What is with North Carolina health insurance not covering maternity?!?!?

[LLN]

OK, here I go again.

I am not an apologist for the insurance industry. I was making very very good money in that industry, and hated every minute so now I make 1/6 of what I was making, but don't need to shower when I come home from work.

The theory of insurance is that one pools the likelihood UNEXPECTED risk of an individual amongst the risk to many. Insurance was designed to make a person whole if an UNEXPECTED occurrence, occurred. It is easier to understand thinking of homeowners. You do not expect to have a fire. If you have an unexpected fire, many others who are paying as well, will not. You will be reimbursed. At the same time, however, you expect to paint, put on a new roof, replace broken stuff, and make additions and mow the yard. You would never dream of having insurance pay for these kinds of things. Insurance is designed to protect against the unexpected.

Well the same theory applies to health insurance, but somewhere along the line, the consumer has taken the position that insurance is a "paying system" not a system to protect you from the unexpected.

Sure insurance will pay for a lot of stuff that is expected, but they charge you more than if you paid it yourself (that would be their expenses and profit).

Being pregnant is hardly an unexpected occurrence. Expecting insurance to pay for pregnancy is a total contradiction to the theory of insurance. You should pay yourself, for this expected expense (in the perfect world). The insurance world as we all know it is not perfect, but the companies, can and do protect themselves from violating insurance theory to the greatest degree possible by imposing rules such as pre-existing conditions. Again, in theory, this is very sound, since if something is already "wrong" it would not be unexpected to have to tend to it.

I am sure many will find this lesson hideous and some will take violent issue. That is why we are in such a mess. We have a big mis-match in expectations and theory.

As an aside, this is one reason high deductible policies should be so inexpensive. The problem is that the pool of people buying high deductible policies has been skewed toward the very sick, those that cannot afford anything else, so the expected low payment from a high deductible policy has been shattered.

Good Luck...Look on the bright side. At least you probably had some fun getting pregnant.

[steve54]

Originally Posted by mommytwingle

My family is trying to move to NC but cannot find health insurance that will cover my pregnancy. We are willing to pay the over $1000 a month for health insurance but the pregnancy is not covered. I can, however, get Medicaid since our family income is so low for a family of 6. Does this make sense when I'm willing to pay?!?!?!?!? If you think the US is not in a health care crisis, think again!

I don't have a down on you or anything but isn't that like having a car accident and then trying to buy insurance to cover it?? or bad teeth and then trying to get dental coverage?
The whole point of insurance is to guard against risk of something happening not to pay for something that is happening or has happened

[Francois]

Originally Posted by LLN

Being pregnant is hardly an unexpected occurrence. Expecting insurance to pay for pregnancy is a total contradiction to the theory of insurance. You should pay yourself, for this expected expense (in the perfect world). The insurance world as we all know it is not perfect, but the companies, can and do protect themselves from violating insurance theory to the greatest degree possible by imposing rules such as pre-existing conditions.

Makes sense to me, that a "voluntary" procedure wouldn't qualify.

Then there's the issue that, if you can't afford to HAVE a baby, how are you going to afford to raise it, anyway?

[enlightenme]

Originally Posted by steve54

I don't have a down on you or anything but isn't that like having a car accident and then trying to buy insurance to cover it?? or bad teeth and then trying to get dental coverage?
The whole point of insurance is to guard against risk of something happening not to pay for something that is happening or has happened

That theory still doesn't work for me. After figuring out costs of having a baby with my insurance after paying my monthly premiums, co-pays, deductibles it was almost the same price as paying for a regular complication fee delivery. My friend who had no insurance and I were pregnant at the same time and I ended up paying close to the same amount after a year of my premiums factored in. I found that pretty crazy. But, the whole point of having the maternity insurance was to cover if something unexpected happened, hence the whole concept of insurance. I only started trying to get pregnant after getting the insurance because I worried about any complications that would have given me higher hospital bills. I am just not a gambling type, so that is why I don't completely support your statement about "The whole point of insurance is to guard against risk of something happening not to pay for something that is happening or has happened." You never know what could happen during a pregnancy!

[InformationPlease]

They have JUST CHANGED all of the rules for Family Planning Medicaid services in NC. As such, as the others mentioned, please, please, please talk directly with someone at your new county's DSS before you make this decision.

They likely won't be able to do much over the phone, but if you explain your situation, perhaps they can at least advise you enough to help you make your next step in this decision process.

I'm sorry I have no more info, if this were last year, I could walk you through it head to toe, the new one, though, I'm still learning myself... though, it is, in theory, supposed to be way better.

I heard (haven't yet seen, so still rumored) that you are now allowed to visit any Medicaid accepting practitioner in NC if you qualify for this service. Previously, some counties only allowed women to visit the local health departments which can have very long waits for service and quite restricted hours.

It used to be very easy (I think someone mentioned this before me) and all you did was go into the health department and apply there, at that location, right before your first appointment.

However, with the new changes, I just don't know about the process or even where to look anymore. Again, as all the others said, DSS is your best point of contact for this round of investigation.

good luck with your pregnancy and your move!!

[InformationPlease]

I saw the DMA site was shared but I don't think this went up (sorry if it did and I just didn't see it).

Your post made me realize I need to get up to date with the who, what, when where and why...

This should be the most current chart for NC Medicaid eligibility.

http://www.dhhs.state.nc.us/dma/medicaid/basicmedelig.pdf (broken link)

Specifics:

Pregnant
Women

Coverage is limited to
treatment for
conditions that affect
the pregnancy.

Medical verification of
pregnancy

Count only the income
of the pregnant woman
and her spouse if
married.

185% of Poverty
1 1 - $1,670/mo
2 - $2,247 /mo
3 - $2,823/mo
4 - $3,400 /mo
5 - $3,976/mo

No resource
limit if eligible
with income
no more than
185% of
poverty

There are other ways you could be covered, as seen within the chart, and again, DSS would be your best explanation of those issues!!

Again, good luck and have a very safe move. Hope this info helps a little!