My husband and I are expecting a baby and have no insurance. The only hospital in town is a private one and does not accept uninsured patients. We make too much money to qualify for state aid and not enough to afford insurance. What are our options for delivery?

A.S.

This question raises several important issues. First, while preparing for delivery is important, the primary concern during pregnancy is good prenatal care. Establishing and maintaining a relationship with a physician, such as an obstetrician or family practitioner, is vitally important to the health of the mother and the unborn child. Newborn health is directly related to the quality of prenatal care. Conversely, the infant mortality rate in the United States is a consequence of the lack of prenatal care.
Second, in many cases, once a person is pregnant it is too late to obtain insurance. Some health maintenance organizations, however, may insure a person who is already pregnant, and the benefits may be excellent. HMOs can provide excellent prenatal and childbirth services with little "out-of-pocket" expenditures required. The trade-off may be that you must choose a physician and hospital in the HMO's network. Some states require insurance companies to insure people with a variety of existing medical conditions, including pregnancy. Still, there may be a waiting period for benefits for existing conditions. To give yourself and your baby a better chance, it is important to explore every avenue available to you for insurance coverage. While it may seem unaffordable, the alternative might be catastrophic.

Third, it is almost inconceivable that a hospital would refuse to accept patients without insurance. Even if a woman has insurance, she may not have coverage for pregnancy/delivery, or such coverage could have strict limitations. This means that a woman or family would be paying for the hospitalization out of their own funds. Most hospitals will agree to a payment plan for services, including childbirth. The American Hospital Association may be able to provide more information.

Fourth, consult your community's public health agencies for more information about programs that may be available to you or referral to agencies or organizations that may be of assistance. Many communities have access to resources other than Medicaid and other state programs.

Fifth, no matter what, it is essential to consult a physician early in the pregnancy and maintain that relationship. Consult your physician about your options for delivery childbirth and paying for the care that you and your baby need. You owe it to yourself and your baby to explore all the possibilities available to you. It may be tough, and it may require sacrifices in other areas, but in the end it is worth it.