It's been a looooooong day. DH had a bad day at work with a patient, so he's very glum and down on himself, and I'm exhausted from orientation stuff at my library. Ordering Malaysian food and watching Netflix, and hoping for a better day tomorrow.
Not sure where to put this so here goes. TTMA U.S. pregnancy care and insurance please.
I already pay out the ass for premiums. My insurance is hardly covering anything related to my pregnancy (it's going towards my deductible but it's still only 70/30 even when that is reached). When I asked insurance they said it was because the providers coded it as "non-preventative and/or non-routine." So when I asked my providers about it they said it was coded "with pregnancy diagnosis, which is customary."
So am I just screwed and will have to pay everything until my deductible is met? One round of standard prenatal labs cost me $100 (after insurance), plus $150 for dating US, plus $50 "specialist" copay for first visit. I'm dreading getting EOBs for the additional urine culture and subsequent visits. The anatomy scan will be astronomical I'm sure. I really don't remember it costing quite this much with DD and I've had the same plan through my employer since before that.
@notthecheat I'm in a similar boat. I paid over $350 for my dating US. Nothing is really covered, and even after deductible is met I'll pay 30% until it caps at $7500. I'll meet my deductible for sure soon, BUT because it resets 1.1.19 I'll be back to building up my deductible again before birth. I'm going to meet with an insurance consultant to see if it'll make more sense to switch to H's insurance (his open enrollment is coming up in November), but we probably won't because even though H's insurance is great for him, adding a spouse (and later, child) is roughly $400 extra per month. So in the long run it probably won't be worth it. This is AWESOME while trying to save up for taking six months off work!
DS born 2/18/2019 DD born 4/1/2023 Baby #3 EDD 11/21/2024
@notthecheat my insurance does lump sum pregnancy service billing AFTER the baby is born, so none of this is even going towards my yearly OOP (deductible is already met anyway). My insurance covers 90/10 and our deductible is 500 individual/1500 family, so the plan is really good all things considered. Some lab work and ultrasound imaging is not included/covered though on a lot of plans. We also pay almost $700/m in premiums. Everybody is on my insurance through the hospital.
@notthecheat I pay the same as you, but for myself only. Nothing is covered at all with my insurance it seems, pregnancy related or not. At least they don't discriminate, they treat everyone equally shitty! I just have terrible insurance, but it's the only one I can have (unless I want to pay $400 extra premium, which is a hard no).
Edit: I pay $115 a month, not per week. For that much money every week, you should be getting something better! Jeez.
DS born 2/18/2019 DD born 4/1/2023 Baby #3 EDD 11/21/2024
Thank you @grebretso I'm a RN, you would think the healthcare field would at least give their employees reasonable plans! But our company relies on reimbursement from Medicaid, which gets stingier every year, which I would imagine is probably related to less and less government funding for Medicaid...
Sigh. I'm sorry your position isn't really much better but I really appreciate the feedback. And obviously the things that are covered for me I still have to pay for, just not as much.
@jessier19 Fuck Penn State. That's ridiculous! I'm sorry you're dealing with that. Because everything else a pregnant woman has to deal with is not enough.
@notthecheat, we’re in a similar situation. We’re paying $950 per month and paying like crazy for labs and appts. It’s insane. I’m sorry you’re dealing with it, too!
You guys my MIL is....crazy. She found out we were having a boy nd we upset because she wanted a girl and then literally said to me “at least you won’t have to worry about a boy being raped as much”. Who in there fucking right mind says that!! It took every ounce of self control not to flip out and just walk away. im so mad I’m shaking!
Parking update: my boss is very much on my side in this, and now we've bumped things up a level and he and my boss's boss are both advocating hard for me. The two-mile walk to the commuter lot was the "solution" the administration proposed for all three of us in my department who applied for parking passes this year. But of course, the other two people aren't pregnant. My boss and his boss are now telling the administration that in my particular case they consider it an ADA compliance issue because it's not reasonable to make a pregnant woman walk that far. So, hopefully with their help this can get fixed? If nothing else, I'm really grateful to know that they're working hard on this for me.
@jessier19 that is great you have such support from your boss! Hopefully things get worked out soon.
I’m sorry for all the insurance headaches everyone had to go through. Healthcare is pathetic in this country and there is really no excuse for it.
We pay about $800 a month for premiums and have a $1500 deductible per person, $5000 per family and are charged $1500 for each ER visit. It’s insane especially compared to my previous work’s plan.
In regards to pregnancy care and delivery my dr’s office called and worked everything out with my insurance re: coverage and I have a lump sum I’m paying monthly towards. So @notthecheat I would push back on your doctor’s offfice to contact your insurance company to straighten this out as it sounds like a coding error.
