Help with insurance decisions for newly immigrating pregnant wife

Hello – I was hoping to get some advice regarding insurance for my wife who is four months pregnant. She is a Dominican citizen – we have been married for over a year and have been living in Santo Domingo together since the marriage while awaiting her visa. She has recently had her spousal visa process approved by USCIS and so we are just awaiting our interview with embassy. We are on track to get her visa before December so we can have the baby in the USA. For anyone who knows about immigration – we absolutely need to have the baby in USA so it is immediately a citizen. If we have it in the DR, we will have to wait another year and a half for the baby to get a visa, even though me, teh father, am a US citizen… However, I am becoming very nervous about the health insurance situation once we get to US too.

My original plan was to add her to my employer health insurance which is an HMO with Kaiser Permanente. This is fine if we go back to live in Los Angeles, which is where the main office is and where there are many Kaiser locations. However, we will have no family/friend support out there to have the baby if we do so. I had already ended my apartment lease out there, and my new plan was to transfer my office to DC area after we had her visa and baby sorted out, so I have no apartment out in LA and had no plans to move there with her. All of my family is in Nashville instead, so I was hoping to go to Nashville to be with my parents to help take care of her and us in the first month of pregnancy and then move to DC. But now there is the problem that my health insurance is an HMO, and Kaiser has no locations in Nashville area. Now, Kaiser DOES say it will cover, or at least reimburse I think, for urgent, emergency care, which would include active labor “when there isn’t enough time for safe transfer to a Plan Hospital before delivery”… But I am unsure if that would also include us intentionally staying in a state without Kaiser locations to have the baby there 🙂

Another option I was considering was getting secondary insurance for her just for the baby, like through the ACA, which doesn’t count pregnancy as a pre-existing condition… but with her normal spousal visa, and us being married for under 2 years, it looks like she’s not eligible for that either!

Finally, a third option we are considering is hiring a midwife and having an in-home birth in Nashville… this would be about same price as going to hospital with regular insurance I think (about $3000), and we could be with family for support. But if anything off happens we would have to go to a hospital anyway.

This is so complicated!! Any advice would be extremely appreciated.