Searching and failing to find maternity coverage in Colorado
Wednesday, December 02, 2009 at 11:58 am
In advance of a bill in the state legislature that would require Colorado’s insurance companies to cover maternity, The Colorado Independent searched for non-employer-based maternity health insurance. How did it go? It was unbelievably frustrating.
Posing as a 34-year-old woman from the high country whose COBRA coverage was running out, this reporter perused websites and called agents to explore the options.
In hours of searching, I found no single plan that would cover standard maternity care for a woman in rural Colorado.
“You just can’t get maternity,” explained one agent. “You first have to get the health insurance and then you add the maternity as a rider” to the policy.
I found three companies offering “maternity riders” on top of available health insurance plans. But in many cases, even the agents earning a commission to sell the plans acknowledged they weren’t very good.
“Maternity benefits on the open market are crummy in Colorado right now,” said one agent. “It’s pitiful that it is that way.”
My first call went to Rocky Mountain Health Plans, since the company turned up high on a Google search for maternity insurance in Colorado. The agent immediately asked for a birth date and then said that a 34-year-old woman would be too old for the plan by the time it went into effect. Maternity coverage is only offered to women between the ages of 17 and 34 and three quarters, she said.
According to state underwriting guidelines, the Rocky Mountain Health Plan maternity rider is also not available to any woman with a previous history of pregnancy complications, which include for example a miscarriage, toxemia, pre-eclampsia, cesarean section, etc. The maternity rider is also definitely not available to any woman who is already pregnant–nor is it available to any adult member of a pregnant woman’s family, apparently to guard against fraud.
So, too old to have a baby with Rocky Mountain Health Plans, The Colorado Independent turned to ehealthinsurance.com, figuring that of the 112 plans listed for a 34-year-old woman in rural Colorado, there must be options.
Yet, according to the agent I spoke with, only one company on the site, United Health, offered a maternity rider.
For $106, I could add a maternity rider onto a United Health plan, which sounded good. But it wasn’t good. In the first two years, the plan only covered $2,500 worth of maternity care.
Since the average cost of prenatal care and delivery in Colorado falls between $10,000 and $16,000, according to the agents I interviewed, this plan wouldn’t come anywhere close to covering the pregnancy— even with discounts negotiated by the health insurance company.
I called a local agent in the high country. He said he could sell a plan through Assurant, but warned that it would be a risk.
He explained that for about $250 a month, a 34-year-old woman could add a maternity rider with a $2,500 deductible to an Assurant plan. She would need to wait three months to conceive. The hitch, he explained, was that she may or may not actually get to use the maternity benefit.
Most women, he said, find they spend between $1,500 and $2,000 on prenatal care— that is, before they ever hit the delivery room. For a normal pregnancy, then, a woman would go into the hospital with only $500 to $1,000 of her deductible left to pay, he said, expecting the insurance to cover the rest.
But, he explained, if the pregnancy has any complications (like a cesarean section or any other complication as defined here by the Colorado Division of Insurance), suddenly the primary policy—with its separate deductible—picks up coverage.
When that happens, he said “your maternity benefit is totally null and void. It’s not being used…. It can get messy. And it’s horrible. I’m not going to sugarcoat it.”
“So it’s expensive,” said the local agent, “and it could not work for you in the long run. But it’s sometimes better than nothing if you can afford it.”
He joined most of the other agents I spoke with in criticizing the products he was selling.
“Do you have access to an employee-sponsored insurance plan,” inquired one agent, helpfully, suggesting I try to get group coverage somehow. “Do you own your own business or does your spouse or significant other?”
“Honestly,” said another, “your best bet is to work out a cash discount with your provider.”
Another agent “highly suggested” I check again to see if COBRA coverage would last long enough to carry through any pregnancy and delivery.
“Group plans in the state of Colorado have maternity mandated,” explained one agent. “They have to offer it. The individual plans do not and typically they do not offer it. Because it can be expensive if you have a premature baby, and they don’t want to have to cover it.”
When I pointed out that every plan in Colorado is required to cover a premature baby, even if the mother does not have maternity coverage, the agent acknowledged that was true.
“Yeah, yeah, it would [be covered],” he said. “So it doesn’t really make sense to me, but for some reason [insurance companies] have decided not to cover maternity in a lot of states now because, I guess, of the expenses that can go along with it.”