@allthingsgo $1500 for ER??!! That's insane! And with those premiums, the deductibles should be much lower. I'm so sorry.
I talked to my provider and I pretty much got the *shrug* "healthcare sucks in this country" response. I'm terrible with negotiating -or peopleing in general- and I'm switching practices anyways so I'm just leaving it at that. If I push back anymore I'm gonna lose it. I've already spent countless hours on the phone pulling my hair and crying with all types of insurance reps.
ETA I specifically told my provider about the coding issues and insurance refusing to pay and she seemed pretty adamant that this is how they code and that is that, what insurance does with it is up to them. Paying for the appointments is treated as a lump sum (which is complicated in my case having to switch practices in between) but anything else like diagnostics is thrown to the wind.
@allthingsgo Girl, I hear ya! Our $950 a month gets us a $3k deductible per family member. I can’t remember what the out of pocket max is, but it’s astronomical, too. I already feel suffocated by medical bills and we haven’t even gotten that far in with the pregnancy bills. I seriously hate living in this country right now.
I am in need of advice. We are trying to plan DD's birthday party in a few weeks (September 14), which is complicated because I want my sister to come, but she has two trips in September. It either would have to be the week before, or at the end of September. My husband and I can't agree, so we were thinking of just throwing it on her birthday, which is on a Friday. It will probably be games/food/cake in our backyard, nothing fancy.
Any thoughts on toddler birthday parties on a Friday evening? Most of her daycare friends usually get picked up just after 5, so we were thinking of having it at 5:30. Am I the only one that thinks that is weird? Or is it reasonable?
@conchispita I don’t think Friday is weird necessarily, but I think right after daycare pick up is cutting it a little close. Could you do it slightly later so parents can pick up, go home to take care of whatever and head back out?
Re: Weekly Randoms (8/20-8/27)
DD born 4/1/2023
Baby #3 EDD 11/21/2024
I already pay out the ass for premiums. My insurance is hardly covering anything related to my pregnancy (it's going towards my deductible but it's still only 70/30 even when that is reached). When I asked insurance they said it was because the providers coded it as "non-preventative and/or non-routine." So when I asked my providers about it they said it was coded "with pregnancy diagnosis, which is customary."
So am I just screwed and will have to pay everything until my deductible is met? One round of standard prenatal labs cost me $100 (after insurance), plus $150 for dating US, plus $50 "specialist" copay for first visit. I'm dreading getting EOBs for the additional urine culture and subsequent visits. The anatomy scan will be astronomical I'm sure. I really don't remember it costing quite this much with DD and I've had the same plan through my employer since before that.
DD born 4/1/2023
Baby #3 EDD 11/21/2024
Is your stuff "magically" not being covered at all if it's related to pregnancy? (And instead going to deductible)
Edit: I pay $115 a month, not per week. For that much money every week, you should be getting something better! Jeez.
DD born 4/1/2023
Baby #3 EDD 11/21/2024
Sigh. I'm sorry your position isn't really much better but I really appreciate the feedback. And obviously the things that are covered for me I still have to pay for, just not as much.
I’m sorry for all the insurance headaches everyone had to go through. Healthcare is pathetic in this country and there is really no excuse for it.
We pay about $800 a month for premiums and have a $1500 deductible per person, $5000 per family and are charged $1500 for each ER visit. It’s insane especially compared to my previous work’s plan.
In regards to pregnancy care and delivery my dr’s office called and worked everything out with my insurance re: coverage and I have a lump sum I’m paying monthly towards. So @notthecheat I would push back on your doctor’s offfice to contact your insurance company to straighten this out as it sounds like a coding error.
I talked to my provider and I pretty much got the *shrug* "healthcare sucks in this country" response. I'm terrible with negotiating -or peopleing in general- and I'm switching practices anyways so I'm just leaving it at that. If I push back anymore I'm gonna lose it. I've already spent countless hours on the phone pulling my hair and crying with all types of insurance reps.
ETA I specifically told my provider about the coding issues and insurance refusing to pay and she seemed pretty adamant that this is how they code and that is that, what insurance does with it is up to them. Paying for the appointments is treated as a lump sum (which is complicated in my case having to switch practices in between) but anything else like diagnostics is thrown to the wind.
DD born 4/1/2023
Baby #3 EDD 11/21/2024
Any thoughts on toddler birthday parties on a Friday evening? Most of her daycare friends usually get picked up just after 5, so we were thinking of having it at 5:30. Am I the only one that thinks that is weird? Or is it reasonable?