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What prenatal care will my health insurance cover?

In the excitement of planning for your new baby, make sure you know what care your insurance will (and might not) pay for

By Barb Breher
August 11, 2017

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Congratulations on the upcoming arrival of your beautiful baby! Thinking back on my pregnancies, I was so excited, but I also had what felt like a million questions and decisions to make. Now, I love helping expecting members understand how their health insurance will help pay for all of the doctor’s visits, tests and ultrasounds.

Here are some common questions I get:

What’s considered prenatal care?

All care you get related to your pregnancy is considered prenatal care. And by that I mean all of the care you get from the time you first find out you’re pregnant to the actual delivery of your baby.

Examples of prenatal care include:

  • Routine office visits with your OB-GYN or midwife
  • Lab tests
  • Ultrasounds and other imaging services

Is prenatal care covered by my insurance?

If you see a provider who’s on the list of providers your health insurance helps pay for (or, “your network”), you shouldn’t have to pay anything for routine prenatal care.

If the provider isn’t in your network, your insurance won’t help you pay for those costs. And all of those tests and appointments can really add up. That’s why I’d suggest contacting your health insurance plan before your first appointment. You can make sure your preferred care provider, like a doctor or midwife, is in your network.

If you have HealthPartners insurance: Check your costs and coverage in your online account

What about genetic testing?

You may be considering prenatal genetic testing in your first trimester. These tests screen for or diagnose a birth defect. This isn’t necessarily considered a routine test, so you may have to pay for all or some of this service. When in doubt, contact your insurance provider to find out what’s covered in your plan. What about a high-risk pregnancy?

If you have special testing, procedures or hospital stays requiring tests and treatment, these may not be completely covered by your insurance. If you have a high-risk pregnancy or a special test or procedure, my advice is to contact your health insurance company before you have those things done. They can let you know a cost estimate for specific procedures. And that will give you a sense of how to budget for it.

Are breast pumps covered?

Before you put a breast pump on your baby registry, check with your health insurance plan. Most insurances will pay for certain models of breast pumps and other necessary medical supplies, as long as you have a prescription. Call your health plan’s member services or go online to check what’s covered.

Talking to your health insurance company?
Here’s your cheat sheet:
• Is [doctor/midwife you’re interested in seeing] in my network? If not, can you help me figure out who is?
• Which genetic tests are covered?
• Are [any special tests/procedures you know you’ll need] covered? If not, what will the cost be?
• Are breast pumps covered? If so, what are my options and how do I get one?

About Barb Breher

Barb Breher is a leader in the Member Services department at HealthPartners. She specializes in individual and family health plans. Barb loves helping members understand and use their coverage (it’s confusing!). When she’s not working, she loves relaxing and camping with her husband and two young daughters. Minnesota locals: she highly recommends Voyageurs National Park.

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