When I found out I was pregnant with my first baby, I felt like I had my ducks in a row. I had good health insurance through my job, I’d chosen an in-network OB-GYN, and I’d even called my insurance company to ask about maternity coverage. “You’re all set,” they told me. “Prenatal care is covered.”
What they didn’t tell me was that “covered” doesn’t always mean what you think it means.
My first wake-up call came at my 12-week appointment. My doctor recommended some additional blood work—nothing scary, just some extra genetic screening since I was over 35. I figured it was routine and said yes. Three weeks later, I got a bill for $800. Apparently, my insurance considered it “elective” and wouldn’t cover it.
That’s when I realized I had no idea what I was actually covered for.
The Things Nobody Tells You About Pregnancy Insurance
Over the next few months, I learned the hard way that pregnancy insurance is full of fine print. Yes, most plans cover the basics—your regular prenatal visits, standard ultrasounds, and delivery. But there’s a whole world of services that fall into gray areas.
Like when my back pain got so bad I could barely walk, and my doctor referred me to a chiropractor. I assumed it would be covered since it was pregnancy-related, but my insurance required prior authorization that nobody told me about. Another surprise bill.
Or when I wanted to see a pelvic floor physical therapist after delivery. “Is that covered?” I asked my insurance company. “Well, it depends on if it’s deemed medically necessary,” they said. What does that even mean?
The most frustrating part was that every time I called with a question, I got a different answer. One representative told me my lactation consultant visits were covered. Another said only certain types were covered. A third said I needed a referral first.
When I Finally Found Help
About six months into my pregnancy, a friend mentioned she’d started using a service called Sheer Health. “They handle all the insurance stuff, so you don’t have to,” she said. At first, I was skeptical—another healthcare company making big promises?
But I was exhausted from dealing with insurance calls and surprise bills, so I decided to give it a try.
The difference was immediate. Instead of me calling my insurance company and getting transferred three times, Sheer’s team would verify my benefits before appointments. They’d check if services were covered, if I needed prior authorization, and what my out-of-pocket costs would be. For the first time in months, I actually knew what to expect.
When my doctor recommended additional monitoring in my third trimester, Sheer made sure my insurance pre-approved the extra ultrasounds. When I wanted to work with a lactation consultant, they found an in-network provider and confirmed my coverage. When I had questions about getting a breast pump, they walked me through the whole process.
The best part? They caught mistakes before they became problems. My insurance company had initially denied coverage for my gestational diabetes testing, but Sheer appealed it and got it covered. I never would have known to fight that on my own.
What I Wish I’d Known From the Start
Looking back, I wish someone had told me that “covered” doesn’t mean free, and that there’s a huge difference between what’s technically covered and what you’ll actually pay. I wish I’d known to ask specific questions like:
- What’s my deductible for maternity services specifically?
- How many ultrasounds are covered?
- Do I need referrals for specialists like physical therapists or mental health conselors?
- What’s the process for getting a breast pump through insurance?
Most importantly, I wish I’d known that I didn’t have to figure it all out myself.
Having Sheer handle the insurance complexity meant I could focus on the fun parts of pregnancy—like setting up the nursery and enjoying those last few months before our lives changed forever. And when unexpected issues came up (hello, sudden need for pelvic rest), I knew I had someone in my corner making sure I got the care I needed without surprise bills.
If you’re pregnant and feeling overwhelmed by insurance questions, you don’t have to navigate it alone. The peace of mind alone was worth it—and honestly, I wish I’d found this kind of support from day one.
At Babe, we are looking to make your life easier. Try Sheer Health for free here.
