Insurance FYI

erkyoung

I just had a baby in April and found out about a little hiccup in our insurance I thought it would be good to share in case there are others of you who didn't know about this. When I got pregnant, I asked my insurance rep all about labor and delivery costs and what would be covered. After the delivery we got our bills and paid up to our deductible of $500 (a total of $16,000 without insurance...wow). Now, three months later we have gotten a bill for $5,000 with no insurance coverage. We noticed the patient's name was my son's whereas on the other bills it was mine. After doing some calling we found out that because we went on my husband's family insurance plan instead of mine (because his has much better benefits) after the birth, any bills under our son would restart the new deductible. Of course we knew the first office visits would fall under this, but what shocked us was from the very minute he was born, he was being billed separately than me at the hospital. So, when I had asked about labor and delivery costs the insurance people only told me about mine, not my son's. I had just assumed we were covered as one for those few days in the hospital. Some parts of the bill are super silly as well, like we are both charged $3,100 for room fees when we were in the same room!

I just wanted to get this out there so that when moms-to-be are talking to insurance people, make sure to ask about the baby's coverage from the moment they're born, especially if you're switching to a spouse's insurance.  

MamaOwl15

I thought well baby visits were 100% covered as per the ACA.

JaqiDec04

MamaOwl15 said:

I thought well baby visits were 100% covered as per the ACA.

There's lot of ways doctors are getting around ACA. And his birth and hospital stay is not considered a well baby appointment.

You may be able to fight some of your sons bills, but generally, yes, he's his own person, with his own deductible and out of pocket maximum to meet.

In some states and some health plans, he's considered a part of you for at least 30 days.

Insurance is a nightmare. Every bill I receive I have to fight for every penny.

Sweet Sadie Mae

Also watch when you sign the exit papers at the end of your hospital stay. I was so anxious to get out of there that I didn't read what I was signing and they charged me for a butt load of drugs that I never had! Shady shade-sters!

DeeGreer

Holy crap. Thank you for posting this!!

fletcherj1

Wow what an unexpected financial hit. This is extremely useful information.

rms924

Very helpful, thank you!

christina4436

JaqiDec04 said:

MamaOwl15 said:

I thought well baby visits were 100% covered as per the ACA.

There's lot of ways doctors are getting around ACA. And his birth and hospital stay is not considered a well baby appointment.

You may be able to fight some of your sons bills, but generally, yes, he's his own person, with his own deductible and out of pocket maximum to meet.

In some states and some health plans, he's considered a part of you for at least 30 days.

Insurance is a nightmare. Every bill I receive I have to fight for every penny.

Yea I had worried about this. It's not the $600 deductible I'm worried about but the out of pocket max being raised once we are considered a 'family' which I have heard is right when they are born. So I think even if I am to stay on my own insurance and add baby it will still go up and will be paying everything double for baby too. Ex 4000 out of pocket max now becomes 8000 plus the $600 additional deductible before that. :-/

JaqiDec04

christina4436 said:

I thought well baby visits were 100% covered as per the ACA.

There's lot of ways doctors are getting around ACA. And his birth and hospital stay is not considered a well baby appointment. You may be able to fight some of your sons bills, but generally, yes, he's his own person, with his own deductible and out of pocket maximum to meet. In some states and some health plans, he's considered a part of you for at least 30 days. Insurance is a nightmare. Every bill I receive I have to fight for every penny.

Yea I had worried about this. It's not the $600 deductible I'm worried about but the out of pocket max being raised once we are considered a 'family' which I have heard is right when they are born. So I think even if I am to stay on my own insurance and add baby it will still go up and will be paying everything double for baby too. Ex 4000 out of pocket max now becomes 8000 plus the $600 additional deductible before that. :-/

We are self employed, so our insurance and deductibles are ridiculous. I have a $2000 per person deductible with an out of pocket max of $6250. We expect to be out a LOT of money for this baby. It's tough.

Luckily, hospitals will take payment plans, usually.

