In-Network Hospital and Doctor? Not Always So!
The majority of people assume a doctor who works in an in-network hospital is also in-network, but that’s not always the case and vice versa. An in-network doctor may have hospital privileges, but that doesn’t mean the hospital is automatically in-network too. Many neonatal intensive care units (NICUs) are hospital contracted, making them out-of-network. Your anesthesiologist may also be an out-of-network doctor.
Call the health insurance provider to learn what doctors/hospitals are in-network and out-of-network to protect yourself financially.
Enrollment and Plan Considerations
Health insurance coverage enrollment runs from Nov. 1 to Dec. 15, with some states extending the enrollment period.
Eligibility to enroll or change health insurance plans outside this time period is based on a “qualifying life event” – allowing for a special enrollment period of 60 days to find new coverage.
Pregnancy is not deemed a qualifying life event, but giving birth is. After giving birth, you have 60 special enrollment days to find new coverage or keep the one you have. Be sure to review plans to see what benefits are offered, including but not limited to;
- Specialist OBGYN coverage
- Labor and delivery coverage
- Pre-natal testing (genetic testing, amniocentesis, ultrasounds)
- Private room coverage
- Non-traditional delivery coverage (midwives, home births)
Giving birth can run anywhere from $30,000 for vaginal delivery to more than $50,000 for a C-section. The cost will vary based on location and hospital as well. None of these prices cover ICU or NICU stays, or if you have yet to meet your deductible, have co-pays, etc. Being pregnant and giving birth is expensive! Do your homework here!
Pregnancy is not a pre-existing condition, but pre-natal, birth and newborn care are. And even though it’s not necessary for major medical insurance, it’s deemed necessary for short-term health insurance. This kind of insurance is ideal for people who failed to get coverage during open enrollment – those who need it for the worst-case scenarios or need a stop-gap in health insurance coverage.
The problem with this coverage is that they can deny you coverage if you have a pre-existing condition or can deny covering anything related to that pre-existing coverage. Short-term plans see pregnancy as a pre-existing coverage, so anything related to it is unlikely to be covered.
