Health Insurance — The Bump
September 2017 Moms

Health Insurance

mrsmarygsmrsmarygs member
500 Love Its 500 Comments First Anniversary Name Dropper
edited February 2017 in September 2017 Moms
I'm kind of playing off the Maternity Leave thread, but I'm wondering what your health insurance pays for and what it doesn't? What are your deductible and copays? Does your OB practice offer any payment plan or discounts? And for all you STM+, are there any costs you would want to give us FTM a heads up on?
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Re: Health Insurance

  • First baby I had PPO Insurance.  I had a $300 deductible, 15% coinsurance, and a $2550 OOP Max.  My doctors office at the time made me pay for the delivery up front, which amounted to $1200, so I paid that in installments over the course of 3 months per their policy.  The $1200 included the 'standard' doctors visits, standard labs, and assumed vaginal delivery.  Ultrasounds were not included in the $1200 so that was paid for by my 15% coinsurance every time I had an ultrasound, which was nearly every appointment. as well as any additional tests that were done, which was a couple extra urine tests due to protein found in my urine a couple times.  And then I had a csection, followed by another hospitalization (that was $90K if I didnt have insurance, whew!) due to complications from my csection, so the end result was I met my $2550 OOP Max easily and paid $0 for the rest of the year for any and all doctors appointments, procedures, etc..

    This time I have HMO.  I had a $25 co-pay my first visit and the rest of my 'standard' care is covered at 100%.  Any extra appointments outside of the 'standard appointments' will result in a $25 co-pay (or $35 if at a specialist).  When its time to have baby, it will be $150/hospital day for the first 4 days and then covered at 100%.  At least this is how I understand it.
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  • Not a darn thing because allied national sucks
  • This go round isn't too bad. Deductible is $5k. When we went in and talked with billing at my first appointment they had everything broken down for basic costs. We're expcecting to pay just over $3k for vaginal, non-epi birth. 

    I have a $40 copay for sonograms and insurance covers the rest for three over the course of my pregnancy. Otherwise, no co-pay. Blood work and everything else is covered in the cost we were quoted. 

    Epidural and anestegiolist (spelling?) were billed later and separately, I believe. And of course prolonged stay or NICU or c-section would be added costs to the original amount given. 

    Our hospital does a payment plan. We have to pay something every month even if it's not the recommended payment. They prefer to have it paid up before due date. 
    <><><><><>DD1- May 2011<><><><><>
    <><><><><>Angel Baby- June 2012<><><><><>
    <><><><><>DD2- March 2013<><><><><>
    <><><><><>DS1- ETA September 2017<><><><><>
  • I have Kaiser, and they estimate that I'll pay a $655 copay, either for a vaginal delivery with a 2-day hospital stay or for a c-section with a 4-day hospital stay. The pre-insurance amounts vary greatly ($16k for vaginal and $26k for c-section) but I guess that doesn't matter since I'm not paying for it.

    Of course, this is just an estimate, who knows what the cost will be when I actually deliver. 
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  • edited February 2017
    no deductible .. i pay $30 copay for the first prenatal appointment and the rest are covered at 100%, ultrasounds and bloodwork and the NT scan are all covered 100% and then $150 copay when i have the baby which includes a 48 hour stay for vaginal birth or 96 hours for csection.. so my total should be $180 with the primary care.. however I did see a RE for the first 11 weeks of my pregnancy and since that is a specialist that was $30 per visit 
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  • With DS, I had a $1300 deductible (DS went on DH's insurance immediately after birth, as I was losing my job a month later).  I think I had a 10% co-insurance?  That was a PPO.

    This time, bc I'm on a family plan, I have a $2600 deductible/ out of pocket limit.  I pay everything out of pocket at whatever discounted price the company gives me (eg- the u/s might be $300 and they will only cover $125. Once they reach an agreement on price with the OB's office, I pay the $125) up to $2600.  After that, everything is covered 100% by my insurance.  Considering a vaginal birth is upwards of $10k in my state, I'm happy with that.  This is an Open Access Plan (OAP), which is similar to a PPO.  

    I just spoke with the OB office, they require a deposit based on whatever your remaining deductible is, 2 months prior to birth.  They do offer payment plans for this, which I'll look into after a few things clear on my insurance (a recent visit to the ER, u/s, etc).  I've already got $900 worth of bills going towards my deductible, so at this rate there may not be a whole lot left in July.  They will reimburse if I pay more than I owe for the deposit, but considering how long it took for me to get all my bills post baby (over 3 months just for the birth), I'd rather not.

    Be prepared for costs that your insurance company may not cover fully.  DH's insurance would only cover half of the cost of circumcision for DS.  You can call ahead and find out from your insurance company.  Also, it's more just having some extra just in case you get a bill three months after birth, when you think all of them have been paid.  For whatever reason, it took forever for all our costs to be processed, even though it was just a three day period I was in the hospital.  

