In Bloom Doula Services

One huge aspect of having a baby is how you will pay for the health care and medical costs that quickly add up throughout pregnancy and during a birth. I know insurance is a messy and complicated monster, but in order to understand why I chose to have a baby without insurance I thought it may be helpful to some to hear my experience, and also to share with you what I am doing instead of using insurance. Lets face it, no matter which way you slice it, having a baby (especially in a hospital) is expensive. With or without insurance.

Our country has a very complicated medical system. In one of my favorite pregnancy documentaries, Pregnant In America, a couple realizes it is virtually impossible to find out the cost of a pregnancy and delivery beforehand. I do not know all the ins and outs of how insurance works, I don’t think many people do honestly, but I do know there are many different variables that come into play concerning the costs to anyone out of pocket. For example: the type of insurance, the amount your employer pays for your policy, the policy provided by your employer, the hospital’s cost of various procedures, and various policies and prices in different states.

I know that no one is having the exact same experience, but I haven’t heard very many good ones when it comes to costs of maternal care.

I never had too much of an opinion about health care or insurance before I had my son, Holden. I can say that stemmed from my ignorance on the issue, my youth and the fact that much of it was all new to me. There is a learning curve to understanding things like insurance. As a teacher, my insurance selection came from my district and my options of coverage didn’t vary much after that. I never had any real medical issues to deal with and I never thought twice about the money leaving my paycheck monthly. To me I was insured, which was the responsible way to be an adult and that was that. Plus we only had one day during the hiring season to go over our benefits and agree to terms. The time wasn’t there for me to do adequate research and understand every aspect of the plan that I was choosing, even if I had wanted to.

But throughout my pregnancy I had a hard and painful introduction to the real world. I had to learn about FMLA maternity leave. I had to wrap my head around doctor payment plans and soon found out that just because you are insured, doesn’t mean your medical bills are covered.

My monthly premium as a teacher in a small Texas school district (before the birth) started at about $375 monthly. I figured all of my maternity needs were covered. To my surprise that was not true. I often had to to pay $175.00 for an ultrasound, or was met with bills after the fact for “routine and necessary” blood tests that my care provider told me were needed, but Aetna claimed were extra. I met my $2,000 deductible through the cost of the actual prenatal care hospital stay, and thought well everything should be covered since I:

1. Pay my insurance monthly and 2. Met my deductible.

I was wrong.

The weeks following Holden’s birth I got multiple bills. Some for me from my midwife covering my prenatal care, some for me from my hospital stay and some for Holden for his stay. All totaling to almost $7,000, that insurance would not cover. I was furious. And confused. I had met my deductible. What am I paying almost $400 a month for? I had an uncomplicated vaginal birth without any induction, pain medication or intervention. I couldn’t imagine what kind of bill I would have been getting if I had ended up having a c-section or a longer stay.

But, that’s not all!

I had to add Holden to my policy by the end of the month to ensure that he too would be covered. My monthly premium doubled! I cried on the phone with the insurance customer service rep. She asked me, “is that ok?” I said, “I don’t really have a choice.” And hung up the phone.

I began to get calls from debt collection agencies begging me to pay in full by the end of the month. I am still, 15 months later, paying off Holden’s birth. I paid off smaller bills, and set up payment plans for the larger bills. This problem didn’t exist for my mom’s generation. Insurance covered everything, and her bill leaving the hospital was minimal. I assumed that this was just our messed up health care system and that there was no alternative, so I should just accept it and deal with it.

The following June, after a few minor issues I went to see a gastroenterologist. I made an appointment, drove into Houston and was hit with a co-pay of $150. I was floored. “That isn’t right,” I argued with the woman at check-in. She informed me that I hadn’t met my deductible for the year, so I needed to pay the co-pay. I paid and was written a referral for a minor out patient procedure. I scheduled it and shortly after, received a phone call saying I needed to pay $800 up front before the procedure was done. I canceled and called Aetna in a rage. I said, “I had a baby this year, I know I met my deductible.” In a very annoyed tone a woman responded that actually my plan had changed to a family plan since adding my son, which switched me to a $5,000 deductible that I in fact, had not met. She said “I am sorry you didn’t know, ma’am.”

I was livid. What am I paying close to $800 monthly for? Where does that money go? For minimal coverage on anything. And if I met my deductible, I would still get bills after the fact. I began searching for an alternative. And found the answer I was looking for. A health share plan!

How It Works:

I had heard good things about Samaritan Ministries from a few friends that used them throughout their pregnancies, and 100% of their maternity costs were covered. I decided to look into this seriously and am so glad I did. Basically a health share plan works like this: you pay someone else’s medical bills each month, and if/when you have a medical need, other members will help pay your bills.

Since becoming a Samaritan member, I have been extremely happy with my experience. Anytime I have spoken with custom service on the phone I am met with a happy and helpful person, who often offers to pray with me. I got pregnant shortly after and have begun to accumulate more and more medical bills. I add the itemized bill, electronically to my Samaritan profile, and am now receiving shares from other members to cover the costs. These shares are often accompanied with sweet letters, cards and well wishes complete with prayers for a healthy pregnancy, safe delivery, and a healthy baby. The switch to Samaritan has been well worth it despite the inconvenience of working with health care providers as an uninsured patient.

