Pregnant and moving to US - can't get insurance - advice needed

[Rubeywednesday]

Hello,

My DH is self-employed and has been offered a years work in California, starting in November. We are both keen to go but I will be 6 months pregnant (with our first child) by then. As he is self-employed we need to sort out our own insurance (his visa sponsor has made this clear also) but I have been led to believe that pregnancy counts as a "pre-existing condition" and insurance will not cover me for my pregnancy and labour.

We have discussed this and the high costs involved (I've been quoted up to $20,000 for a straight-forward labour!) and as I am currently healthy and enjoying a normal pregnancy we are thinking of going for it over there.

I would like advice from anyone who's been in a similar situation, and/or advice about choosing a gyno/obstetrician in the LA area. Will all obstetrician's take cash paying clients or are do they only work for insurance companies? should i be looking at insurance for health issues unrelated to my pregnancy at the same time? are we completely mad to contemplate this?!

any advice gratefully received!

Standard prenatal care/vaginal birth is more like $6000 - 8000.

The problem is the high C-section rate that you would need to be able to fund.

Paying for your own insurance can be very high too. You would need to budget approx. $500 a month.

I'm from Cali- and worked in the hospital system for many years. If your going over on a visa you should be able to qualify for insurance in the US. Any OB/GYN practice and hospital will take cash, however most are just used to billing people since so many don't have insurance anyways. I'd look into programs called Healthy Families and even Medi-cal ( if your pregnant you should qualify) You might have co-pays, but it would be nothing to just paying out of your own pocket.

If you do end up paying out of pocket, I would suggest sitting down with the billing department and working out a deal. Many will take less than half of what is said owed if you pay in full. Others will just work out a payment plan, (even if it's just 5 bucks a month) The truth is most Americans have Medi-cal, and that only pays for approximately 35-40% of the actual hospital bill, the rest just gets dropped. The hospitals are just happy to get what they get.

Good luck- I promise the US health care system isn't as scary as it sounds. I'd be surprised if you didn't have a great experience. Don't be shy about bossing around the nurses either. It's their job to make sure your birthing experience is as close to how you want it as possible!

that's all great advice, thanks very much! I'm sure you can see how daunting all this is to someone who's been lucky enought to have the NHS all my life! I am genuinely excited about having a baby in the US though.

one more question, this sounds really silly but what is the best way to find a good OB/GYN practice if I have no contacts out there I can ask? do you just go through the phonebook? are they all attached to the hospitals? are their any websites I should know about?

thanks again

What part of Cali are you going to? There are doctors that are assigned to specific hospitals which also have their own private practice. Otherwise, talk to hospital staff- they know all the dirty secrets and who is the doctor to have! There are websites that people can leave comments about how they feel they were treated, however I find most people only go on those things if they have a problem.

If you find a babies and bumps group, talk to the ladies there, word of mouth is invaluable.

we'll be in LA, or near about. Not too sure yet.

Is it true that midwifery is illegal in some US states? I'm glad to note that's not the case in CA

Yeah it is in some states. There are differences though, there are certified nurse midwives ( which are nurses that cross train as midwives ) and those are 100% legal in all 50 states. Then there are certified professional midwives (which don't have to have any medical experience save taking a midwifery course) and those are illegal in 12 of the states. It has to do with only certain situations though, they are allowed to aide in hospitals or do prenatal care, they just can't perform home births legally. It's all about being monitored by the state medical board.

If your going to be in the LA area, Mount Sinai Hospital is one of the top hospitals in the country. Here is a link to there labor department.

www.mountsinai.org/patient-care/service-areas/obgyn-and-reproductive-services/areas-of-care/obstetrics

I think David and Victoria Beckham had their baby girl there. Just a fun fact. :D

well if its good enough for the Beckhams! : )

thanks for your advice - feel a lot better about it all now

Hey no problem- I had my second here in the UK, it was really scary for me since I didn't know what to expect or how things worked. I wish somebody had helped me out with a few of the details.

Hope things work out for you. What is kinda cool is that your baby will have US citizenship if they want it. Nice to have the option in life. Makes me happy to know my little one can choose where he wants to make a life for himself.

If you have any more questions about Cali or the health care system feel free to send me a PM. x

If you turned up in the hospital in labour then they HAVE to take care of you during labour even if you don't have insurance. There were signs to this effect when I gave birth to DS1 in New York.

Obviously it would be preferable to get decent ante-natal care though to make sure that you and the baby are healthy.

I cant link to it because I am not a Times subscriber, but there was an article on Monday from a Dad whos baby was born at Mount Sinai. It was eye wateringly expensive!

Just watch "The Business of Being Born" before you go for it... !

But good luck with whatever you decide

Couple of points based on other comments.

The US citizenship is not a choice. Anyone born ther is a US citizen.

You can turn up at the ER in labour, but they will bill you and chase you down. As a non-citizen, you are not allowed to rely on public funds, so would get no help with pre-natal care or well-baby care.

Actually Mindthegap, citizenship is ALWAYS a choice. If I decide to naturalize here in the UK, I can choose to revoke my US citizenship. It would be the same for the OP's child. Of course the citizenship is there if they want it, and when the child is 18 it's something they should really think about because the US taxes all it citizens wether they live there or not. It doesn't really effect them unless they make over £90,000, but it's still an extra tax form to fill out every year.

Yes , non-citizens are not allowed access to public funds (however, they really are considering they are plenty of free clinics that ask no questions about citizenship- especially in the LA area) However, if her husband is working and paying taxes and is there on a legal visa- they have every right to insurance. In fact no where on Medi-cal's website does it say that they must be naturalized citizen, just a California resident and pregnant. If they make over a certain amount they might not be qualified or might have a co-pay. The point is they should look into it, because it could help them.

