Individual insurance may have to cover maternity care

Anh Van never intended to have children. So when she went to the doctor for what she believed was the flu, she was surprised to discover she was pregnant. Then she got another shock: Her private insurance didn’t include maternity care.

Van, who has insulin-dependent diabetes, called several companies but couldn’t find anyone willing to cover her pregnancy.

“Every insurance company we called basically denied us,” said her husband, Brian Huh. “It was pretty appalling.”

Although HMOs and employer-based insurance policies in California are required to include maternity care, individual policies are not. That leaves women who are self-employed or not covered at work with few options, including paying out of pocket for pregnancy and childbirth costs.

A bill on Gov. Jerry Brown’s desk would change that, mandating that insurance plans in the individual market cover maternity care. The legislation, SB 222, is part of a package of bills that would affect healthcare for pregnant women and close what advocates say are loopholes in the law. The governor’s office declined to discuss Brown’s views on the bills.

Pregnancy care and delivery costs can run tens of thousands of dollars, with taxpayers often picking up the tab for those without insurance coverage. The proposed legislation would help reduce public outlays, according to the bill’s sponsor, Sen. Noreen Evans (D-Santa Rosa). “It saves the state money because those women now are turning toward state-supported healthcare because they can’t find their own healthcare,” she said.

Roughly 19% of people with individual policies had maternity coverage in 2009, down from 82% in 2004, according to Evans.

Often, a woman is pregnant before she realizes what her insurance plan is missing, said Shannon Smith-Crowley, director of government relations at the American Congress of Obstetricians and Gynecologists. “It’s only when she goes to the doctor’s office that she knows she doesn’t have coverage,” she said.

Women who meet certain income requirements and do not have insurance that pays for maternity care can apply for the public Access for Infants & Mothers program, which typically covers all costs. But women sometimes miss critical tests and care before they get onto the public plan, Smith-Crowley said.

Insurance companies disagree on maternity coverage, with some arguing that policyholders who don’t need it shouldn’t have to pay for it, said Richard Wiebe, spokesman for the Assn. of California Life and Health Insurance Companies.

Some companies believe establishing a new pregnancy coverage mandate in California is unnecessary because federal health reform will require it in 2014. “Why pick a fight that has really already been decided?” Wiebe asked.

A second bill, SB 299, would require employers to continue providing health coverage for women on maternity leave. Although new mothers are guaranteed four months of unpaid state disability leave from their jobs, their employers don’t have to keep insuring them during that time.

Women are put in a “terrible position” of choosing between medical care and leave from work, said Beth McGovern, legislative director of the California Commission on the Status of Women, which sponsored the bill. “To put women in that position when they have to choose between those things is really outrageous,” she said.

A third bill, AB 568, would prohibit the use of shackles on most pregnant prisoners and ensure less restrictive restraints.

Van, who lives in El Monte and works at a printing company, said she considered having an abortion because she knew her pregnancy was going to be risky — and prohibitively expensive. But about two months into her pregnancy, she learned that she qualified for the state program and wouldn’t have to pay for her maternity care, including visits to specialists who could help manage her diabetes during pregnancy. The costs climbed to about $250,000, she said.

“It was a huge burden taken off your shoulders,” she said.

After several hospital stays, Van gave birth to Simone at Huntington Hospital. The baby was more than two months premature but now is 2 and healthy.

Kimberly Chavez, who lives in Los Angeles and works in television production, said she always knew her Blue Cross policy didn’t include maternity coverage. When she got pregnant, she thought she could just change the policy and pay more. But that wasn’t the case.

“It was a scary situation to be in,” she said. “The stress that it caused for the first part of my pregnancy was horrible.”

Chavez was also eligible for the state program, but she would have had to switch doctors. Instead, she paid out of pocket for prenatal appointments and the state program covered her delivery. Her son was born in July. Her debt from the pregnancy was about $20,000.

anna.gorman@latimes