Urban Mamas

Is financing fertility a completely out-of-pocket expense?  Jennifer is finding herself facing fertility issues and needs your advice.  She emails:

I have searched your site to see if there are any past blogs on fertility issues. I find myself in a painful situation at the age of 38 and very much wanting a second child. Unfortunately I just had my third miscarriage (second in a row) and was very surprised to find that my insurance (which is very good insurance) does not cover any fertility issues...not the work up, the diagnosis or the treatment. I am hoping to tap the wisdom and experience of other Portland Mamas who may have experience with fertility treatments, who may have ideas about which insurance (if any) covers fertility, and how people financed the costs which seem as if they can get expensive so quickly. Thanks Mamas....

Yesterday was my last day at work. It's a complicated story about "not giving 100%" and needing to spend way more of my percentages here at home on my kids. I'm starting a new freelance career that will pay a lot less than my former career, and naturally, includes only the benefit of complete freedom from externally-imposed responsibilities. Health insurance and maternity leave and retirement? I'm hoping my good, nourishing cooking and royalties from my soon-to-be-pitched book will cover me. (It's good to think positive.)

I can't afford Cobra and I think my income will be too high to qualify for the Oregon Health Plan (though maybe I'll be close). We get supplemental insurance through the Army Reserve's Tricare program for $82 a month but I doubt it'll help me without the primary insurance. I'm considering just paying out-of-pocket for services we need (like well-baby visits and the occasional checkup for Jonathan and myself, plus dental visits). Compared to the retail price of health insurance for my family -- between $400 and $1000 a month, plus deductibles and co-pays -- a few hundred here and there doesn't seem that bad. And honestly: I'll bet my out-of-pocket costs with employee-sponsored United Healthcare were at least $2000 in the past year.

Of course, that's assuming that I don't have another emergency like the one where Monroe ended up riding the ambulance to get stitches in his eye. And I have three extremely energetic and risk-loving boys. When I tweeted about my quandary over insurance, I found a few other mamas responded back almost immediately; they, too, were foregoing insurance due to great expense. We've talked before about insurance providers and insurance for pregnant mamas (thank goodness that's not a factor for me right now). While this is a great time to get very, very angry over the state of our nation's health system (John McCain accused Barack Obama's plan of being like England's -- I thought to myself, if only!) -- it's also a time to evaluate the options in reality. For those of you who don't get, or can't afford, insurance through your work or your spouse's work: What do you do?

Update: I wrote a post on WalletPop about "The Gilbert Plan," the way health care policy should be. What do you think about that?

Typically we try to not inundate readers with the same question, but Melissa's is specific and nuanced enough that we thought it would benefit others.  Where can Melissa find the right insurance plan?

I'm in the midst of changing the health insurance plan for my daughter and myself. I'm self-employed and my husband's plan is pathetic, not to mention insanely expensive, so the kiddo and I currently have the highest level individual coverage plan through Kaiser which we barely ever use. This is such a waste of our money. My ideal plan would look something like this...

• western medical emergency insurance plus coverage of dermatology
• natural healthcare coverage for naturopaths, acupuncture, etc.
• dental

Am I dreaming? Do any of you have experience navigating individual plans? I can't imagine I'm alone in looking for this. Maybe what I need to do is get just emergency insurance and then pay out of pocket for the rest. (?) Ugh. It's overwhelming and I keep putting it off. Then we get our bill and I freak out thinking what we could have done with all that money. The insurance industry is disgusting. But that 's not my point... Folks, we need your help here. Thank you very kindly!

Please help Megan with any suggestions you may have:

I'm new to Oregon and am looking for low-cost insurance for my family.  I'm looking for a good insurance agent that can help me navigate the Oregon Health Plan or other options for my kids, one has cerebral palsy.

Do urbanMamas have experiences to share with various insurance providers - Lifewise, Healthnet, Blue Cross/Blue Shield, Standard?

