insurance coverage for NICU stay? — The Bump
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insurance coverage for NICU stay?

I have wonderful insurance in fact we had to pay minimal amounts for all of our IF treatments.  Just wondering what most will cover for NICU costs and additional unforseen costs? I have CareFirst if that matters. (BlueCross BlueShield PPO).

Thanks

 

 

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Re: insurance coverage for NICU stay?

  • I have BCBS and was extremely blessed to pay nothing at all for my babies NICU stays (25 and 32 days) - I didnt pay anything for my entire high risk pregnancy either (including a 4 week hospital bedrest stay). We are so very very lucky.

    I would call BCBS and ask what is covered under your plan. They were awesome when I called to just go over what was covered. Also: if you decide to FF, it is covered under prescription benefits on some plans if your doc will write a script for it (ours does, saves us TONS of money) - so ask about that as well. They also paid in full for my pump when I was pumping while in the NICU. Make sure you ask abotu everything, because some of this stuff they dont advertise that they cover.

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  • It all depends on  on when your babies come. Mine were 27 weekers, one with a heart conditions. All said and done we were billed 2 million dollars.  Some insurances make you just pay a in pt co-pay, som have deductibles. It really varies so widely.
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  • imagecaitdana:
    It all depends on  on when your babies come. Mine were 27 weekers, one with a heart conditions. All said and done we were billed 2 million dollars.  Some insurances make you just pay a in pt co-pay, som have deductibles. It really varies so widely.

     

    Are you responsible for the whole 2 million or is that the total and you are responsible for a portion?

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  • Just look at your out of pocket maximum amount on your insurance coverage.
  • I have BCBS and I had to pay $2500 for family deductible b/c they stayed in hospital for longer than normal well care for baby, if it had been take home babies it would have just been $1000 for me and they would be covered under my deductible, just call and ask them what is covered under your plan. Be sure to write down confirmation numbers and rep name incase they give you wrong info, you can dispute the bill if they misrepresent your coverage... I called 3 diff times and got the same info from diff people to make sure I knew what to expect. Btw they did give me the wrong info once and B/c I had it all recorded I only had to pay what they quoted me.
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  • The bills aren't done yet, but just one baby cost over $170k. I'm sure her sister wasn't much different. They were in for 43 days. We have been billed around $4k and we have BCBS of MN.
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  • imageMommyTeacher:

    imagecaitdana:
    It all depends on  on when your babies come. Mine were 27 weekers, one with a heart conditions. All said and done we were billed 2 million dollars.  Some insurances make you just pay a in pt co-pay, som have deductibles. It really varies so widely.

     

    Are you responsible for the whole 2 million or is that the total and you are responsible for a portion?

    Oh no. If the girls had been released prior to the end of the year it would have been just $100 copay per child.   Since they were released in Feb/March we switched insurance plans at work so we owed $3500/ child so $7k. But because they were so little they qualified for medicare and disability due to low birth weight so medicare picked up the 7k and  we owe nothing now.

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  • DD was in for 4 weeks.  I never totaled the bills but it was high.  We were very lucky to have great insurance so we paid nothing for the NICU itself.  DD came home on a heart rate monitor so we did have some expense with that and copays for the specialists.  We have Kaiser.
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  • I have not investigated the details, but the coverage sheet for my insurance says 100% for hospital stays, so I assume that covers NICU. I should look into it though to be prepared.
  • I have BCBS  too, and we had to pay copays for their hospital stays ($500/day up to three days per kid) and 10% of the doctor costs. But becuase of lower premiums, we put the boys on DH's BCBS HMO policy which has higher copays. I wish we'd put them on my policy just until the next open enrollment, because my copays for them would have only been $200/day/kid (up to three days). Ah well, hindsight is 20/20.

    I can't remember how much we ended up paying total, maybe $6000? Maybe less? $4500 for the hospital stays for them, for sure.

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  • Funny I just got off of the phone with my BCBS PPO of NYS. They told me that although the hospital I am delivering in doesnt have a NICU (I am debating on driving over an hour to a hosp that does) that if the babies are transfered to a NICU hosp no matter what hospital it is, it will be flagged as a medical emergency and be covered under my participating provider plan. I will be calling again in the future to confirm this. As for deducible/copays I am not sure if we are responsible for those. I had no out of pocket pays with my first daughter though (no NICU there though)
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  • kegkeg member

    Definitely call your insurer to verify what they will cover and what you will be responsible for.  My plan covered maternity stuff 100%, so all my OB and MFM appointments and my couple inpatient hospitalizations were completely covered.  However, NICU babies were considered medical stays and not maternity so we had to pay something like a deductible and then 15%. 

    Also, remember that if you have preferred providers and you are treated by a non-preferred provider that you don't have much control over (like a NICU doc, radiologist, etc), you can appeal.  We had a couple situations where we appealed and they were covered as preferred providers. 

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  • thank you for posting!!!

    I am calling my insurance company now!!

  • We had to cover our family Out of Pocket Maximum (4k for our plan), then everything was covered at 100%. Most of that came from my hospital bedrest and then the c-section, so I think we only paid around $600 for both girls' NICU stays as most of our 20% responsibility was taken care of with my bills.

    The upside to this and the fact that the girls were born in Feb is all of our medical bills after they were born were covered at 100% as we'd met our out of pocket max for the year. 

    We'd known we'd likely hit the max for last year, so we took advantage of my employer's flex spending account, so the 4k was taken out of my check over the course of the year and we just ran the associated card for the bills. Worked out very well for us, and it was nice not having to stress over it.

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  • We had excellent insurance when I gave birth (didn't cover any infertility, but pretty much covered the entire pg).  All we paid was my deductible for being in hospital ($500) and they covered the 3 of us's stay of 7 days ea!  I was amazed. 

    Sidenote - it even covered their circ 100%!

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  • With BCBS, we paid close to $12K out of pocket for our trio's birth and 67-day NICU stay. I believe our total billed to insurance was around $800K
  • imagecaitdana:
    imageMommyTeacher:

    imagecaitdana:
    It all depends on  on when your babies come. Mine were 27 weekers, one with a heart conditions. All said and done we were billed 2 million dollars.  Some insurances make you just pay a in pt co-pay, som have deductibles. It really varies so widely.

     

    Are you responsible for the whole 2 million or is that the total and you are responsible for a portion?

    Oh no. If the girls had been released prior to the end of the year it would have been just $100 copay per child.   Since they were released in Feb/March we switched insurance plans at work so we owed $3500/ child so $7k. But because they were so little they qualified for medicare and disability due to low birth weight so medicare picked up the 7k and  we owe nothing now.

    Do you know what the cutoff weight is for that?



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  • imagecaitdana:
    imageMommyTeacher:

    imagecaitdana:
    It all depends on  on when your babies come. Mine were 27 weekers, one with a heart conditions. All said and done we were billed 2 million dollars.  Some insurances make you just pay a in pt co-pay, som have deductibles. It really varies so widely.

     

    Are you responsible for the whole 2 million or is that the total and you are responsible for a portion?

    Oh no. If the girls had been released prior to the end of the year it would have been just $100 copay per child.   Since they were released in Feb/March we switched insurance plans at work so we owed $3500/ child so $7k. But because they were so little they qualified for medicare and disability due to low birth weight so medicare picked up the 7k and  we owe nothing now.

    Do you know what the cutoff weight is for that?



    image

    Spontaneous Di/Di twin boys born at 34 weeks on 02/21/2011
    Baby #3 due January 2016
    Lilypie Premature Baby tickers

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