“I have to go to the bathroom!” I called out to my husband as I leaned against the garage with a mighty contraction. Baby #2 was on his way and Joseph was just ahead of me, ready to drive–with appropriate urgency–to the Atlanta Birth Center*. We’d picked the birth center first for its philosophy on mama/baby care, but not far down the list of the many benefits was also their approach to pricing, which, after our first baby’s birth, was a GIANT relief.
You see, we had our first while we were “covered” by catastrophic insurance. We never knew when the bills would stop coming or what in the name of backless hospital gowns each code meant. It’s the kind of thing that’ll make you want to turn down the iron supplement even though you’re anemic. Because who knows what they’ll charge you for it and if they’ll code it for the higher price because it’s a Wednesday, or because you’re wearing green, or because you’ve never watched an episode of GoT.
The birth center’s flat fee came with my favorite kind of surprise: none.
But just as we were about to head on out to our dimly-lit, tranquil birth, I reached the bathroom and had another contraction..and then another. As the pressure mounted (pun fully intended), I realized Baby was coming–right there in that powder room. Surprise!
Just as I “was delivered of a healthy baby boy” (as I heard a British commentator describe Meghan Markle’s experience), a gloved hand reached around the doorframe. That hand (which belonged to an as-yet invisible EMT) cut the cord. And just like that, we were in an ambulance headed to the nearest hospital.
It was, of course, out of network. The bills (which we are still paying nearly 2 years later) followed. I spent many hours swaying with my newborn in an Ergo carrier making phone calls and taking notes to get the bills submitted as an emergency so they could be covered in-network. Even then, our family deductible was $16,500.
Just as we’d made a plan to (slowly) pay off our unexpected bills, I heard a podcast episode where Katie Wells (Wellness Mama) shared her experience of using a combination of concierge medicine and health sharing ministries to get the care she wanted, save money, and not be concerned about getting buried in costs for accidents or unexpected illnesses. I had to know more.
If you’re happy with your coverage, carry on with your day and read no further. If not, you may find a solution in one of the less common approaches I researched in my pursuit of something better for us and our situation.
WHAT’S THE PROBLEM?
As small-business owners, we always find ourselves in that awkward segment of people who don’t have insurance through work AND don’t get a substantial subsidy from the ACA. Finding coverage that works for us has been one of the hardest parts of building our business. And that’s saying something because building a business is HARD, y’all!
For us, the main problems with traditional insurance are the expense and the inconvenience. In addition to that $16,500 family deductible, our insurance plan at the time of Baby’s arrival still had a high monthly premium. I thought of it more like catastrophic insurance by another name.
More irritating to me than the cost was that our in-network providers were inconveniently located (often 45 minutes+ away) and it was hard to find providers who shared our philosophy on health.
WHAT ARE THE OPTIONS AND FOR WHOM DO THEY WORK BEST?
I researched this subject for myself as well as for a client. The original post goes into the same options as below, but without our personal experiences.
Going uncovered or having catastrophic insurance: We played both of these games for a while. Even with our catastrophic insurance, it still made sense to negotiate the cash rate for the birth of our first child. Barring major complications, we would still pay less. It did not alleviate any expenses from routine visits and we did occasionally have large bills we paid for out of pocket. In theory, the catastrophic insurance keeps people from going bankrupt if something major happens.
Here’s the BIG news for 2019: The federal mandate is gone and taxpayers will not be charged for being uninsured.
ACA enrollment/other state-funded options: Those best served by this option usually don’t have insurance through work and do qualify for subsidies. I found that applying at Healthcare.gov is a fairly laborious process, but you often know by the end of it what you qualify for. Life changes such as losing coverage or getting pregnant often qualify you for special enrollment periods. You may apply for state-funded Medicaid or the Children’s Health Insurance Program (CHIP) options at any point as well. Check the income requirements for your state to see if you qualify.
Unregulated insurance: This is kind of the wild, wild west of insurance and is detailed further in the aforementioned linked post. The main thing here is to read the fine print because these options are unregulated by the gov.
Concierge medicine: Unless there is some major overhaul of the health system, I could see this option rising in popularity. Essentially, you hire a doctor on what amounts to a sort of retainer system. With that system, they can take on fewer clients and be more responsive to and familiar with the ones they do have. A major bonus here is that you can conduct much of your medical business over the phone/text/video chat. While this is an extra expense (sometimes as low as $50/month) for those with insurance, it can provide cost savings to those foregoing traditional insurance (read on). You also don’t pay co-pays or deductibles.
Health cost-sharing ministries: Visit any of these sites and you’ll see very quickly that they avoid all language that is associated with insurance. I’m sure the lawyers had a field day with this one. These are ministries. As such, they require some sort of statement of faith and often don’t share costs for things outside of their beliefs (abortions, for example).
The basic premise is that members pool monthly payments to share when another member has a medical need.
Cost-sharing ministries offer an alternative to/supplement to traditional insurance. For people who only qualify for plans with high monthly premiums and/or deductibles, this option offers cost savings.
Members are technically self-pay, which allows you to choose care providers based on whatever is important to you (such as healthcare philosophy, convenient location, etc.). Here’s a Consumer Reports rundown on this approach.
Other cost-sharing services: At least one company is offering health cost sharing without any religious affiliation required. First memberships started in Jan., 2019, so it’s a young company, but KNEW Health targets health-minded individuals and considers itself a “safety-net for large, unexpected medical costs.”
As someone who has navigated insurance more than I would have liked, this is where I see the most potential for the immediate future. A well-run business in this arena stands to provide a meaningful service for a large consumer base. I’d really like to see more options here. Please comment if you know about any!
We shed our insurance and went with a cost-sharing plan plus a form of concierge medicine. We’ve saved money, but even more importantly: no more effing networks! Still, it’s not perfect and I’d like to see more options in the cost-sharing arena.
Healthcare is one of the bigger decisions we make in life. What options work for you? Why?
As for the birth of our son in a totally unplanned way. All I can say is that I look back at it as one of the best couples’ team-building activities of all time.
*We liked their philosophy and our experience there so much that we serendipitously ending up making this video for the Atlanta Birth Center.