JaqiDec04

OP - your $5000 bill, should be covered by your sons insurance, if you purchased insurance for him, which you have 30-60 days to do, post birth.

christina4436

@JaqiDec04 If I am understanding how it works correctly. OP will have to pay part of that $5000 ( the deductible which is $500 plus 20%+ of baby's bill depending on her plan, up to the out of pocket max for the now family/baby, which is usually double of just the mom's out of pocket max). So depending on what the total baby's bill was the $5k may be accurate that she has to pay.

My manager who had a csection said her bill after insurances was $15k. Now csections are a few thousand more but it probably makes sense on an average insurance plan having to pay $6-10k out of pocket. She said they did a payment plan if you don't have that to shell out all at once. I was only planning for $4k which is my out of pocket max, but then when I heard this whole 'baby bill' piece, was then thinking it will be more like $9k all said and done.

I wish an insurance company would sit down and explain in simple terms but I have a feeling it won't be this easy to hear this sort of info from them! Will have to make some calls for sure...

VallieS86

I haven't called at all but I asked a coworker what she ended up paying. She said she called, and they told her the bill would be 1500. When the bill came, it was 3000. She called and asked what the heck. 1500 per person. So I'm expecting to pay 3000. It's interesting that they don't tell you the whole amount when you call though. Jerks.

bgriest

I have a $300 deductible on my plan which I've already met with blood work and ultrasounds.

The baby will be going on my fiancé's insurance! I just read this to him so he's going to check and find out if he'll have a deductible when he switches to family plan when our son is born.

When I asked my insurance what my hospital bill will be they just told me I have to pay the hospital fee listed on my card which is $250.

Now I'm wondering if it'll somehow come to way more than this.

leighann1

@bgriest you might want to double check that hospital fee - mine said the same thing, but what they really meant was that it's a daily fee. I have a $500/day copay for hospital stays. I'm saving a minimum of $2000 in case of C-section, which will likely be a 3-4 day stay. 

I have an HMO, so I'm hoping I'll be able to avoid a lot of surprise charges, but I'm sure something will get thrown at me. Insurance is so frustrating. 

Bochella

Double check to see if the baby is covered under the mothers insurance for the first 30 days. We usually add a baby the first of the month following the date of birth as the baby is under Mom. Could just be our state but it doesn't hurt to ask.

mrsdhouse89

Hmm weird. I was told as long as baby isn't in the nicu then baby and mom are billed together. It must be different by hospital and insurance carrier. Our hospital gave us a breakdown of costs in writing so we know what to expect.

intheversa

OK something doesn't sound right here. Sorry but I'm worried that the hospital didn't bill your claims correctly. Up until 3 weeks ago I worked for a major health insurance company (I quit) and I went over newborn coverage with doctors all the time.  So I'm just curious about your plans coverage. Also sorry this is long.

If your husband works for a small group employer (under 100 employees) then it should have automatic coverage for your son for his first 30 days of life. If the company is over 100 employees then it is up to the employer for how the coverage works. Some employers make you add the baby before they will cover them, others will automatically cover the baby for the first 30 days or in my companies case the first 4 days of life. That's how they get around ACA. So if your son was never added or when he was added they didn't retro back his coverage to his DOB then I can see where they could bill you for no coverage. Do you know when his coverage date started or if you had the automatic first 30 days of life covered? 

Also MOST health plans follow the standard while the mother and newborn are inpatient for the standard 48/96 hour stay the newborn's charges should be covered under the mom's deductible. I have seen plans that put any newborn charges under the baby's own deductible and I suspect that yours worked the same way based on what you said:

erkyoung said:

After doing some calling we found out that because we went on my husband's family insurance plan instead of mine (because his has much better benefits) after the birth, any bills under our son would restart the new deductible. 

