Cost and coverage FAQs:

Mom edition

Pregnant mom reading tablet

We want every PriorityMOM™ to have the best pregnancy possible. That’s why we want you to better understand your health plan and coverage during this time. Save this FAQ for quick reference. And remember, there's no such thing as a silly question—especially during pregnancy!

Are my pre- and post-natal visits covered?

You'll want to schedule all of your pre- and post-natal visits to monitor your health before and after pregnancy. It's also the best way to monitor the health and growth of your baby. But are they covered?

Coverage for these services varies by plan, but we can point you in the right direction. In the My plan section of your member account, download the Member Packet from your documents. In there you can find your specific coverage details for "Maternity Services (Prenatal and Postnatal)."

Many of your pre- and post-natal services such as immunizations, postpartum visits and gestational diabetes screenings may be covered as preventive care in your plan. Preventive care services are generally available at no-cost. Check your preventive care guidelines to see which are covered by your plan.

How much will labor cost?

When your big day arrives, you may be wondering how much you may have to pay out of pocket, whether you have a vaginal birth or caesarean.

You can use the Cost Estimator tool in your Priority Health member account to see what you might pay for a vaginal birth and C-section. Simply search "delivery" while in the tool. You can also call your provider directly to confirm the estimates.

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Does my plan cover genetic testing?

There are several genetic screening options available during pregnancy. These generally screen for genetic defects and health conditions. Most of these tests take place between 10 and 15 weeks, and many consider them a good way to identify any potential defects. But are they covered?

If clinical criteria are met, genetic testing may be covered. Talk to your provider about whether genetic testing would be beneficial.

How can I find the right obstetrician (OB) or pediatrician?

Choosing your OB during pregnancy and your child's pediatrician are big decisions. There are several factors that you'll want to weigh in regarding the kind of birth you wish to have. One factor we can help with is how to choose an OB and pediatrician that's covered in-network. But how?

Three words – Find a Doctor. In your member account, you can use our Find a Doctor tool to select OBs and pediatricians in your network. You can even see how far their offices are from home or work, which can be important as you'll be visiting often both during and after pregnancy.

Find a Doctor

Can I change health plans during pregnancy?

Depending on your coverage and/or your situation, you may be enticed to change health plans as you become a parent. Don't worry, it's a part of parenting and we encourage you to weigh your plan options often to match your situation, both for you and for baby! But, can you change plans?

You cannot change health plans after you find out you're pregnant. However, you can change health plans the moment you add baby to your plan as a dependent. The best way to go about this is to talk to your employer's HR department. They can help you understand your options.

How (and when) do I add my new baby to my health plan?

Okay, baby has arrived and you're in charge of their health and wellbeing. It's time to make sure they have health coverage and add them to your plan as a dependent. Okay…but how? And when?

  1. Take a deep breath. Your baby is covered in your inpatient hospital stay up to 48 hours following a vaginal delivery. Having a C-section? If so, your little one is covered up to 96 hours afterward.
  2. Complete a change of status or plan form as soon as possible.
  3. Return the form to your employer's human resource department or representative.
  4. Your employer will send the form to Priority Health within 31 days after birth to continue coverage on your health plan.

What you'll need: Your baby's SSN, your Priority Health member ID number and primary care provider information.

Plan ahead and download the form now.

Do I need a prior authorization for any hospital stays?

Sometimes hospital stays require a prior authorization from your health plan. Whether or not you need a prior authorization often depends on your plan and if the facility is in or out of network. Will you need one?

Inpatient hospital stays for you and baby of up to 48 hours (routine vaginal delivery) or 96 hours (C-section) do not require any priority authorization if it's in network. If you have an HMO plan, you'll need authorization for any stay out of network, such as an emergency situation or while traveling. If for any reason you or baby must stay beyond that amount of time, the hospital and Priority Health will handle authorization for you so you can focus on baby.

Does my plan cover breast pumps?

You'll be amazed at the breast pump options, models and makes available to you. Should you choose to breastfeed baby, are breast pumps covered?

Yes. Breast pumps are covered at 100% when you buy from a covered partner. All you need is your insurance group number and your Priority Health member ID number at the time of purchase. You'll also be asked to provide your doctor's information such as name, address, phone or fax number. We encourage you to choose from several hospital-grade options.

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Is circumcision covered?

Having a boy?! Circumcision is another important decision you'll face as a parent. If you decide to have the procedure done, is it covered?

While we can't help with your choice, we can say that the procedure is covered as part of your inpatient hospital care for your newborn. However, cost sharing like coinsurance and deductible amounts can vary by plan.

Where can I find all of my plan details like deductibles, copays, coinsurance and out-of-pocket costs?

There's much to keep track of when it comes to costs associated with your care. We encourage you to remember your deductible, copay, coinsurance and out-of-pocket amounts in your plan. But where can you find that information?

You can find all of your plan documents in your Priority Health member account—both online and in the smart phone app. Having all your info in one safe place takes all the busy work and guess work out of understanding your plan as you begin to use it more and more. Log in today and get started.

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We realize you'll have more questions along the way. And that's perfectly normal. We look forward to helping you navigate your costs and coverage during your pregnancy and beyond. Look for other helpful hints, tips and info in the coming weeks from PriorityMOM.

And remember, we're as excited as you are!

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