Skip to main content

You're Pregnant: Breaking the News to Your Insurance Company

This article contains important questions about pregnancy coverage, which you should present to your insurance representative .
Pregnancy Coverage and Your Insurance

You're Pregnant: Breaking the News to Your Insurance Company

After you break the news to your husband, the next in line to hear the story might very well be your health-insurance agent. If you already have a doctor who participates in your insurance plan and who you want to help deliver your baby, you're all set. But for many women this is the time for making careful choices about the person who will give them prenatal care and who will eventually deliver their baby. Before you can begin to look around or interview physicians, you'll first need to find out what doctors and facilities in your area are covered under your plan. Some plans give you the freedom to choose any health-care provider you like (count yourself lucky if that's your plan). But nowadays, most have a list of participating doctors and hospitals that you must choose from if you want your insurance to cover the bills. If that's the case, there's no sense interviewing a long list of health-care providers, only to discover that the right person and hospital for you are not covered by your plan.

Questions to Ask Your Insurance Representative

When you call member services (the phone number is usually printed on your insurance card), have a pen and pencil handy to write down all the information. First ask if your policy, or your spouse's, is the primary carrier. Then ask the primary provider the following questions:

  • I'd like to find a good doctor to care for me during my pregnancy. Can you send me a list of the family practitioners and obstetricians in my area who participate in this insurance plan?
  • What kind of coverage do I have for pregnancy?
  • Are hospital bills covered?
  • What about tests prescribed by my doctor?
  • Which procedures need preapproval?
  • What kind of coverage do I have if I experience complications during the pregnancy?
  • What kind of coverage do I have if I deliver a premature baby?
  • Is there a deductible amount that I must pay first?
  • What percentage of the bills will you pay?
  • Is there a limit to my policy coverage?
  • Will you make payments to me or to the health-care provider?
  • I want it noted on my records right now that when the baby is born he or she should be added to my policy. (If you don't have this noted before delivery, you will have to call the day the baby is born, otherwise all expenses related to infant care up to the time you make the phone call will not be covered.)
  • Are the expenses of an at-home birth or a midwife or covered under my policy? (If you are considering these options.)

If you don't have health insurance, don't let this keep you from getting the prenatal care that's vital to your health and the health of your baby. Call your local hospital and ask where you can find a free clinic. Also ask whom you can speak to about your eligibility for charity care programs or Medicaid.

Join the Family

Your partner in parenting from baby name inspiration to college planning.