SMR: Insurance question - PG running through 2 years

Temp6313048411121614

So our insurance term runs from 1/1 - 12/31.  I don't know if all insurance coverages run the same way, but assuming they do...if you get KU 1 year but deliver the following, do you have to pay 2 years of deductibles, or do all of your bills hit 1 years deductible?  We have a HIGH deductible ($5k) because the savings was worth it monthly than the "lower" ($3k) deductible.  Just curious how this works for most (I may call my insurance carrier to ask at some point, but don't have time right now and it's always such a PITA to call them).

OrangeSmoke

One year.

Because technically - your delivery happens on a specific date.  That's the event you are paying for... not the whole pregnancy.

Are you KU?!?!

Temp6313048411121614

OrangeSmoke:

One year.

Because technically - your delivery happens on a specific date.  That's the event you are paying for... not the whole pregnancy.

Are you KU?!?!

No, not KU, just wondering for future reference.  I didn't know how the billing worked for all of the dr. appts and such.

AlishaMay

With my insurance, only my out of pocket expenses (copays) count toward my deductible.  My visits were billed to my insurance based on the date of service, and I had no out of pocket expenses for those, so they didn't count toward my deductible.  The only out of pocket expenses I had were related to the delivery and after care.

Temp6313048411121614

Awesome, good to know. 

OrangeSmoke

Aussie*s_Mom:

OrangeSmoke:

One year.

Because technically - your delivery happens on a specific date.  That's the event you are paying for... not the whole pregnancy.

Are you KU?!?!

No, not KU, just wondering for future reference.  I didn't know how the billing worked for all of the dr. appts and such.

I actually thought about it more as I ran out to get lunch.  So it might be two years depending on what your insurance is like.  The deductible would be whatever the date the service is performed.  So if you have co-pays or other charges for your prenatal visits, then that would go into year 1.

So it's actually pretty simple, whatever the date the service was performed on, that's the deductible it goes against.

jsw555

Two years - it doesn't matter if a single condition spans both years. However, you would be unlikely to hit the full $5K in copays within the first 6 months of pregnancy.

twinsmom23

Two years.  

Temp6313048411121614

Alright, well that stinks.  I  didn't even hit my full $3k with the twins (all in 2009) but with all of the "what if's" it'd be nice to know that it wouldn't go over $5k instead of the maximum being $10k.  We all know how there can be so many complications with a pg and especially a multiples pg.

Sharra711

Aussie*s_Mom:

Alright, well that stinks.  I  didn't even hit my full $3k with the twins (all in 2009) but with all of the "what if's" it'd be nice to know that it wouldn't go over $5k instead of the maximum being $10k.  We all know how there can be so many complications with a pg and especially a multiples pg.

YUP! They go by the 'date of service' and once the 'new year' begins you start allllllll over : (

klr210

We also have a high deductible plan and it actually affected when we started ttc. (yes I know that is risky since you never know). At any rate, I knew that medical bills are sent to insurance at date of service and didn't want to have to deal with the deductibles and max out of pocket for 2 plan years since it is EXPENSIVE! I was thrilled when I called my OB though and their billing person patiently explained their procedures to me. They basically bill the intake and 1st prenatal visit (which included labs) then don't bill insurance again until delivery, which means the largest majority of the bills will fall within one plan year. This helped our plan for when to start ttc. Of course, what we didn't count on was a surprise u/s expense at 9 weeks, finding twins and then the news of an u/s every 4 weeks which would be billed at date of service. Anyways, between talking to insurance and the billing dept. I was able to get a clear picture of how and what we would pay. Like I said, it helped us decide when to start ttc and also allowed us to prepare financially for setting pre-tax $$$ aside to cover the expense with our HSA (assuming you have an HSA or FSA account you can contribute to). We also have a payment plan with our OB/GYN office where I pay out of HSA during my visit so a good portion of my deductible will be paid ahead of time.