    Side note- If you are BFing/ EPing and plan on getting a pump, look into *when* your plan will send it.  My last insurance company would only send it after the baby was born.  I had a list of companies from my insurance that were suppliers I could get the pump from. I contacted the ones that had the pump I wanted, and asked how long shipping would take.  I chose the one who did overnight delivery.  You can get the 'Rx' for the pump and all the paperwork taken care of ahead of time with most of the companies, so all you have to do is contact them when the baby is born.  *Some insurance companies will allow you to get the pump much earlier, but if you're going to need it at home, this is important.  You can also do rentals with the hospital most of the time as well.
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  • JNR6510JNR6510 member
    500 Love Its 500 Comments Second Anniversary Name Dropper
    edited February 2017
    I have fairly good insurance through my job. I have an annual OOP max of $2500. It's a $15 copay for each visit and am expected to pay 10% up to the $2500. After that the rest of my healthcare for the year is free. Our OB/MFM's office bills separately from the hospital. For the OB, they estimate $5000 for normal vaginal delivery with no complications and only 1 US (20weeks) included. C-section was $7000 for uncomplicated with the same single US included. All other labs, US, testing, hospital costs are not included. I fully expect to be paying the full $2500 at the time of birth. Thankfully $1500 of that is already set aside so we have been saving a little bit each paycheck for the last $1000. The hospital won't bill except for the co-pays and for items not included in the general delivery package until post-partum.

    ETA: autocorrect does strange things...
  • My insurance sucks and I'm not sure about anything other than the copay which is $50 a visit.
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  • So for my daughter, 4 1/2 years ago on a different insurance, we paid a lot because I had a high deductible. We had to pay around $1500 to my OB which we could pay monthly. Then the delivery cost around $3600, which we were able to pay monthly for 3 years. We also paid some things before hand too separately, not sure of the amount. I just remember constantly handing out my card and getting bills in the mail, it was so stressful. Now with this PG, I have pretty good insuarance. No deductible and copays are on the lower end. I haven't called to find out the amount yet but going off my enrollment packet, it's $500 per day for inpatient stays. I have a decent Aflac policy that will cover all of the out of pocket costs and then some, so it's a stress that we won't have to deal with this time around, thank god. 
  • As a Canadian, this is such a strange thread to read! With both DS and my loss the only thing I paid for was my prenatal vitamins. I think my benefits through work paid $200 to upgrade me to a semi-private room after DS' birth.

    I'm not very familiar with the American system, but if you have no insurance through work are you just on the hook for tens of thousands? 
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  • We have a $10 copay per visit that counts towards our deductible, which I can't remember the exact amount of, but it's low. My insurance covers up to 15 ultrasounds, and all bloodwork, as well as a limited portion of most genetic testing. (But our state also provides some free and discounted genetic testing.) I am blanking terribly on all the details, but when we had a consult with them about this pregnancy, our total cost (not including the $10 copays) is going to end up being around $500 if we have a normal vaginal birth and hospital stay, $800 for a c-section and longer stay. 
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  • As a Canadian, this is such a strange thread to read! With both DS and my loss the only thing I paid for was my prenatal vitamins. I think my benefits through work paid $200 to upgrade me to a semi-private room after DS' birth.

    I'm not very familiar with the American system, but if you have no insurance through work are you just on the hook for tens of thousands? 
    You have to buy private insurance or if you're close to the poverty level you get enrolled in Medicaid and don't pay any medical bills. 
  • As a Canadian, this is such a strange thread to read! With both DS and my loss the only thing I paid for was my prenatal vitamins. I think my benefits through work paid $200 to upgrade me to a semi-private room after DS' birth.

    I'm not very familiar with the American system, but if you have no insurance through work are you just on the hook for tens of thousands? 
    You have to buy private insurance or if you're close to the poverty level you get enrolled in Medicaid and don't pay any medical bills. 
    There's also the HSA option that a lot of people transitioned to after Obamacare pushed up premiums and deductibles. Basically instead of paying a premium every month to an insurance company, it goes into a health savings account that you can only use for healthcare. There are tax benefits and stuff that goes along with it.
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  • @mrsmgee that's a viable option only if you make good wages. Poor or lower middle class simply don't make enough to put away into an HSA to cover maternity medical costs. 
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  • @Becky012016 That's true, I was just adding to your answer for @MyNamesTaken question. My dad went this way when his deductible became unreasonably high. 
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  • @mrsmgee I completely forgot those existed for private individuals lol It does worry me though that the Rebuplicans want to replace the ACA with HSAs since those really only help the better off type of people. 
  • I'm not trying to get into a political argument, but I wonder if the ACA does get removed, if healthcare will become more competitive again, causing rates to drop.
    DH was self employed last year and when he turned 26, we looked at options for him. He couldn't get any subsidies because he made over 25k. In our case HSA was not an option because we didn't make enough and we actually thought about betting that he wouldn't get sick and paying the penalty. He ended up on my insurance, but I can't help wonder that if the Affordable Care Act hadn't been in place, if we might have been able to find something on the market.
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  • I think the plan was to have the ACA fail enough to push us into a single payer system like Canada, UK, most of Europe. If we could regulate the insurance companies and pharmaceutical companies that would drop the costs of insurance too. It's crazy how much those CEOs make per day but then bitch about how much it costs to insure their customers. The cost of medical care is rediculous here, for sure. 
    CarebellajessieR358BookitBoo
  • Interesting! Thanks for the insight!
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  • I have a $25 copay for the first visit, and a $750 deductible. I have yet to say whether this is decent insurance, as I have a feeling there's more to it. 

