Questions to ask your insurance provider when you get pregnant!

Questions to Ask Your Health Insurance Provider During Pregnancy

When we were pregnant with our first, I was fortunate enough to be doubly insured by my job and being on my parents’ health insurance still (because I was 25). I called both companies and basically said, “hey I’m pregnant, and I don’t even know what to ask you.”

I literally knew NOTHING about health insurance. Couldn’t have even differentiated between deductible and copay. Didn’t know what an out of pocket max was.

Since then, we’ve had a few different job changes, including a period where we didn’t have a viable insurance option, so we partook in a Christian medical sharing network which is a legal alternative to health insurance. We ended up paying for the entire second pregnancy with that organization, and because of the way it operates, I had the chance to learn a lot more about pregnancy coverage, insurance questions, how much things cost, etc…

Anyway, this isn’t meant to be a comprehensive guide to all that. Maybe that post will come another day (thrilling, I know)! But I did want to spell out a few questions that you can ask your insurance provider once you find out you’re pregnant.

Just call the number on the back of your card and say you’re newly pregnant and have a few questions. They’ll get you to the right person.

Then, ask away! (and write down the answers)

  1. What is my copay for the standard appointments during prenatal care? (Usually once every 4 weeks from week 10- 26, then every 2 weeks from week 26-34, then every week. Plus an ultrasound appointment and any other appointment the doctor deems necessary.)
  2. Is there a copay for extra visits to my OB during prenatal care? (Like, if I feel cramping and need to go in separate from one of my 4 week visits)
  3. What is my annual deductible?
  4. Once I reach my deductible this year, what percentage do we each pay? (Often it’s 80% them/20% you)
  5. What is my individual and family annual out of pocket maximum and how does it work?
  6. Do costs for the baby in the hospital count towards my individual out of pocket max or family out of pocket max?
  7. When do I need to call in to add the baby to the policy to make sure his or her medical needs are covered?
  8. If I need or want testing during the pregnancy, what is covered by insurance and what isn’t?
  9. Do you reimburse for a breast pump? Which pumps? What is the process?
  10. Is Doctor So & So in network?

Hopefully these will get you started with the discussion, and hopefully the person you’re talking to is helpful. I’ve generally found that when I’m asking someone these questions, they’re pretty helpful.

If you don’t understand something, just keep asking. It’s all so complicated! Also, feel free to ask questions here in the comments below.

By the way, I made a printable version of these so you can easily have the questions and answers accessible for your phone call! Grab it by clicking the button below.

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9 thoughts on “Questions to Ask Your Health Insurance Provider During Pregnancy”

  1. You should call and see what’s included and what’s billed extra… I’m not sure! We didn’t have very many ultrasounds – just one at 20 weeks. With one baby, I wasn’t sure on due date so we had one around 12 weeks to check baby’s size, but I don’t believe I was billed separately for that. I can’t remember for sure. I would ask them to sit down with you and explain all the charges and decide if it’s worth the hassle to you to figure that out. If they’re not up front about costs and you’re not totally committed/ in love with your OB, you could always switch. Maybe just ask these 10 questions to the practices you’re considering before joining. Sorry if that’s not much help!

  2. wow thank you! I am so overwhelmed with all this. and the first bill already came. the OB office had me pay it and then they sent a letter with an obstetrician contract… I was like why??? ist that something your office does too? Also I am only in my 1 trimester and they had me already do 2 appointments with ultrasound where they charge me for the vaginal and the regular each time…. is that normal too? The first set they did was at 6 weeks (I told them its 6 weeks for sure they still had me come in and di the ultrasound) it was too small and hey couldn’t confirm the pregnancy so they had me come in again and charged me again. am I just being hormonal or ist this a bit screwed up. they never ever even mentioned to me that they would send me a contract like that.

  3. You will need to find out if you need to stay in network or if you can go out of network it maybe be cheaper for you to make sure your staying in network lower cost deductibles and maximum out of pocket costs. Also if you plan on doing any testing to make sure you check to see if this will be covered by the insurance some may require a pre authorization from the Dr’s office. if the dr’s office does not obtain a pre authorization it could cost you more money out of pocket.

  4. Another good question is “does my insurance cover a Breast pump and how much?” Many will give you a refund or send you one.

  5. We used Samaritan Ministries and had a great experience! Here’s their website. I highly recommend them and would suggest your family member give them a call and say “I’m looking for an alternative to health insurance, could I ask someone a few questions.” They’ll be very helpful. Use the contact page to contact me if you need more info/ help. Good luck!

  6. I have a family member looking for alternative health insurance. Could you email me more info I could pass along to her and her husband? Thanks!

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