Affordable Care Act and Pregnancy

Let me say, this is not my strong suite. Insurance, copays, deductables…huh?

The new Affordable Care Act has new benefits for woman and pregnancy.

Gestational diabetes screening: This screening is for women 24
to 28 weeks pregnant, and those at high risk of developing gestational diabetes.
It will help improve the health of mothers and babies because women who have
gestational diabetes have an increased risk of developing type 2 diabetes in the
future. In addition, the children of women with gestational diabetes are at
significantly increased risk of being overweight and insulin-resistant
throughout childhood.

Breastfeeding support, supplies, and counseling: Pregnant and
postpartum women will have access to comprehensive lactation support and
counseling from trained providers, as well as breastfeeding equipment.
Breastfeeding is one of the most effective preventive measures mothers can take
to protect their health and that of their children. One of the barriers for
breastfeeding is the cost of purchasing or renting breast pumps and nursing
related supplies.

Start dates vary: Depending on your plan, coverage may not  really begin this week. Confused? Some private health insurance plans will  not begin offering the new preventative care benefits until your plan  renews. So if your plan renews on January 1, 2013, that’s when you’ll be able to  reap the breastfeeding benefits.

Grandfathered plans are exempt:     If your health insurance plan was in  place before March 23, 2010 when the Affordable Care Act was signed, it is not  required to comply with the new breast pump and breastfeeding support  provisions. That said, you may still have some coverage, and will only have to  come up with a co-pay or deducible out of pocket. Not sure if your plan is  grandfathered? Call and ask.

You might need a prescription:     Sometimes your  insurance will require a prescription from your health care provider, but many  simply need your doctor or midwife’s name and phone number.

You can choose your pump:      Think your health care plan  will only cover inexpensive handheld pumps?  Wrong! You should be able to get a top of the line, double electric breast pump through your insurance company. Alternatively, your plan will cover the  rental of a hospital grade breast pump.

You need to find out where to buy it:      Many insurance  companies will connect you to a medical supply company that can ship your  desired breast pump directly to you.

Bottom line: Start by calling your insurance company.  They’ll be able to tell you exactly what your plan covers. But don’t take “I  don’t know” for an answer. Since this s a new policy, some customer service  representatives may not be aware of the specifics yet, but you shouldn’t stop  asking until you get a clear answer about what’s covered and how to get  it.

From iVillage


Check out the info from Breastpumps Direct



The website for Pregnancy, Childbirth and the Newborn has a list of questions to ask your health insurance provider:

Find out what your insurance covers: Check your written policy guidelines, contact your insurance company, or check with your employer’s human resources department to find out the answers to these questions.

  1. Does your insurance cover pregnancy and birth?
  2. What types of care providers are covered: OB? Family Practice? Midwives?
  3. Is there a specific list of providers you must choose from?
  4. What birthplaces are covered: Hospital? Birth Center? Home birth?
  5. Are there certain facilities you must use?
  6. Are there set copayments?
  7. Do you need to pay a percentage of the costs?
  8. Will they cover routine prenatal care?
  9. Will they cover prenatal tests, including ultrasound, amniocentesis, etc.?
  10. Will they cover prescription medications?
  11. Is there a copay?
  12. What do you need to do to inform them of the pregnancy and birth?
  13. Will they cover childbirth preparation classes?
  14. Will they cover birth doula services?
  15. Will they cover pain medication and anesthesia fees?
  16. How long can you stay at the hospital after the birth?
  17. What newborn care will they cover? Routine care? Special Care? Circumcision?
  18. Will they cover lactation consultants to help with breastfeeding?

If you do need to pay out of pocket, or pay a portion of the costs:

Call the patient account office at your birthplace or call your caregiver to find out what to expect.

  1. What is the typical charge for prenatal and postpartum care?
  2. What is a typical charge for a vaginal delivery with a one-day stay?
  3. What is the typical charge for a cesarean with a three-day stay?
  4. What are the costs for pain medication for labor, or for a cesarean?
  5. Will you be charged for nursery care for your baby, even if your baby stays in your room with you?
  6. What will happen if your baby needs any special care?
  7. Can you prepay the costs?
  8. If you prepay for pain medication, can that money be refunded if you choose not to use pain medication?

After the birth, plan to contact your health insurance company within thirty days of your child’s birth, adoption, or placement for adoption and request a special enrollment to cover the event.

Check out the website for more (and better) information.


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