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Mom Faces Bankruptcy After Birth Complications Land Her in Insurance Hell

Photograph by Amy Jay

Amy Jay is furious that the birth of a child could lead parents to financial ruin, as it might for them. Her second daughter, Evelyn, was born prematurely in January and spent weeks in the NICU. Though Evelyn is now a healthy 4-month-old, the family was hit with a massive $173,000 hospital bill—and that's not even counting the pregnancy bills Amy racked up herself.

The 27-year-old mom's journey to keep baby Evie healthy during pregnancy and after birth has been a difficult one. With her history of recurring miscarriages and infertility, Amy had to undergo additional testing, including special blood tests to count her hCG levels, and take progesterone supplements, which is commonly prescribed to help preserve the uterine lining and maintain a healthy pregnancy.

But she was horrified to learn that the drug would cost nearly $200 a month and none of it would be covered by insurance. She also started receiving bills in the mail for almost $200 every time a lab was done, which she says the insurance also deemed unnecessary.

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"I had two choices: Rack up debt on a credit card or risk losing another baby," she tells Mom.me. "Obviously we chose to do whatever was necessary to keep our growing baby safe and we spent hundreds of dollars out of our own pockets on this drug."

Amy says in a YouTube video that she had to borrow money from her mom for three months to be able to afford the prescription, and her doctor and she agreed they would quit the supplements a bit early since she was doing well and it was too expensive.

During this time, the pregnant Amy and her husband Mac (28) were living in North Carolina with their now 2-year-old daughter Zeruah. Though they were medically insured through Mac's work, they quickly realized they would need better health insurance benefits. So despite loving his job, Mac started looking for other options and applied to over 1,000 IT positions. He was finally offered a job with great health insurance benefits in Alabama, so the week before Christmas, the family packed up and left to a place where they barely knew anyone.

Because Mac started his new job in January, the new benefits wouldn't kick in until February 1, and Amy was due to give birth on February 9, the Jays knew they had to dot their i's and cross their t's. So they signed up for Consolidated Omnibus Budget Reconciliation Act (COBRA) insurance, a temporary continuation of a group health coverage, and had to pay more than $1,500 to ensure they would be covered during the transitional period through the old plan.

They also talked to the old insurance company to get authorization for both the doctor and hospital in Alabama. But because the old plan didn't cover any doctor or hospital outside of North Carolina, any option the Jays chose would have been considered "out of network."

"We were assured that, while it would be more expensive, there would be an out of pocket maximum and that we could deal with the massive and inevitable bills through a reasonable payment plan," Amy says.

Photograph by Amy Jay

Evie was born at 36 weeks through C-section. Her lungs were immature and failed to produce surfactant, a substance that largely prevents the collapse of the alveoli and helps breathing to be relatively effortless. The newborn had a collapsed lung and required intubation, sedation, respiratory therapy, cardiology visits and testing, as well as around-the-clock care by hospital staff.

Meanwhile, Amy also had complications during her C-section recovery, including a severe postpartum infection and high fevers that required antibiotics.

To add to the chaos, Mac was only able to take a couple of unpaid days off since he had no saved up paid time off yet and the company didn't offer family leave. He would see Evie and Amy at the hospital after work, then go home to tuck Zeruah into bed, every day.

"We were exhausted out of our minds, and overwhelmed with all of the stress and responsibilities facing us every moment," Amy says. "We never heard anything from anyone with the insurance company or Mac’s old company, and therefore we assumed that everything was covered and that we would soon be receiving and explanation of benefits from the insurance company, and then would receive a bill for our portion of the entire ordeal. We were very, very wrong."

Photograph by Amy Jay

On Amy's birthday on March 13, she received a bill from the hospital for $173,000. Amy's bill of about $8,000 was because the hospital was out-of-network, but all of Evie's bills were all billed directly to the family.

"I felt like my world stopped," she says. "I stopped myself from panicking. I knew something was wrong. There’d been some mistake. We had been assured that nothing like this would happen."

But after lots of calls, emails and even seeking legal counsel, the Jays found out that Evie was never added to the plan. They would have had to add Evie within a 30-day window, which they didn't realize existed.

"That paperwork, and the initiation of having it done, was, apparently, our responsibility. We received no reminder or warning, and because our first child was born under Tricare during my husband’s time Active Duty in the Army, we had no experience with this kind of thing. We never learned in school anything about health insurance. We were totally uninformed," Amy says.

They appealed, but their appeal was denied. They also tried applying for other options that might help, including Medicaid, but made over $100 a month too much to qualify.

"During the most tumultuous, terrifying, and physically and emotionally painful time of our lives, we were expected to have known to do something no one ever told us we had to do," Amy says. "And because we didn’t do it, we would be responsible for over $200,000 in medical bills."

This is the reality of health care, and childbirth, in America.

After talking to everyone involved, it was clear to the Jays that their only real option would be bankruptcy. It's tricky to exactly pinpoint how many people have ended up bankrupt because of their medical bills. Current estimates are as high as 60 percent. Still, the major consensus is medical bills often take a big toll, even with insurance coverage.

After hearing about Amy's experience, a women's fitness Facebook group that she is a part of, decided to fight for the Jays by setting up a GoFundMe with a goal of $25,000.

"Those women have fought and fought for us in a way that I could have never imagined," Amy says in her video. 'They have advocated for us, loved us ... I could never ever express my thankfulness for it."

Amy says they have been given an option by the hospital to pay significantly less, though they can't disclose the parameters. And hopefully, with the help of the GoFundMe campaign, they will not have to file for bankruptcy.

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When asked what she thinks are the main issues with our health care system that led her family to this point, Amy pointed to a horde of problems, including loopholes in the system, how pre-existing conditions are treated by insurance providers, misinformation, and having health care dominated by for-profit insurance companies.

"The fact that my story is not uncommon is heartbreaking as there must be families who are in similar situations, through no fault of their own. This is the reality of health care, and childbirth, in America," she tells Mom.me. "Obviously, I hope that the GoFundMe helps raise enough for us to pay the bill. But I want so much more than that. I want people to be made aware of the reality of the situation in the U.S. I want people to petition their local congresspeople and senators and demand better for the average American family. I want people to be empowered to get educated on their healthcare rights and entitlements, and know and understand their plans and coverage. Ideally, I want reform, but we need to go one step at a time."

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