  • I have a 550 deductible, 1400 oop maximum. It's a $50 copay per obgyn visit. I'm not sure how much the hospital will cost but I plan on going up there soon so that they can give me the breakdown of costs. I want to prepay for the birth that way I don't have any financial stressors after the delivery. 
  • I have a $35 copay for the first OB visit then nothing until delivery. It's $1000 deductible then 10% coinsurance until I reach my $2000 max OOP. I'm fully expecting to pay $2000 come September. It could be worse though :/
  • Correct, no insurance = lots of debt. I had my appendix removed in a very routine surgery last year (no complications or anything) and if I didn't have insurance, I would've owed $30,000 or so. Canadians are lucky to have the system you have! I'm jealous! 
    JNR6510
  • @noelgawrysiak Yikes that's crazy!

    I remember someone on the loss boards talking about having to choose between the procedure she wanted (D&C) vs a much cheaper in office procedure that would have been more emotionally challenging. Making a health decision based on finances instead of what's best for the patient is heartbreaking.

    Our system is definitely not perfect but I'm so grateful for it. I know paying higher taxes is not a popular idea in much of the US but I love my healthcare, Employment Insurance, and Canada Pension! 
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  • PPO here. With DD I paid around $1k for ob, $700 for vaginal delivery and 48 hr hospital stay, $150 for epidural, and $200 for in hospital pediatrician. Total was just over $2k.
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  • I am so thankful for good insurance.  My co-pays are a little higher at $40, but I don't have a deductible and my maternity standard care is covered at 100% I believe.  With my first, my hospital "bill" or EOB was $65,000 (I had some major complications and a 10 day stay) and we paid $175.
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  • I am sooo jealous of everyones insurance and/or better healthcare system. My husband gets insurance through work and our individual deductible is $3000 and NOTHING is f'ing covered prior to that, after is 80/20. Prenatal and vaginal delivery is $3400 and I don't have to pay on it until I give birth. Ultrasounds and bloodwork I have to pay when I get the bill. We make too much to qualify for payment assistance, but can only afford to put $50 a month in our HSA. We'll use our savings to pay on the debt until I go back to work. 
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  • I just got this information from my dr today. I have to have the portion to my OBGYN paid in full by my 24th week which is $2057. My uktrasounds have a $20 copay. My out of pocket maximum is $4500 so I'm sure the hospital portion will be the additional $2500. :-( I just wish I had more than 10 weeks to pay off that 2 grand. It sure has me stressing. 
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  • ITs so strange to me that some of you have to pony up before having services rendered. Last I checked, I didn't have to pay my water or electric bills until after I already used those services. Nor do I remember having to pay DS's ER bill until after we were discharged. 
    mandt0917SuperKristy85
  • @Becky012016 I don't get it either, and I'm not happy about it.  For DS, I went to a major hospital in Baltimore for prenatal care and the birth- we didn't owe anything until after treatment (u/s) or actually giving birth.  Now we're in this tiny "city" and it seems like its very common here.  Are people here less likely to pay their bills then in Baltimore city?  I have no idea, but it seems like you would expect the opposite.
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  • We're paying $650 a month until like august I think. It sucks.
  • atthemomentatthemoment member
    250 Love Its 100 Comments Second Anniversary Name Dropper
    edited March 2017
    I cant believe drs make u pay upfront! Wtf. I never heard of that before but Ive been seeing the same OB practice for 8 years now. Im really fortunate with my insurance. Our deductible is $300. Everything covered 100% after that as long as its in network. No copays for prenatal checkups. $275 maternity inpatient hospital copay. Only complaint is that they just changed from a calender year to a plan year and my deductible renews is july so we will end up paying the $300 again. With ds he was jaundice and his care wasnt "routine" so he got his own hospital copay and deductible billed to us. I think overall my last pg cost like $ 1200 in medical bills.
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  • Now, I don't have any Medicare supplement plan so I have no idea about this. But I seriously feel the need of enrolling in a healthcare plan. I think I need to enroll in the Mutual of Omaha supplement. Having a plan will keep me insured. I will check the details about it and will get myself insured.
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