The Benefits:

I am paying half of the monthly premium now to have no outstanding charges because they cut out the middle man, which is the [corrupt] insurance companies. I knew if I wanted to keep having children I could not afford to pay $7,000 for each of their births. So, in August I dumped Aetna and joined Samaritan Ministries. I pay just over $400 a month and my entire pregnancy will be covered. For me it was an answer to my prayers.

In addition to saving money monthly, and saving money by having the pregnancy covered in full, Samaritan also covers up to $500 in costs for a doula (another thing my insurance didn’t do.) Y’all know how important having a doula is to me (8 Reasons Why You Need A Doula.)

My family is still getting established. We are trying to pay off debts, save money, pay our bills and live life. Saving about $400 monthly and eliminating the outstanding bills following another birth helps us out tremendously.

The Downside:

Samaritan has a few drawbacks, but since they are not an insurance company of course there are some differences. First of all, they do not cover preventative care, which includes panel blood tests, vaccines, etc.  Samaritan basically only treats illnesses, injuries, and maternity costs. This does exclude elective procedures and procedures that go against Christian beliefs, as they are a Christian group.

I can’t say that a health share plan is the answer for everyone, or the best option for every family. I strictly looked into how coverage would impact my family and that was that. I would do adequate research on what they would cover for your family’s needs to see if it is a good fit.

It isn’t necessarily an easy way to deal with medical providers either. I now need itemized bills to prove to Samaritan what I actually need coverage for. I am shocked at some doctor’s office’s reluctance to give me itemized bills, just as I am shocked at the actual costs of maternity care, what is and isn’t actually medically necessary and how much my former insurance actually did not cover of Holden’s birth.

Some of the break down looks like this:

The total cost for Holden’s birth including my care and his throughout our 36 hour hospital stay totaled at $9,806 dollars. Aetna covered only $1,303.71 of that. The remainder was “adjusted” and I was sent bills that totaled to $6,175.96.

I prefer this type of care, despite the pain that is explaining to my doctor’s office (repeatedly) that I am uninsured or “self pay,” which carries a stigma for some reason. I picked up on this in my postpartum recovery room when my postpartum nurse waltzed in and said, “I am so happy to finally get a mom who is married, college educated, AND has insurance!” That statement made it clear to me that there is an attitude against those who aren’t married, educated, or insured, and I have noticed a clear difference in how I am treated at various doctor’s offices now that I am “self-pay.” Complete with rude expressions, loud declarations to other people in the front desk area that I am “self-pay” and a refusal to return phone calls.

I know a health share plan isn’t the answer for everyone, but there has to be an alternative to insurance. To me it seems like robbery. Women who are already either without income or usually on some sort of reduced income, like maternity leave are now hit with the financial burden of insane medical bills despite paying high monthly premiums to their insurance companies. How can anyone win here? What is a solution?

I do grow more and more frustrated with the medical system, though. Recently, at my 22 week appointment, I was told that I had a bill for $3,000. Since I am self-pay I need to pay for my delivery beforehand in order to insure that the care providers are compensated. This needed to be paid by my 28th week of pregnancy. I told them that I could not pay that, but if they gave me an itemized bill I would be able to make payments shortly. Again I felt bullied and shamed about being unable to pay. She informed me that an itemized bill wasn’t possible to get until after I had been charged with the services. Then asked if I could pay 1/2 of the charge that day. I said “$1,500? Today? No.” She questioned if I could maybe do $400 a month or charge my credit card. She even suggested I apply for Medicaid.

I politely told her that I have nearly maxed out my credit card paying for ultrasounds and office visits for this pregnancy (waiting to be reimbursed through the health share), with costs for things like a nearly $900 level two anatomy scan. I am still paying monthly for my first son’s birth still, and will only be able to pay for things I can get an itemized bill for. We went in circles for a while, and I told her everyone will be paid, it will just be after the fact.

My background is in Social Work. I know I am ineligible for Medicaid. I also know that as a teacher I am financially messed over by what is available to me. I resent the fact that even as a full time employed teacher, someone thinks I should ask for government assistance to accommodate the hospital as opposed to try and work with me and my health share plan.

I have wondered if moving to an alternative birthing location would be more accommodating. Maybe I should consider a birth center, or a home birth? Insurances notoriously don’t cover the costs of home birth or sometimes even birth center births because there is no profit for them. In my case it would have been cheaper to pay for a midwife to accompany me at my home birth than pay for a hospital birth fully insured.

I will continue to dodge the financial office at appointments until I receive an itemized bill because there is no use in explaining the health share plan ins and outs to them, yet again. I don’t know how anyone in America is actually affording the birth of their children, and I had the bare minimum. I cringe at the thought of a bill for a cesarean and the stay there after.

I am saddened by the state of our health care system, but am unsure of how to navigate it in any other way. If a health share seems like a great option for you or your family I would encourage you to look into it. I has been the biggest blessing for my family and one of the best decisions I could have made.

What are some of your experiences with insurance? Or a health share plan? Anyone willing to share in the comments below? I’d love to hear more about what other women experience throughout the pregnancy and delivery process.