So assuming you asked all these questions then sadly you would owe the $5000, but when you're calling your insurance company about these benefits make sure you ask:

• Does the baby have auto coverage for the first 30 days? 
• What is my deadline to add the baby before I have to wait until open enrollment?
• Will my child's impatient charges be covered under my deductible during our standard 48/96 hour stay or do they have their own?
• Can we retro our coverage back to the child's DOB once they're added?

And don't afraid to call twice or check with your HR department as well. Sometimes reps will misquote you and believe it or not you won't always be protected if they tell you wrong. Hope this helps!

christina4436

Some insurance companies may have an online estimator or APP. United healthcare does and I plugged everything in on here and got a $15k appx bill but only having to pay about $2600 out of pocket since I paid about $1400 already for appts And my out of pocket max is $4000. On here it has the newborn care listed under all of my stuff, so I am going to call and confirm with them to make sure this is accurate. I've attached a screenshot, pretty neat all the detail you can get.

Either way- I don't get how people think they are only going to be paying $250/500 to have a child if you don't have some sort of government plan or assistance. From what I have heard that seems very rare. And the fee on card is just a copay due at time of visit, that doesn't mean you don't have to pay anything else... Totally depends on your coverage. For instance mine is 80/20 which I think is pretty standard, but I know my parents who work for NY state had 100% coverage at some point.

Everycol0r

Lurker here.. I use to be an insurance broker

The moment your child is born he/she will incur charges under whomever is the primary insurance carrier and will be subject to THEIR OWN DEDUCTIBLE. So if mom's deductible is $500 for an individual (and say $1000 for family), baby will now fall under his own deductible of $500 (which will total $1000 mom + baby family deductible).

Baby is automatically covered for 30 days on the primary's insurance policy and will DROP OFF if no contact is made with the insurance company. It happens automatically in most cases so be sure to submit official paperwork adding your child to your insurance plan to continue coverage past the 30 days. Some charges incurred in the hospital are NOT considered well baby and do not fall under preventative, so you will get a bill.

Just because he is on "moms plan" automatically does not in any way mean he falls under the deductible. A deductible is per person & once the baby is out, he's considered a person in the eyes of the insurance company.

The most important thing, again, is submit official paperwork within 30 days of date of birth so that you're baby will not loose coverage. I dealt with this a lot & it's a 50/50 shot if the insurance company will add the baby back outside that timeframe.


ETA: just want to add the a deductible is important but you really need to look at your out of pocket max. You'll receive bills regardless of meeting your deductible until you hit that max. Some folks are fortunate enough to have OOPMax amounts that are the same as their deductible so once they meet their ded they are done but that's not common.

intheversa

I'm only disagreeing with the 30 days auto coverage rule. If it's a 100 plus employer group they can do whatever they want. If they don't want to cover the baby for the first 30 days, they don't have to. I worked for United Healthcare and their employees only had the first 4 days covered for the baby. Some don't auto cover period. You have to ask what the company auto covers if at all.

JaqiDec04

I've learned enough firing with insurance to know, every single insurance plan is different. It depends on your insurance company, your state, your plan, your hospital, your doctor, and now it's billed to your insurance.

And for anyone who only has to pay $500 to have your baby, you are so extremely lucky. This child will cost us at least $10,000 and that's not even counting premiums.

lchan527

Also just want to point out that at least with my insurance, any charges in the last 3 months of the year usually go to the next year's deductible so even if you've hit your deductible for this year by now, it may reset when you have charges accruing in October.  

dchiapella

Such a helpful thread! Thank you so much ladies!!!!

eat111315

This is a great post. We got hit with about a $5k bill after my daughter was born (and we had decent insurance) We fought it tooth and nail to no avail. Things like "nursery charges" (she roomed in) that were $400 a night just made my blood boil. For our second, we stayed 24 hours and the bill was more reasonable but still pretty large.

One thing we learned the hard way was the epidural is super expensive- like almost equal to the cost of everything else. It got billed as a physician fee plus by the hospital because it was administered there. I'll get another one all the same but that bill was a whopper.

