The Insurance Trap of Prenatal Care
Tags: Health Care Reform, Insurance, Womens Health, Healthcare, Pregnancy

I’d like to tell you a story. It’s a story about how yet again, the US healthcare system is messed up.

This is about prenatal care. Because I am pregnant. And this is something that with each appointment, I learn about how the system is built against patients. What do I mean? Let me explain.

Firstly, this isn’t about the care that I receive. My doctors have been great. I’ve been comfortable at appointments. I’ve had my questions answered. I haven’t felt judged by asking any questions or with any decisions that I have made. So this isn’t about doctors.

As so many stories on healthcare in the US are, this is about insurance. And I am someone who is extremely fortunate. I am employed fulltime by a company that offers pretty good benefits. My coverage is mostly good. I say mostly good because I have learned, through being pregnant, that insurance companies really, truly, honestly want to do all they can to not pay for services.

So what am I talking about?

Before becoming pregnant, I looked up within my plan information all of the coverage I would receive being pregnant. Admittedly, I didn’t dig deep into what I found, which wasn’t a lot. There was language about routine prenatal care being covered at 100%. Ok, great. That seems good. Anything routine — anything my doctor deems as routine, regular care-would be covered 100%. Anything that wasn’t routine would be covered differently, which for me for in-network services would be 80%-20% until deductible was met.

Ok, sounds simple enough.

However, what I learned after receiving my first bill, which was for the appointment that confirmed by pregnancy, was that my insurance company thinks of routine very differently than I do. Different than my doctor does. Different than patient advocacy groups do. WHICH IS A PROBLEM.

I get it, to make the already complicated world of insurance and billing less complicated, contracts are in place between providers and insurance companies where coverage is determined for certain care. I work in healthcare — I probably know more than the average person does about the system. Which is why I understand how it works and what to look for when I get bills.

So I get a bill, and it looks…wrong. Like I’m being charged for an ultrasound (necessary to confirm the pregnancy and confirm location of the pregnancy, because if ectopic and it ruptures, I could die.). I’m being charged for urine and bloodwork? What the hell! All of this is needed. All of this is routine care, especially at the beginning of the pregnancy.

Anyway, I start to ask questions. And I learn that my coverage is actually NOT GREAT. I compare the standard of care recommended by multiple organizations (example — American College of Obstetricians and Gynecologists, a very reputable organization), and I see that much of my care won’t be covered. And so far, I have a routine, non-complicated pregnancy.

What’s hilarious is that when I started asking questions, anyone I would talk to on the phone would point me to the member area of the website. I’d say I checked that area-no information. They’d look and find…also no information. They’d look at their materials, and find nothing more. As far as I know, No one seemed to know anything about coverage, or why coverage for routine care wasn’t considered routine.

So I wrote a long complaint about how the company was contributing to the US maternal mortality crisis by not covering routine care. That their system is hurting patients. I am fortunate to be able to afford these bills, but it’s not about me. This is about me knowing that so many others cannot afford care, and that I feel I must speak up and demand answers. Demand that there be explanations for why the standard of care isn’t covered. So far, no response, but I will keep asking questions and keep digging.

Would it be different if I had a different plan from my employer? Potentially, but that’s not the point. (I could write another piece, and might, on how employer-sponsored coverage, the overarching way our US healthcare system works, is also NOT GREAT, but I won’t get into that now).

This story isn’t over. One day I’ll post the letter I wrote, but since this is ongoing, I won’t — yet.

Learn how to read your bills and ask questions. Because our healthcare system isn’t built for patients. It’s not built for you to receive affordable care. It’s not about ensuring you get the care you need. It’s not about you.

It’s about them and making more money. Making more money despite record profits in a year of a pandemic. Making money despite so many health crises going on. It’s about them hiding information and not knowing answers to questions so you give up instead of fighting to get what you need to get.

Insurance can be a scam. I learned this through getting pregnant, and learning about the trap of insurance in prenatal care. Protect yourself, because you’re worth protecting!