Before getting pregnant, understand your insurance plan

Planning for a pregnancy is an exciting time for every woman and one of the most joyful experiences they will have in their lifetime.

For most women preparing for a pregnancy means getting in shape, eating right and planning the timeline to have the baby. But in this day and age, with all the pressure of Americans getting insurance, not understanding insurance, or the potential tax penalty for not having insurance can lead to people thinking that all insurances are created equal – but they are not.

So today’s message is, as you think about everything else you need to do before getting pregnant, think about what insurance you have, or need to get. It’s crucial that soon-to-be-mothers make a plan.

Having a baby means a lot of choices to make. I want to point out several of them and get your feedback about this very important topic. 

The first thing you want to do is find the doctor you want to deliver your baby and evaluate you throughout your pregnancy. Many patients find a doctor based on recommendations and online reviews that you find on websites like Healthgrades.comor These medical review sites don’t tell the full story. My advice is to go to the doctor’s office in person and have a conversation with the office manager to find out what insurance that particular doctor takes. Does it match what you have or are you going to have to get a new plan? A common mistake is making an appointment to see a doctor and not finding out until after they get there that they don’t take your insurance plan. You have to do your homework.

The second question you want to ask yourself is what hospital do you want to deliver? It’s not uncommon for doctors to have admitting privileges at two or three different hospitals and if that hospital doesn’t accept your insurance plan you may have to deliver at another hospital. This situation can be stressful and disappointing for expecting mothers who had a particular hospital in mind. You may want to make sure your hospital and insurance coincide with covering a high-risk care nursery, anesthesia, and 24-hour consultants.

What does your insurance plan actually cover? In my more than 30 years of experience with expectant mothers, there are four items that are a common source of controversy and confusion when it comes to the type of insurance women get. 


Does your insurance cover services for infertility treatment, including IVF? Now you may not think you need it, but you never know. If you end up needing infertility coverage and it isn’t available to you it becomes an out-of-pocket cost that can end up costing you thousands of dollars.


How many sonograms does your insurance actually cover? You would be surprised how many companies limit how many you can receive during pregnancy. The question isn’t just a ‘bottom-line’ number. Many mothers need more sonograms throughout their pregnancy because the baby needs to be more closely monitored. If your plan limits the number, that could be a problem for you.

Genetic Studies

What kind of genetic studies does your insurance company cover? The field of genetics has expanded dramatically, even in the past decade. Now we have blood tests for Down syndrome and genetic markers that reveal if you are at risk for other various diseases during pregnancy. The issue that happens regularly is that you may be offered the tests by your physician but not your medical insurance. This situation causes a lot of anxiety for pregnant women.


Does your insurance company cover anesthesia? Anesthesia is administered in over 90 percent of deliveries. Make sure before you are on your way to the hospital to give birth that your insurance company covers anesthesia and that your anesthesiologist is also covered for that service. If not, the bills can add up quickly and potentially put you in debt. 

When you’re expecting a baby, having the right team of doctors and staff on your side is essential. But remember, insurance is a bureaucratic service, and unless you read the fine print you my find yourself at home with a healthy baby–but with a lot of bills that could have been prevented.