2nd Trimester

Insurance Shocker

I knew our health insurance sucked but this is truly shocking. 

Our OOP cost for vaginal delivery WITH health insurance (includes monthly premiums, max OOP and copays): $22,580 

OOP cost for emergency C with same coverage: $25,580

 

Our OOP cost for vaginal delivery WITHOUT health insurance, paid upfront in cash: $4,500 (includes my midwife, 24 hours in the hospital and all standard checkups and care for me and baby.  Also includes catastrophic coverage for a NICU stay)

 

Our OOP for the emergency C paid cash: $ 7,500

No brainer!  Goodbye, crappy insurance

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Re: Insurance Shocker

  • OMG that is insane! I'm so sorry you have to deal with that. I don't understand what the point of that insurance is. Why bother having it if they aren't going to cover anything. I hope you are able to find something else.
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  • Holy freaking moly!  That's INSANE.

    My deductible was $3,000 and then insurance covered the rest, except $500 to the anesthesiologist.

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  • Wow!!!!  And I thought our co-pay going from $100 to $500 was bad.  Good luck!!!
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  • Are you sure that the $4500 and $7500 include what you'll owe to the hospital, and not just the amount paid to the midwife/OB? $4500 for a midwife (prenatal + delivery) sounds fine, but my hospital bill would be separate, and would be in the $15k+ range.
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  • Your insurance sounds horrible.  To bad it's not 2014.  maternity care with reasonable OOP costs is a requirement under federal health reform in the large group, small group and individual insurance markets.

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  • image Mmm79:
    Your insurance sounds horrible.  To bad it's not 2014.  maternity care with reasonable OOP costs is a requirement under federal health reform in the large group, small group and individual insurance markets.

    That is if your company decides to continue carrying a corporate policy- it will become so expensive when the healthcare reform policies go into effect that a lot of businesses won't be able to afford to provide this 'benefit' to their employees. If you think your cost now is bad, wait until you have to pay for private insurance. It may reduce your OOP cost for the procedure but your monthly premiums will sky rocket. 

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  • image TMWarren85:

    image Mmm79:
    Your insurance sounds horrible.  To bad it's not 2014.  maternity care with reasonable OOP costs is a requirement under federal health reform in the large group, small group and individual insurance markets.

    That is if your company decides to continue carrying a corporate policy- it will become so expensive when the healthcare reform policies go into effect that a lot of businesses won't be able to afford to provide this 'benefit' to their employees. If you think your cost now is bad, wait until you have to pay for private insurance. It may reduce your OOP cost for the procedure but your monthly premiums will sky rocket. 

     

    Oh sweet Jesus. Not this debate. Save it for the election booth.

     

     

    That is pretty crazy though. I am incredibly grateful for our military insurance. If I had to deal with the civilian world my brain might explode.

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  • That is shocking! I think we pay the hospital $150 but everything else is covered under my insurance.
  • image hansonam446:
    image TMWarren85:

    image Mmm79:
    Your insurance sounds horrible.  To bad it's not 2014.  maternity care with reasonable OOP costs is a requirement under federal health reform in the large group, small group and individual insurance markets.

    That is if your company decides to continue carrying a corporate policy- it will become so expensive when the healthcare reform policies go into effect that a lot of businesses won't be able to afford to provide this 'benefit' to their employees. If you think your cost now is bad, wait until you have to pay for private insurance. It may reduce your OOP cost for the procedure but your monthly premiums will sky rocket. 

     

    Oh sweet Jesus. Not this debate. Save it for the election booth.

     

     

    That is pretty crazy though. I am incredibly grateful for our military insurance. If I had to deal with the civilian world my brain might explode.

     

    Sorry! I didn't realize this was/is a debate on here- and it wasn't my intention to start/continue a debate). We have a HDP plan at work (my DH and I work for the same company) so we have high premiums monthly, and then the HDP to meet annually and it stinks, but I guess it could always be worse (not referring to reform).

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  • How much are your monthly premiums? Is that for a year or just while you have been pregnant?
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  • Holy cow, what is your max OOP? 

    Like a pp said I would verify that there are not additional costs for hospital or anesthesia.  I'd be shocked if the hospital was less than $7500 itself.

  • Does that even actually cover ANYTHING?  I have pretty good coverage, but did see the actual hospital bills for DD's birth.  OOP I only paid $450, but the total cost for my c-section was around $25K.
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  • image hansonam446:
    image TMWarren85:

    image Mmm79:
    Your insurance sounds horrible.  To bad it's not 2014.  maternity care with reasonable OOP costs is a requirement under federal health reform in the large group, small group and individual insurance markets.

    That is if your company decides to continue carrying a corporate policy- it will become so expensive when the healthcare reform policies go into effect that a lot of businesses won't be able to afford to provide this 'benefit' to their employees. If you think your cost now is bad, wait until you have to pay for private insurance. It may reduce your OOP cost for the procedure but your monthly premiums will sky rocket. 

     

    Oh sweet Jesus. Not this debate. Save it for the election booth.

     

     

    That is pretty crazy though. I am incredibly grateful for our military insurance. If I had to deal with the civilian world my brain might explode.

     

    I agree and I'm so sick of it I could cry BUT it's really important that people understand this (and frightening that they don't).  Obama does not have a magic wand!  It's not going to just "get better" in 2014.  That money has to come from somewhere and it's really going to hurt a lot of people.    