Everycol0r

lchan527 said:

Also just want to point out that at least with my insurance, any charges in the last 3 months of the year usually go to the next year's deductible so even if you've hit your deductible for this year by now, it may reset when you have charges accruing in October.  

This should only be the case of you have a policy year plan instead of calendar year plan.

Calendar policies run January 1st to December 31st.

Policy year plans are less common but run from whatever month the employer designated say, October 1st to the last day of September the next year and then resets October 1.

It should say on your SBC whether it's calendar year or policy, and if not you can call your insurance company and ask. Your HR should know as well.

If you have a calendar year policy, in no way would I allow them to apply end of the year charges to the next year deductible. I'd definitely fight that.

intheversa said:

I'm only disagreeing with the 30 days auto coverage rule. If it's a 100 plus employer group they can do whatever they want. If they don't want to cover the baby for the first 30 days, they don't have to. I worked for United Healthcare and their employees only had the first 4 days covered for the baby. Some don't auto cover period. You have to ask what the company auto covers if at all.

That just astounds me. I dealt with UHC frequently (as well as Aetna, BCBS & Humana) and not once did I ever come across them saying an employee only was allowed 4 days of coverage for their NB. I'm not saying you're wrong, but in the hundreds of dealings with them and other carriers I never came across this. I know that self funded groups can set a lot of parameters, but we didn't deal with many self-funded groups so that might be why I never came across that. We had groups with over 300 people and still had auto coverage for baby for 30 days. It's entirely possibly that it could also vary from state to state on what they require insurance companies to provide coverage for in regards to NB coverage. I'm in Texas so it could play a part.

The Newborn & Mother's Health Protection Act has a lot of good info if anyone is curious.

ETA: words

Rikki_5

Thanks for this thread.  It makes me realize that hospitals really are just about the $$.  It makes me want to have a home birth.

intheversa

@Everycol0r I agree with you, a lot of plans, even self funded allowed 30 days of coverage automatically. For UHC employees only if you have a baby, they are covered for the 4 for days of life and then they must be added or no coverage until open enrollment. That honestly may have been a new rule. Before I quit I double checked our newborn coverage and that's what the benefits stated. UHC never had the best insurance for their employees honestly. 

I also mostly worked with self-funded large group employers (like 10K +) and large hospital systems employee plans that had their own tiers and rules. I saw a lot of large group plans that didn't cover the newborn at all, you had to add them. It's terrible because that is the last thing on your mind when you're in the hospital. Fully Insured plans have that 30 days auto coverage and follow state mandates. Honestly I'd rather have a Fully Insured plan for the state mandates. Self Funded plans can do whatever they want, hence UHC's 4 days newborn coverage rule. 

I agree with you on the last quarter carryover (money accumulated towards the following years deductible Oct. - Dec) being only on policy years. I rarely saw it though, mainly because a lot of large group employers don't offer it. 

I'm actually about to call my insurance company to double check a few things, my husband's plan is also through UHC but I'm not as familar with it and I don't want any surprises.

nbpa3027

All insurances are so different that I agree it is best to call and get an explaination of the benefits you and your child will receive for both conventional delivery and csection.

The hospital where I had my first two always got preapproval in writing, so I knew a couple weeks before I had them what I would be owing. Be sure to get it in writing, just in case they try to change it on you.

Also, be sure and ask your hospital of they offer any discounts for paying early/before you leave the hospital. One hospital near us gives a 15% discount if you pay before you leave the hospital.

I also want to repeat what someone said about the epidural. We have excellent insurance coverage for our hospital network (paid just over $800 per kid) and if I had gotten an epidural it would have cost me almost $3000 more and that is after the insurance paid.

JaqiDec04

So I just got off the phone with Anthem Blue Cross (I'm in California). The baby is covered automatically the first 30 days on my crappy, high deductible Covered California purchased plan. He even gets to share my deductible. So my $15,000 delivery, just because a $6.250 delivery. Woohoo!

I highly recommend you girls call and speak to your insurance companies.