More and more I’m seeing people reporting that they had what they considered to be routine medical care during pregnancy, and they were shocked to find that their insurance did not cover the costs. Here are some of the situations that have come up:

  • A woman had routine first trimester blood work drawn at the lab in the same building as her care provider’s office. She verified in advance that this lab was covered by her insurance. But she received a bill for services because the lab was considered to be a “hospital” lab, and since she had not been admitted to the hospital for treatment, she could not use the lab.
  • A woman had a routine first trimester ultrasound at the ultrasound clinic in the same building as her care provider’s office. Like the situation above, she verified in advance that the clinic was covered by her insurance, but again found the services were not covered because it was an “in hospital” clinic, and she had not been admitted to the hospital for treatment.
  • A woman had a genetic screening done that was optional, but she did not know it was optional, nor did she know that she would be billed $800 for it under her high deductible insurance plan. Because her pregnancy straddled two calendar years, she did not max out her deductible the first year.
  • A pregnancy spanning two calendar years will result in needing to meet the insurance deductible twice–a significant consideration for pregnancy timing if you have high deductible insurance.
  • Multiple women have shared about being billed for the newborn hearing screening that is done in the hospital. The company that does the hearing screening was not “in network” for their insurance, even though the hospital was. This screening can be done after hospital discharge with a provider who is in network if the provider in the hospital is not in network. This can happen with any specialist that is not a hospital employee that is involved in a person’s care while in the hospital. I almost had an entire hospital visit not covered by my insurance because the doctor who was on-call for my doctor who authorized me to use the Emergency Room (when I was in excruciating pain from a torn ligament in my knee) was not an “in network” doctor! He wasn’t even involved in my care beyond the quick phone consult to make sure my injury was serious enough for the ER vs waiting through the weekend to go to my primary care doctor on Monday.

I share this with you as a note of caution. You should not expect your medical care provider to be aware of the nuances of how your insurance functions. They are an expert on your medical treatment. I find that in general, the doctors don’t know a lot about the insurance issues. They have an insurance billing person (or persons) in their office…and they trust that person to know everything their particular office needs to know. Once you walk outside of the doors of their office…they don’t know what goes on with insurance unless you go back and tell them.

I even have had doctors express extreme shock at the price of meds…they don’t know what they cost ($75 for a prescription antihistamine, when a $10 box of Benadryl was an acceptable alternative), or know things like dosing amoxicillin tablets 3 times a day (500 mg each dose) costs less than a third as much* as dosing 2 times a day (875 mg per dose). They just write the script for 2 tablets per day, thinking it is easier for a patient to remember to take the pills 2 times a day rather than 3.

Unfortunately, for you, that means that you might need to have an MBA in medical insurance policies…

*In the case I know of where this came up…the pharmacy only had the name brand amoxicillin in the 875 mg dose…at a price of $75 for 10 days’ treatment, compared to $5 for the generic amoxicillin 500 mg dose.