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Wendy B
I just became eligible for Kaiser HMO through my work and I'm pregnant. Lot's of questions, can't find answers?
I just became eligible for Kaiser HMO through my work and I'm pregnant. Lot's of questions, can't find answers?
I am currently covered through medicaid. If I accept the insurance will it cover the pregnancy considering i'm 4 months along? Also, the plan says it covers up to $75000 a year, but I have a problem pregnancy and already know it will be a planned c-section due to the circumstances. Just this will be over the $75000 yearly max. Does that mean that I won't be covered for anything else. Also, it says no pharmacy services covered, yet I will need certain shots and medications. I will also be medicated through the c-section and afterwards for pain. Will that not be covered either.

I was very excited when I saw that I could finally sign up for medical, but now I'm afraid I'll be much worse off financially if I do. Also, I looked online and found the closest Kaiser Clinic is close to an hour away. Is it possible that there are smaller Kaiser Clinics that aren't listed on the Kaiser website or will that probably be the one?

Thank you!
                     
 




Zarnev
Rating
Jenn is incorrect. Group policies must cover maternity from day one; pregnancy cannot be considered pre-existing.

Anything over the $75000 yearly max will be your responsibility. That is very low for a yearly max - are you sure of that amount? Also, 75k is a lot for even a complicated C-section; the insurance company has negotiated rates with the doctors and hospitals. You'll need to contact Kaiser or the hospital to see what the negotiated charges will be using the plan. Chances are they will be lower.

If you still qualify for Medicaid you can keep Medicaid. Kaiser will be the primary and Medicaid will be secondary. Since the Kaiser plan does not cover pharmacy Medicaid should pick up that cost.

You will need to use clinics that are contracted through the Kaiser HMO. If there are no Kaiser clinics close there may be other clinics that are contracted. You'll need to contact Kaiser to find out where you can get services.


Jenn
Contact Kaiser and ask them your questions. From my understanding of most insurance plans, they probably are not going to cover your pregnancy nor the birth as it will be considered a pre-existing condition. Is it possible to hold on to the Medicad and subscribe to Kaiser throughout your pregnancy? You would then have dual coverage to hopefully have one insurance to pick up where the other leaves off. You need to contact them using the customer service number on the back of your card.

Should you discover that neither will cover you for all or a portion of your expenses, talk to the hospital. The hospital will have someone who is knowledgeable about programs that help with the expenses or can work out a payment arrangement with you.

Good luck!!


KG Mom
Rating
You need to call Kaiser, but.....

1. Under Federal Law, pregancy cannot be considered pre-exisitng. So it doesn't matter that you are 4 months along, you will be covered.

2. C Sections typically run $5K. Has someone told you that you would hit the $75K? Also, assuming you will be doing everything at a Kasier facility, I doubt their contracted rate hits $5K. I don't care how many sonograms you need.

3. Are you concerned about the $75K due to baby costs? If so, you need to ask Kaiser when you call if the baby has its own $75K max per year or if its part of your annual max. NICU costs can be pretty high and that may be a factor.

4. You typically lose Medicaid when getting access to private health insurance, but it will depend on your income. You need to talk to Medicaid about this

Congratulations and good luck!


stephenweinstein
1. Becoming eligible through work may make you ineligible for medicaid, even if you decline the coverage through work.
2. Exclusions of pre-existing conditions do not apply if you had prior coverage (including medicaid) for the 18 months immediately prior to the start of the new coverage; if the new coverage is a group plan, which most insurance with work is, then only 6-12 months of prior coverage are needed to avoid the exclusion of pre-existing conditions.
3. Medication for a c-section is probably part of the hospital bill, not a separate pharmacy bill.


mbrcatz
You're planning on a C section that's going to cost over $75,000 a year? Yikes! Never heard of that.

But, once you hit the $75K, that's IT. No more coverage. No medications, either, according to you. Usually anesthetic isn't the same thing as prescriptions.

All the Kaiser clinics should be listed on the website.


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