The US has a really bad reputation (rightly so in some things) that they just let their citizens sit and suffer without access to healthcare- the truth is there are always options and places to go if you need it. You just need to be pointed in the right direction and ask the right questions.

Ruby, I am in LA. US insurance doesn't consider pregnancy a "pre-existing condition" in the same way the UK insurers do.
If you run searches on UCLA medical centers, you will come up with a bunch, in Santa Monica, greater Los Angeles. Of these you will find specialist OBGYNs and the best bet is to register with one who is near you. Most of the UCLA doctors take most of the insurers and list them on their websites.
There are also plenty of emergency walk-in clinics around LA where you could indeed walk in, without insurance if you needed urgent help.
Good luck, it sounds exciting - all of it!

Just to add that us ins takes pre existing as most people have ins through work so change ins every time they move jobs. You can also get different levels of ins that cover you just for life & death type things, up to ones you can break a toe nail and they fix it. Of course there is a huge difference in the cost of premiums. You might be best off getting something for critical care, so you're covered if there's a major problem, but should you get something like an infection you would have to pay for a go visit and the med. Unless you can safely predict what illness you will have it's hard to know the best option.

It's like getting car ins in the Uk, but slightly more worrying if you get it wrong.

(btw us citizenship lapses if your kid lives outside the us most their childhood. You would also need to register them in the Uk as well if you want them to be a Uk subject)

US citizenship doesn't lapse.

If a child does not live in the US for 5 years over the age of 14, then they don't automatically pass on citizenship. It is conferred when their child enters the US for the first time, and they become naturalised US citizens.

As for British citizenship, the child is automatically a British citizenship at birth if born abroad as long as one of their parents in a British citizen who was born or naturalised in the UK. All that is needed is a British passport from the British Consulate in Washington DC using the parents' documentation and US-issued birth certificate.

You have to be careful about information posted here about insurance and pre-existing conditions. There is some protection when moving from one group policy to another, but this does not hold for someone moving from no insurance to private insurance. In the latter case, pregnancy does usually count as a preexisting condition, and for American citizens, they can get some help for prenatal care and childhood vaccinations from the state, but immigrants and visa nationals aren't eligible for public funds.

I have to add- illegal immigrants receive healthcare on the tax payer all the time. Especially in OB cases. No one is going to let a pregnant woman go without prenatal care. In my 10 years in health care I have never seen it happen. 3 of those years my job was to process insurance and provide patients with information regarding emergency medi-cal and other forms of government aided insurance. There are tons of private insurers that do not consider pregnancy as a pre-existing condition, you might have to pay more than the average person would in premiums, but the coverage is there if you do the leg work to find it.

Worst case would be you have to be a private pay- in which you can always deal with the hospital directly like I've mentioned before.

Not legal migrants, in work, from the UK.

My friend pays $900 a month for her health insurance for 3 of them- self employed so that is the kind of figure you will be looking at.

My c section bill came to $40000 in LA at a normal hospital so be aware if you do not get insurance that could be what you are looking at.

On a positive note I had a brilliant experience of giving birth here- the documentary- teh business of being born is a load of biased pagwash IMO- very one sided and not to be watched if you do come here- it just scaremongers. The quality of care here is amazing and the americans are generally some of the nicest people I have come across in their helpful manner- generally.

Hey I am in a similarish situation to you. I am a US citizen but have returned while pregnant and uninsured as well. DC1 was born in the UK in a midwife led situation so I wanted the same again. I have found that I was able to qualify for medicaid and I believe non Us citizens can as well too. So find that out ASAP. If you do have to pay cash in hand I belive midwife led home births are the cheapest and then birthing centres. If you want an epidural etc you're gonna pay for that also they don't have gas and air in the states!!! . You can in some states (including mine) have a birth at home with midwife or in a birthing centre as well on medicaid. If you get medicaid they will give you lists of OBGYN who accept it. The people I spoke with never mentioned any alternatives being available. I found out through my wn research so you should look in to it as much as possible. Congrats on your new job and enjoy the better weather

OP, no advice on your topic, but wanted to mention that there's a great audio podcast called Pregtastic that's run from San Diego. If you subscribe on iTunes, you can pick and choose to listed to the topics or birth stories that interest you. It always has a forum of pregnant women on the show and it will give you a good idea of the pregnancy "culture" in Cali.

In the case of pregnant women, the state medicaid will cover you whether you are a citizen or not afaik. I wasn't a citizen (had a green card) when DD3 and DD4 were born and was on medicaid in the state where I lived (exH was self employed). You do need to have a valid visa though. No insurer in my state would allow coverage for maternity charges until you had paid premiums for a minimum of one year prior to having the pregnancy confirmed. All the insurers in my state sold maternity coverage as an extra. It was not included in the standard packages you could choose from, and it was not included in 'basic hospitalisation' type plans (which is what we had; all we could afford as exH was self employed).

I used an OB/GYN practice for DD3 and a certified nurse midwife practice for DD4. Way back when DD2 was born I used the same OB/GYN practice and they were happy to set up a payment plan to cover the 20% of costs that our insurance didn't cover. We got bills that time from the hospital and the doctor, separately, and as iirc we had payment plans for both.

FWIW, your DH's employment offer without insurance coverage is not a good one imo. You and he really need to think about insurance.

If I were you, at 6 months, I would stay home and go out to California after the baby is born. The baby would need a visa to travel to the US with you. You will have so little time when you arrive to get everything arranged, between choosing a healthcare provider and sorting through all the finances, on top of the challenge of finding your bearings, and it sounds as if you can expect no help at all from your DH's employers.. I would not like to chance it.