Having a Baby in America?

[QueenofWhispers]

Hello Ladies,

I'm an American transplant in London and I had my fist DS in London. I had him privately as my insurance covered it. Husband has since changed companies and our current insurance will not cover maternity (very sad). 

I am now contemplating having my second child in Texas closer to my parents (mother is a doctor and I would feel more comfortable with her around). I'm expecting a private birth in Texas to be far cheaper than a private birth in London but I don't know how how much they would cost. I haven't spoken to my mother about it just yet as I am not sure if this is just too drastic a choice.

does anyone have any experience?

As for passports, we went on holiday when DD was 12 weeks old and had her passport comfortably ahead of this. I can't remember for sure the timings, but we didn't expedite, so this was still an option if the worst came to the worst.

I did intervene, though, and expedite her birth certificate when she was two weeks old. That meant appearing in person at county hall (which was 30 miles away from where we lived). Two weeks was about the amount of time it took for the hospital to transfer their records. I then high-tailed it to the Post Office to apply for the US passport.

I have had two babies in NJ in the past 2 years. Cost for DD was $10k for delivery (was induced, had preclampsia ended up with EMCS). The aftercare was another $10k. I was in hospital for 5 days.

With DS I was in for 4 days, technically 3 from POV of insurance. Total cost was $8k for CS and $5k for hospital stay.

I don't know if the clause about no exemptions for preexisting conditions has kicked in yet. Your mother will know. It might be cheaper for you take out coverage here in the US. Should something happen you are covered and won't end up with a $200k bill. Another trick might be to take a job so you can join a group plan. There are no preexisting conditions for a group plan.... (Starbucks baby!). I have known a few people who found out they were pregnant just before being laid off in 2008-2010 take jobs at Starbucks just for the health insurance.

You won't be able to fly past 36 weeks and I would suggest you fly over on a flat bed if you can. Def request low salt dinner and drink tonnes of water.

BTW - I totally get you on not wanting to go with the NHS. However, bear in mind that at the C&W you can pay for your own room but medical is paid for by the NHS. I was quoted about GBP10k for a 5 day stay but this included me having an doula 24/7 while in hospital. This is what I was going to do when DH was asked to transfer to the UK when I was 6 months pregnant. I had raised blood pressure so couldn't fly, and with the higher taxes in the UK it wasn't a great move for DH, so we passed on the move.

Another thing to consider is that if you have been out of the US for more than 5 years I don't think your child won't be considered for US citizenship if born out of the country. Check with the embassy if this is the case. They will know for sure.

US citizenship is not determined in how long the parent has been out of the USA.

I found the page. Seems you are right and the guy working for immigration (who granted me citizenship!) was wrong!

I had DD in New York 1.5 years ago. Everything was covered by insurance except for our co-pay. Not sure if this means the final bill refkects the insurance company's rates and whether there are different ones for individuals paying privately.

Had a natural labour, got stuck at 9.5cms, EMCS, 4 nights in hospital. Pediatrician visits subsequently covered by insurance fully, so don't know what they cost.

Seems NY is an expensive state as our total bill for delivery only was $55k! (We only paid the 10% copay).

Other thingnI would consider is how quickly you want to go back to the UK. We were advised not to travel by air (my fam is in the UK) until DD had had at least her three month shots. I know a lot of people travel before then, but the concern was around catching lurgies etc in confined spaces.

I've checked and both my children are still entitled to American citizenship.

insurance good idea. Actually, spoke to mother last night and she has re-activated an older policy. I can't believe how easy that was. Gotta love blue cross blue shield. So now I'm not too worried about having to pay out of pocket for this birth.

still not sure if it'll really take six weeks before bean will get his/her passport to fly back home. At this point, financially having the baby in Texas is my best option....however if it's a six week wait to come home after birth then perhaps I still have a lot to consider.

for those who think I'm being mean
I'm not being rude at all; you may be confusing my response towards the experiences I have already had on the NHS with contempt towards a service that prides itself on being available to alland equally-for free. I am sure that in some areas the NHS is very good; just not in mine.

I'm not being contemptuous in anyway. At almost every avenue where I have had to seek medical attention I have used the NHS first and found them lacking. Please also take into consideration that I have medical professionals as family members and am used to another type of system. I have not said one is better than the other; I have said that in America they would have caught my pre-eclampsia sooner than they did here.

