10 Questions to Ask Your Insurance Provider When You Get Pregnant
Friday, April 12, 2019
Insurance was always such a confusing aspect for me even prior to being pregnant. Since birth I have been fortunate enough to have an amazing immune system, so I rarely have had to go to the doctor in my adult life, meaning I never came close to meeting my deductible. As soon as I found out I was pregnant there were so many questions I had, so I reached out to my insurance provider to get the answers. Here’s all the information I recommend gathering and questions you need to ask. Be sure you have a pen and paper handy when you call!
Is Doctor “ABC” an In-network provider?
First and foremost, before you start establishing a relationship with an OB, you want to make sure they are in-network. In-network means that you insurance covers that doctor and will pay for any visits within your plan parameters.
What is my annual deductible?
Your deductible is the total amount you will pay out-of-pocket. Some insurance providers have different deductibles for medical services and prescriptions. If you are on a family plan, you will want to see if it is individual deductibles or family deductible.
What will my insurance cover once I meet my deductible?
Once you reach this deductible amount, your insurance will begin paying based on what your plan says. For example, let’s say you have a $500 deductible and once you meet it, you insurance covers 100%. However, some plans do not cover the full 100%. Some insurance plans will only pay a certain percentage once deductible is met. For example, 80% once deductible is met, meaning you will still pay 20%.
What is my max out-of-pocket expense?
While you still may be responsible for covering 20% (give or take) once your deductible is met, you will eventually meet your max out-of-pocket limit, meaning insurance will cover 100% after this point.
How will my pre-natal visits work? Is there a co-pay or do I pay all our of pocket until deductible is met? Are ultrasounds included in a visit co-pay or will they be paid out-of-pocket?
Some insurance plans will have a set amount you pay for a doctors visit. My co-pay is $10 per doctors visit. Be aware that in most cases, co-pays do not go towards your deductible.
Is “ABC” test covered?
In the case that you are doing any sort of extra testing for you or baby due to health risks or concerns, you want to run those by your insurance first. Sometimes these test required what is called “pre-authorization” which simply means that want to know why you need the test prior to giving you the ok to get it.
What is the process for adding the baby to my insurance once he/she arrives?
If you insurance is provided through your employer, the answer will most likely be that you will need to contact them to add your baby.
Do you cover or reimburse for a breast pump?
I have experienced two different set ups when it came to obtaining my breast pump. My insurance stated to call a 3rd party that would've had me purchase it on my own and send in a receipt to be reimbursed. The other option I found through online research was Aeroflow which accepted my insurance and offered an online website I ordered from and the total was $0. Here's my post on how easy it was to obtain my free breast pump through Aeroflow! Both situations worked great, but honestly I felt Aeroflow offered the easier way to obtain my breast pump. I would suggest asking about this before you hit your third trimester.
Do you reimburse for a birth class?
The classes that help you prepare for labor and delivery may be covered! Ask what the process is to get reimbursed. Make sure to check with your hospital as many of them offer complimentary classes as well. You can also sign up for a free online prenatal class from a Labor and Delivery Nurse here.
Make Sure To Sign Up for Online and/or App Access
This is just a side note and a personal preference, but I figured I would share. Calling insurance companies is a pain. I have online access to see all of our claims, where we sit with our deductible, etc. in an online portal and it seriously saves so much time (and sanity!) versus calling into the company. Ask your provider if this is an option for you!
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