Health care Living with risky coverage gaps
By Amy Wilson

(MONEY Magazine) – Kavita Daswani, West Hills, Calif.

Three years ago, Kavita Daswani found herself in a health insurance bind. The now 39-year-old novelist and fashion writer from Hong Kong had recently married and moved to the U.S., and she knew that obtaining health insurance was a must. But there were challenges: She and her husband are both self-employed, and the only policy they could find (for just under $600 a month) had a 12-month waiting period for maternity coverage. "Of course," says Daswani, "I conceived 10 seconds after we signed on."

After a heated conversation with her insurer--"I told them a company shouldn't dictate when a client gets pregnant," she says--the couple decided to have a home birth, something their policy would not have covered even after the waiting period. The $5,000 out-of-pocket costs included prenatal check-ups with the midwife, sonograms, a doula to care for Daswani while the midwife focused on the labor, and follow-up visits.

Then an unexpected twist changed the insurance picture. After 36 hours of labor at home, Daswani needed to have a cesarean at the hospital. Because the procedure was an emergency, her insurer picked up $17,000 in hospital and doctor bills.

Today the entire family is covered by a policy from Blue Cross. They keep the premium below $400 a month by insuring Daswani's husband Nissim and son Jahan only for catastrophic and emergency care, not routine doctor visits. The couple pays for pediatrician visits out of pocket; Nissim rarely sees a doctor, preferring to rely on non-Western medicine. "Insurance is a potential minefield," says Daswani. "The reality is, it's up to the consumer to identify what they need, to simplify their choices and always ask about what's covered." --AMY WILSON