**Speaking to the midwives at the Kensington Wing they also admitted that they would have caught the pre-eclampsia sooner than the NHS because the NHS maternity unit was understaffed and supplied with student workers who were more worried about not having to work past hand over.

I'm also American and had my DS in London. I'm not going to fault you for your opinions, while I know the NHS is great for many people, I did not have a very good experience myself. So I think it's understandable not to want to risk a repeat experience.

But I think you should stay and go private in the UK. You only need to go private for the delivery, after that everything is covered.

In the US you will be liable for everything, and I personally would not put a lot of stock in this reactivated blue cross policy -- I mean, really? That sounds too good to be true. You are pregnant, living abroad, and suddenly they will cover you? And they are not airtight, they are free to challenge paying out for everything and you may find yourself in an almighty struggle afterwards. (My best friend had blue cross in another state when she had thyroid cancer, and they tried to deny so many of her claims, she had boxes and boxes of paperwork from arguing with them.)

God forbid you have complications, your bill can easily go up by tens of thousands. You say you won't have to pay out of pocket with this insurance, what are the deductibles and upper limits? Not to mention, the cost of flights to the US and the complications from being abroad for a few months.

What about your DP? Would he be there too? Can he take off work? Would he miss out on that early bonding time?

Basically, I totally understand why you want to do this, but I think it's a pretty dramatic step to take that in the end may not save you that much money.

Queen is right that if you have private medical care which involves you seeing an obstetrician any time you like, and at your request, they probably DO pick up problems earlier.

The downside of this is that across the board, if we're looking at it from a population level, all that extra monitoring results in higher rates of intervention while not (again - at a population level) improving outcomes for babies, or so it seems. The US system is hugely wasteful compared to the NHS, which gets far, far more for its spend in terms of health outcomes in maternity.

I personally chose private midwifery care for my second and third babies. Pound for pound, when backed up by NHS obstetric input for a high risk mother (which I was) I think this represents the very best value in terms of good outcomes for the money you're putting in.

I totally understand and sympathise with women wanting private care. When it comes to maternity care the biggest weakness in the NHS is the lack of continuity of caregiver. If they could sort this issue out it would make a huge difference to women's experience of public maternity services.

Yipee for Blue Cross Shields. They are very good.

FYI - With DD the paediatrican let us fly after her 2 month check up where she had her first set of shots.

I think you need to consider worst case scenario here -

What if the birth doesn't go well?

How much for your medical fees - blood transfusions? Emergency surgery? How much does it cost for an emergency hysterectomy (god forbid, but you wouldn't be the first or the last)?

How much for the medical fees of your DC? How much is nicu? Resucitation? Emergency surgery on an infant?

How much is it to repatriate a body if it goes perilously perilously wrong?

Realistically have you got the cash to cover it without insurance in a worst case scenario?

I don't have any experience of giving birth in America, or privately in the UK - but -

If you go to America, and things go badly, what happens then?

What happens if your baby is ill when it's born, and needs to be admitted to SCBU / NICU?

What if you have complications, and it's not just a straightforward vaginal birth / c-section?

Will this Blue Cross Blue Shield insurance you mentioned pay out if your baby ends up in neo-natal care for an extended period? Or if you need more care than standard?

If anything like this does happen, are you absolutely 100% certain that you've got insurance to cover it?

If you're not certain of that, then I think it would probably be better to stay in the UK for the birth, even if giving birth privately in the UK is a bit more expensive. I'm sorry that you've had bad experiences of the NHS before, but at least if the worst case scenario does happen, the NHS is there as a back up and won't leave you bankrupted.

I agree about the need for the NHS to sort out continuity of care: that's the thing that made a HUGE difference between my pregnancies (and has made me seriously consider having #3 before we leave the US even though it'd mean a much smaller gap than I'd optimally want). Having the same doctors for every single appointment and knowing that one of them would deliver my baby was fantastic: they knew my history, I didn't have to explain everything every time (which can be upsetting if there are things which are hard to talk about) etc etc.

The UK midwives were all great, but it felt like I had to go right back to the beginning at every appointment...

How long is a piece of string?
Check the latest pregnancy dates you can fly by. I would plan to go at least a month before that date to prevent risk of cancelling, or maybe a minimum month before I developed pre-eclampsia last time. I presume someone will help look after OP's DC1, too.