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  • image wifeofaussie:

    I knew our health insurance sucked but this is truly shocking. 

    Our OOP cost for vaginal delivery WITH health insurance (includes monthly premiums, max OOP and copays): $22,580 

    OOP cost for emergency C with same coverage: $25,580

     

    Our OOP cost for vaginal delivery WITHOUT health insurance, paid upfront in cash: $4,500 (includes my midwife, 24 hours in the hospital and all standard checkups and care for me and baby.  Also includes catastrophic coverage for a NICU stay)

     

    Our OOP for the emergency C paid cash: $ 7,500

    No brainer!  Goodbye, crappy insurance

     

    Are your premiums like $1000/month or something?  This doesn't make much sense.  Even out OOP, a vaginal birth at a hospital shouldn't cost 22 grand...

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  • image AmyRI:
    Are you sure that the $4500 and $7500 include what you'll owe to the hospital, and not just the amount paid to the midwife/OB? $4500 for a midwife (prenatal + delivery) sounds fine, but my hospital bill would be separate, and would be in the $15k+ range.
    Oh yeah, I'm sure!  $2,200 is for the midwife to do prenatal care/delivery.  $2,300 is due to the hospital for a normal, vaginal delivery.  This is all provided we can pay before the delivery, which we can.  If anything happens, like a C section or if I ask for an epidural then we'll be billed the difference after the fact.  We're definitely gonna go this route.  I took DD and myself off DH's plan last time I had the opportunity.
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  • image Cellis:
    How much are your monthly premiums? Is that for a year or just while you have been pregnant?

    Our monthly premiums would be $1500 a month for our currently family of 3.  $6k deductible and $7500 max OOP and the monthly premiums don't count towards this.  After all of that is met, they still only pay 80%.  It's a total ripoff.  We decided to only cover DH.   I dunno if that premium would go up with a pregnancy, I didn't bother to ask.  Thankfully, we weren't being covered yet, this is a new job for DH so we just opted not to have coverage for anyone but him.

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  • image wifeofaussie:
    image AmyRI:
    Are you sure that the $4500 and $7500 include what you'll owe to the hospital, and not just the amount paid to the midwife/OB? $4500 for a midwife (prenatal + delivery) sounds fine, but my hospital bill would be separate, and would be in the $15k+ range.
    Oh yeah, I'm sure!  $2,200 is for the midwife to do prenatal care/delivery.  $2,300 is due to the hospital for a normal, vaginal delivery.  This is all provided we can pay before the delivery, which we can.  If anything happens, like a C section or if I ask for an epidural then we'll be billed the difference after the fact.  We're definitely gonna go this route.  I took DD and myself off DH's plan last time I had the opportunity.

    Derr misspoke.  I meant we went off DH's old policy and didn't elect coverage with this crappy one.  It's good coverage for him because he's a pilot and needs to be covered anytime, anywhere and this will do it, though it's only catastrophic coverage.  It's just lousy for family coverage because of the high premiums/deductibles.

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  • I am 100% OOP for this pregnancy because I am self-employed and have private insurance which does NOT cover maternity in Texas (and a lot of other states too).

    All told, I will pay about $14,000 for my twins which includes:

    $2500 - OB Package with c-section
    $2500 - MFM Package for AMA and multiples
    $1200 - Labs and other ultrasounds in OB office
    $500 - Anesthesiologist for epidural
    $7300 - Hospital package for a c-section, includes 4 nights and is all-inclusive. 

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  • Something still seems off, but I'll still throw out there that you will have other medical expenses besides just delivery.  Well baby checks are not cheap oop.

  • image wifeofaussie:

    image Cellis:
    How much are your monthly premiums? Is that for a year or just while you have been pregnant?

    Our monthly premiums would be $1500 a month for our currently family of 3.  $6k deductible and $7500 max OOP and the monthly premiums don't count towards this.  After all of that is met, they still only pay 80%.  It's a total ripoff.  We decided to only cover DH.   I dunno if that premium would go up with a pregnancy, I didn't bother to ask.  Thankfully, we weren't being covered yet, this is a new job for DH so we just opted not to have coverage for anyone but him.

    But that $1500/ month, and the deductible and max OOP, are not all for your delivery.  You need to subtract the amount you would be paying normally for your DH, and the amount you expect to pay for your DD.  And if your OOP costs are only $7500 for a C-section, then that would simply be your max OOP--and you shouldn't pay more  (The 6k deductible and 7.5k max oop should overlap, and even if they didn't, a C-section costs what it costs--not more than 7.5k.)

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  • In the end we decided to go with a birth center so we'll be paying a bit more but it's less likely to increase.  The numbers I was given for the hospital were for 12 hours of labor, 24 hours postpartum and an extra day if I have a C section.  They didn't include any extras like an epidural, circumcision for a boy, etc.

    For the birthing center, we're only out $5,500 for prenatal care, delivery and use of the facility, plus another $100-$500 for labs and the cost of our hypnobirth class if we decide to take one.  So still not terrible.  If we end up with a C section in that scenario, we'd be in some trouble with the bill but then we just make payments.  Not the end of the world.  I'd rather pay the hospital/doc for services rendered than pay my insurance company's crazy premiums and get stuck with a lot of bills anyway.

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