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Baby, Freestyle: Paying for pregnancy in Texas is effing nutz.

2010 July 8

Editor’s note: Our baby crusaders Danielle and Adam just found out they were pregnant-but then they saw the sticker price. Eh gah!

Adam’s money concerns:

My first phone call after we found out we were preggers was to, no… not my family… but to Blue Cross Blue Shield, my insurance company. Kids are obviously a long term expense, but HAVING kids can cost as much as that black Prius you’ve been eyeing. So I wanted to know how we would go about this through my ridiculously expensive healthcare.

BCBS was very excited for us, and was completely not interested in helping out. If you are on an “individual” plan, pregnancy is considered a pre-existing condition, yes, like cancer… or HIV… or an old knee injury you had surgery on. The healthcare system won’t touch it.

ANY individual plan has this rule in place, and even if you have a company “group” plan, this can still be the case more often than not. No sh*t. That healthcare plan you pay out of pocket for as a self-employed individual, 200 bucks a month or so, doesn’t cover the one time cost of bringing a new life into this world. Bizarre, sad, and another indication that the US healthcare system has missed the target.

Now, people have been having babies, well… forever. And I went through a little bit of a belief-system change when I realized that the out of pocket cost for having a child could cost up to $15,000 in a hospital. I welcomed the idea of in-home birthing, mid-wives and doulas, not only because the cost was significantly lower but because of the fact it’s OFF the healthcare system radar, considers birthing as a more holistic process, and doesn’t WANT to hurry the process of natural childbirth for a quicker turnover and a higher bill.

As Dani dug into how to work the system, we really balanced wanting to have the traditional in-hospital birth with a natural childbirth.

Danielle’s research

The doc came in & said to us, “You’re pregnant! [dramatic pause] Is this good news or bad news?”  After our initial happy/shocked/OMG! tears & a barrage of info that I still can’t recall, my reply was “Let me call my insurance company & then I’ll let you know.”

My first step wasn’t thinking about names or picking out colors… I did indeed call my insurance company.  You know what they told me?  MATERNITY IS CONSIDERED A PRE-EXISTING CONDITION IN TEXAS.

Begin freak-out.

It’s true… completely inexplicable, but true.  The Individual policies Adam & I have both been paying every month for years were now completely useless at the time we needed them most.  We were trying to bring a new life into the world & day 1, 8 o’ clock the insurance company failed us. So… we moved into action.  We WILL NOT pay full-price for this baby. I will find a baby coupon or frequent sex miles to redeem.

First, if you’re in the corporate world you may be OK. The group policies those major companies have you on often do cover maternity, but if you’re thinking about having baby then you should call right now & find out.

Here are the findings of my discount-baby research:


Texas’ Medicaid system is very lenient on income when it comes to qualifying pregnant ladies.  I don’t care how much you make, it is ALWAYS worth applying.  I thought I made too much until I got the glorious phone call from a caseworker who told me otherwise. Get ready for lots of reading & research, but once you wrap your mind around it you’ll be graced with Texas’ version of a Groupon for having babies.  [resource: Texas Health & Human Services Commission]

Texas Risk Pool

If you are, in fact, too much of a baller to get Medicaid & you opt for a midwife, doula, birthing center or any other alt method not covered by insurance, the Texas Risk Pool will step in & cover complications in pregnancy not covered by insurance. [resource: Texas Risk Pool]

Birthing Centers, Midwives

I’m not going to go into the many varying opinions on hospitals vs. birthing centers right now but I will say that a birthing center was our first choice but it’s not covered by our Baby Groupon YET (they will be covered soon though, so says our Congress). If you’re paying out-of-pocket & are into all-natural awesomeness, then check these ladies out!  From start-to-finish, Birthing Centers or a Midwife will run you about $3,500 – that’s a hell of a deal!  If you go this route, they cannot treat complicated pregnancies so check out the Texas Risk Pool mentioned above.


Though we want to do this natural & Adam is in charge of kick-fighting the nurses & docs when they suggest pitocin, epidurals and especially c-sections, we are going to give birth in a hospital because our Groupon fully covers it 100%.

You can still have the baby the way you want, you hippie, but you will have to prepare for a fight. If you’re going the hospital route & paying out-of-pocket, you should negotiate like crazy.  Best advice I’ve read, make an anonymous call to find out what the hospital charges for everything then make them an offer in writing for exactly half of that.  They will work with you.

So, the moral of the story is… you don’t have to have a trust fund or be a 9-5′er to procreate, but you do need to accept that there’s no friggin’ stork that drops baby on your doorstep. You’re going to have to spend a lot of time &/or a lot of money.  We opted for time. No one’s going to figure it out for you, so buckle down & start crunching numbers while your baby mama makes some phone calls.

Did your insurance cover your pregnancy?

Do you have any tips for dealing with the medical costs?


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4 Responses leave one →
  1. July 8, 2010

    Twitter Comment

    ROA Baby, Freestyle: Paying for pregnancy in Texas is effing nutz.:

    Editor’s note: Our baby crus… [link to post] via @ATX4U

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  2. July 8, 2010

    Twitter Comment

    RT @ATX4U: ROA Baby, Freestyle: Paying for pregnancy in Texas is effing nutz: Our baby crus… [link to post]

    - Posted using Chat Catcher

  3. Cile permalink
    July 8, 2010

    I am with you sweet parents to be. Switched to group healthcare in anticipation of needing maternity coverage, and you have to have employees for that. There’s really no good alternative for self-employed folks.

    A person sitting next to me at a nail place told me that lacking maternity coverage, her bro-in-law negotiated the amount of cash he and his wife had to pay directly with the hospital billing departments in advance of the birth of his two kids. Interesting….

    Just went through the health insurance / baby doctor thing - if you find a pediatrician who takes a fixed cash payment, let me know. I opted to add the baby to my healthcare plan (read: threw in the towel after calling various pediatric practices and asking for out-of-pocket pricing).

  4. Ashley T permalink
    September 10, 2010

    Great info! And congrats!! I was in the same boat with BCBS: no maternity coverage. I went with birthing centers for my 2 pregnancies and loved the experiences ( Austin Birthing Center most recently and loved them!)
    Anyway, BCBS was cold to me too, until I lucked upon Erna. She was the grandmotherly voice on the other end of the phone who was kind enough to tell me things no one else would. Like: even though my birth wasn’t covered, if there were any emergencies, like needing a c-section, etc, they WOULD be covered. And once labor starts, the baby is automatically covered. Anyway, she was generous with her explanations and loophole knowledge. I didn’t end up needing it, but I think she eased my mind so much that my fear didn’t mess up the birth. 1800 459 8431 ext 7524
    Anyhow, best of luck!!

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