Coverage for Pregnancy: Not All It's Cracked Up To Be

Sarah Wildman experienced the problem that the National Women's Law Center has been talking about for months. While many women's rights groups (and conservative congressmen/women) are getting up in arms about abortion coverage in the new reforms proposed by Congress, the real issue at stake is the way insurance companies deal with pregnancy for those on the individual insurance market. As Sarah points out, having a baby in this country is expensive:

One CareFirst rep we actually managed to reach explained we had maxed out because the benefit was “capped” at $3,000 per pregnancy. That means $3,000 for all pre-natal visits, tests and sonograms, labor and delivery, hospital stay and hospital care. In what mythical U.S. hospital is nine months of medical care paid for with $3,000? The study by the National Women’s Law Center found that (in 2006) a normal vaginal birth cost, on average, $7,488 in hospital charges alone. Using examples of riders similar to mine, NWLC found that women with uncomplicated vaginal births would pay between $6,780 and $9,682 out of pocket. C-sections came in around $13,000 nationally, and for them, the out of pocket costs ranged from $10,000 and up. I presented those numbers to CareFirst, and they freely admitted they knew their policy in no way came close to covering a pregnancy. “It’ s a crappy benefit,” one rep admitted to me.

And this is if women can get coverage for her pregnancy with an "opportunity to buy additional coverage—known as a “rider”—to tack a maternity benefit onto your plan. It’s almost always only available in anticipation; if you try to buy the rider once you’re already pregnant, the fetus becomes a 'pre-existing condition.'"

What Sarah's story shows is that we often think of different kinds of care not getting covered by insurance because it's experimental or unique. Sarah's lead shows this:

Our six-month-old daughter cost over $22,000.

You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.

Her experience shows precisely how screwed up our system is now. It's not risky proceedures or unique circumstances that aren't covered by insurance. Instead, insurance companies skimp on basic medical care that is commonplace.