Double Deductible Discussion

catnipskma

Anybody else researching this dilemma right now? All suggestions and advice are welcome. I'm trying to educate myself as much as I can, to see if there is anything I can do to not have to pay two deductibles come baby time.
I know about "global billing" but I have read that the ins companies still go by "date of service" regardless of when they are billed.

Anybody have experience with BCBS with this type of situation?

I know I'm just wishful dreaming,
but I'm hoping there is a way I can't think of right now to alleviate having to pay twice, since my plan starts new every Jan. 1st. And I'm due 1/14.

From what I am reading, my ins company won't roll over my prenatal OB/GYN costs into the new year . I'm curious to the benefits of possibly switching plans at open enrollment time? Oct/Nov I think... Or is that just going to equal out in the end anyways? We currently have a high deductible to meet, and co insurance after that..

Please note, for those that think I'm publicly whining, I understand having a baby is expensive and we are thrilled regardless of what we will end up paying in the end as there are so many unknowns at this point... I'm just looking for possible solutions I haven't thought of or heard yet . Thanks in advance ladies!

vvitchhazel

I can't answer your question, but I can sympathize with insurance woes. I switched jobs right before getting my BFP and now I'm having so many issues trying to square away my insurance. The worst part is that no one will so much as book me for an appointment because of it, so I've been hitting up the free clinic. So stressful!

WLJ2

Not sure if I can really help with that your asking. But i thought I'd share what happened when I had my first son who was born January 3rd. My ob did not bill for any prenatal charges until u had my son. So, my delivery ate my entire deductible and I owed nothing to my ob. I actually got money back from th because they had over billed me for what they thought I was going to owe.

kmcc14

We are expecting to have to meet our deductible twice.  Even if everything is still billed at the end, I think they still have to retro bill each item to your insurance by date of service.  From an insurance perspective, January is definitely not an ideal month to have a baby, unless you happen to have a plan that resets mid-year.  The only way that you could really help yourself during open enrollment would be to opt into a lower deductible plan, if that is financially feasible for you.

Mommyduclos

I had BCBS with my first and only had to pay the deductible for delivery, I paid a single copay for ALL prenatal care, but I'm sure every plan is different so you may just want to call your agent and see if they can help you.

suziq1978

Dirty Lurker Here - but I work in Benefits so I can answer your question.

There really is no way around this.  You are going to have to meet your deductible for the current plan year, and then you will have to meet it again for the next plan year.  You also need to keep in mind, that you will have to meet the deductible for your child as well (if you add him/her onto your insurance).  So, if your plan is a $1000 deductible individual and $3000 deductible family, you will pay at least $2000 at the birth for deductibles plus any co-insurance.

Switching plans might be a viable option if the plan you are switching to has lower deductibles and co-insurance or is a co-pay plan.  That will save you money in January, but not right now.  Also, you will want to make sure that your providers are in network under the new plan as well.

A really good option would be to enroll in your company's flexible spending account for your new plan year.  You can enroll for a total of $2550 for the plan year, and they will divide this by the number of pay periods available for the year and deduct that amount from your paycheck.  You will have access to these funds prior to actually paying them into the account, so you could cover deductibles (depending on what they are) when you have the baby.  Some flex plans have debit cards that are pre-loaded and some you have to pay and then submit a claim for reimbursement.  If it were me, I would definitely check to see what is offered regarding flex at the company.

Hope this helps!

kmcc14

Mommyduclos said:

I had BCBS with my first and only had to pay the deductible for delivery, I paid a single copay for ALL prenatal care, but I'm sure every plan is different so you may just want to call your agent and see if they can help you.

Yeah this is something that will vary by plan.  Some plans don't cover anything until your deductible is met.  Others will give you a co-pay for visits, but then anything else will go against your deductible.  My plan covers a physical and a gyno visit at 100% with no co-pay, but everything else goes against my deductible.  Once my deductible is met, my co-insurance kicks in.  Because of this, I carry a low-deductible plan.

catnipskma

Thank you very much for everybody's input! I greatly appreciate it!!

My last pregnancy, I worked and had group insurance with a flexible spending account for medical and you bet I took advantage of that!

This time, I'm a SAHM, and hubby's work does not carry insurance, so... Individual plan for us, $6000 ded with 20% co-insurance per person on plan... I think $12350 max OOP.

Ahhhh well it was worth the question, even if the answer is no way around it. I think we may opt into a lower ded plan come October, then use the baby as a qualifying event and change plans again possibly...

Thanks again everybody for your input!!

enkb

Glad to see this discussion, I've been wondering the same thing but haven't quite gotten up the nerve to look closely at our insurance to find out the answer yet.  Since I'm using a midwife, I'm prepared for our insurance to not cover anything, and her fees are low enough that if all goes to plan it will be fine, but if we end up high risk it could be a big deal I know. 

I never think trying to be financially responsible for your family should be looked at as a negative thing, good for you for thinking about it early! Avoiding as much stress as possible can only be a good thing!

Blueyedsky

Same exact situation for me. Thankfully my deductible is my total out of pocket max. I do have a question for the lovely benefits lady @suziq1978 so for a birth they bill mom and baby as two separate people? And you have to meet deductible for both?? That is news to me if I'm understanding it correctly

kmcc14

I was under the impression that the baby is billed under the mom's benefits for the first month.

catnipskma

kmcconnell22 said:

I was under the impression that the baby is billed under the mom's benefits for the first month.

This is a great question I didn't think to ask or pay attention to before. But I am calling my ins today, and this thread has given me GREAT questions to ask of them!!

suziq1978

@Blueyedsky - Yes, following the birth baby is considered a separate covered individual from mom.  Mom's deductible will cover all care for baby while in utero, but once outside of the womb baby has a separate deductible and co-insurances.

This is definitely something to keep in mind if you have a high deductible health plan as you will have to pay a deductible and co-insurance for mom's hospital stay and a deductible and co-insurance for baby's hospital stay.

@catnipskma - is your $6000 deductible the individual deductible or the family deductible?  This can make a huge difference in what you are going to have to pay out of pocket.  If your plan has a $6000 individual deductible and a $12350 max oop per person you are looking at paying a bunch when the baby is born.  That would be a minimum of $12000 plus the 20% co-insurance after you meet the deductibles.  If your plan is a $6000 family deductible with a family max oop of $12350 then you won't be paying as much oop but still a lot.  Also, you'll definitely want to make sure that birth is a qualifying event to change plans and/or carriers.  Under most state and federal guidelines, birth only allows you to add the baby to your coverage not make any other changes.  If you are looking at switching to a lower deductible plan I would do it during open enrollment so that you at least have less to pay in January.

@kmcconnell22 - I think what you are referring to is the time frame that you generally have to add the baby to coverage.  Most insurance plans will cover baby without receiving official enrollment documentation for the first 30 days.  If the baby has not been officially enrolled within that time frame then any bills paid for baby would be rescinded and healthcare providers would be required to pay the insurance carrier back and then they would bill mom.

I hope I've been able to answer some questions.  Good luck to all of you!

catnipskma

@suziq1978 So informative!!! Thank you! Yes my plan is 6k ded for each individual and will be very pricey so I'm def going to switch, and I will confirm that the qualifying event will allow for family changes, not just baby addition . Thank you so much!!!