My husband and I have a baby on the way. Currently, I'm on an employer sponsored insurance plan with Providence. The experience with Providence has been excellent; however, I won't be returning to work after the baby comes and we are going to need to switch to a new insurance plan. My husband has his own small company and so he is looking at getting a plan for his employees. Of course, we want to choose a plan that will be ideal for everyone participating,and will also be accommodating to our family with the new baby in mind. So, I'm hoping for a little feedback, good or bad about: Lifewise, Healthnet, Blue Cross/Blue Shield, and Standard Insurance. Does anyone have horror stories or rave reviews to share about any of these providers?

Health insurance is important, especially if you have little ones or if you're expecting little ones. Lara has a situation:

My husband is about to leave his current employment and start his own business, I am 7 months pregnant and we need to sort out some new health care. While we could keep our current insurance through his employer, we would prefer not to as it’s a pretty crappy plan that will have us paying many thousands of dollars to have our baby (a high deductable plus 30% of hospital stay with a very high maximum). We are hoping that as a small business we can drop his current insurance and apply for a better plan that will cover more of the birthing expenses. Are there health plan that don’t consider pregnancy a pre-existing condition? Does any one know of a good plan that wont have us paying for most of the birth ourselves?

Since we're still on the topic of pediatrician's, Rebecca's interested hearing if anyone has experienced billing woes:

I am in the midst of an conflict with my pediatrician's office regarding billing practices, and it has got me wondering how widespread the problem may be...so I wanted to inquire if other uMs might have had similar difficulties.

My family has an insurance policy through Regence BC/BS which includes 100% well baby coverage for 8 pediatricians visits in the first 24 months of life. The ped group that I had chosen has twice billed two visits in my daughters first 9 months of life with diagnosis codes, thereby resulting in only partial coverage by insurance and me getting a bill. What is so frustrating is that we visited our pediatricians under the impression that they were "well child" visits...we did not make the appointments with specific complaints. Upon researching the charges with my insurance company, I have been surprised to discover the diagnoses resulting in these charges...one of the two visits in our case was "functional disorder of the gastrointestinal system"...doctor speak for constipation. I had mentioned that my daughter was occasionally constipated at that visit, but it was simply mentioned in a conversation regarding the well being of my child.

I am a physician, and perhaps since I have just finished my training and have not yet practiced on my own, I am naive to billing practices. But this does not seem right. It seems to me a clear example of why health care costs are so high.... Anyone out there with similar problems? Thanks!

Recently, I got a call at work from my husband.  It went something like this:

Husband:  "Hi. I'm in urgent care.  My headache hasn't gone away, I'm waiting for a CAT scan.  I've been here since 2 pm.  Can you pick up the kids?  You might want to call the sitter. I've gotta go."

Me: "Um, sure.  It's a quarter to five.  It's going to take me an hour.  Have you called the sitter?"

Husband: "I haven't had a chance. Can you?  I've gotta go."

Whaa?  The phone call caught me completely by surprise since (a) I usually don't get very many calls from my husband at work (b) we have not yet encountered a bind where I absolutely needed to pick up the kids (c) I only got enough information for all sorts of crazy scenarios to go through my head.

In the end everything turned out fine.  The diagnosis wasn't conclusive but something to the effect that he probably caught a virus and the side effect was a head-splitting migraine that left him unable to function normally for at least a couple of days.  However, for me, this was a good time to reassess our ability to deal with the impact of these worst-case scenarios.  When you're young, healthy, and financially stable you barely give thought to thing ever going wrong in life.  You start thinking about it more when you have kids.  And, then you really think about it when a situation scares you into more thoughtful consideration.

In my head, I made a mental note to check my husband's life insurance policy.  I have one for myself for enough to probably cover our mortgage, but that's it.  So, I googled to figure out how much insurance we would need. The results are dizzying.  According to a simple lookup table of just income replacement, my current insurance coverage probably would not be sufficient if something were to happen to me.  My husband's coverage would also need significant readjustment.  As a family, we do need to make the time to talk seriously about planning for life insurance. 

As I was chatting about this with a mama friend, she suggested also putting together a will.  So I mentioned this to my husband.  He thought this was a good idea.  "Sure.  Can you search for a form on the Internet?" he replied.  Yes, that's right.  That's what my lawyer advised!  There are plenty of documents that you can find or buy on the Internet to plan out your will and file with the local courts.  So, for those who have gone through both processes, it would so nice to hear from you, to see what's worked best for your families.