Clinics: A number of clinics are available throughout the metro area that provide care to pregnant women at very low rates. A few of these clinics include:

Midwives: Midwives provide prenatal care for low-risk pregnancies. Many midwifery programs work through local hospitals. Mountain Midwifery Center in Englewood, near Swedish Hospital, provides a free-standing birth center. Women who are considered “low-risk and normal” can receive care and deliver their babies at the center, said Heather Thompson, Ph.D. and a post-partum doula at the center. (Doulas provide information and support to women rather than medical care and work in conjunction with physicians or midwives.) An uncomplicated vaginal delivery that requires no intervention at the center costs $4,500 for all prenatal care, delivery and post-partum care up to 6 weeks, Thompson said. To learn more or find a midwife, contact the Colorado Midwives Association.

Hospitals: Nearly every hospital offers a discount for self-pay patients that can save you thousands of dollars. Some hospitals even offer discounted package programs that includes prenatal care, deliver and post-partum care. The key is to contact the hospital as soon as possible. Hospital financial counselors will help assess whether you are eligible for any government assistance and then work with you to determine your costs and how to pay those.

The average charge at a Colorado hospital for a normal vaginal delivery without complications and a normal newborn was $11,014 in 2008, according to the Colorado Hospital Association. This charge does not include physician fees.

St. Anthony Central Hospital offers self-pay patients with normal pregnancies prenatal care through a midwife, delivery and post-partum care for $4,285, says Barbara Hughes, director of women’s services for the hospital.

“We want to make sure that women who don’t have insurance can get high-quality care, so we’ve come up with this package,” she says. Women who do not have complicating risk factors — such as diabetes, high blood pressure or are carrying twins or more — should be able to use a midwife, says Hughes, a certified nurse midwife for 25 years.

As another example, Swedish Hospital offers all “self-pay” patients a discount that “levels the playing field for self-pay patients to end up with the same rate as insured patients,” said Julie Lonborg, spokeswoman for the hospital.

It’s important to note that most hospitals will not send a self-pay patient’s account to a collection agency if the patient is working with the hospital to make even small payments regularly.

For a list of hospitals and their web sites, contact the Colorado Hospital Association.

Doctors: If you want or need to use a physician, start with your current physician if you have one. Physicians often will work with existing patients to provide care at discounted rates, particularly if you had insurance in the past. If you don’t currently have a physician, you can get a referral to an obstetrics practice that offers discounts for self-pay patients through your local hospital or health clinic. As you consider the costs, be sure to ask about lab work and other tests as those will be separate charges — sometimes hundreds of dollars worth — that the physician does not control.

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