Anyone understand insurance?

Soph13F

I was just looking over my insurance info, and was trying to figure out what the costs might be associated with delivery.  My coverage is 90/10 and deductibles are $250 - Individual and $750 - Family.  I am currently the only one covered, but once LO is born he'll be under my insurance also.  My out of pocket maximums are $2,000 individual and $6,000 family.  I'm so confused about insurance to begin with.  After the baby is born I know I'll have to pay my deductible and then insurance will kick in and pay 90%  Right?!?  Would I pay the individual or family deductible?  I've never had to use insurance for anything other than regular doctor visits w/co-pays.  So I'm just trying to understand and get an idea of what I'll be looking at paying after delivery. 

jf198400

It depends on how much your hospital bill total comes to, but I think the most you will be paying is $4000 total- that's $2000 max on yourself, and $2000 max on LO.  You can contact your insurance company ahead of time to have them explain it to you.  Also if you pre-register with the hospital, they will probably give you an estimate of how much you will owe.

greengirl0909

First you pay your deductible. That's all you, so it looks like $250.  Then the 90/10 jumps in.  They split the bills that come in for that up to $2000. So I would say your max out of pocket for you is $2250.  LO will be covered under you for a little bit. Unless you have extended NICU stays or other complications you shouldn't see a bill for LO.  (although I don't know about circumcision, because we didn't have one, so that might be a charge you'd see if you were to have a boy)

ssimon621

Your $750 family deductible means that you would pay a $250 deductible for each family member up to three people $250x3 and the same goes with your Out of Pocket Maximum.  Therefore, up until the baby is born you will pay your $250 deductible and up to $2,000 out of pocket, which usually does not include your deductible (it depends on your insurance policy) 

 Once the baby is born you will have a $250 deductible for each of you and $4,000 Out of Pocket Maximum.  Also, remember the money you pay in co-pays at doctor's visits does not add to your Out of Pocket Maximum total, only the money that you spend on the 90/10 split.

 Hope this helps!!

marissabarone

I am the benefits administrator for my organization. Once your $250 deductible is met, your insurance will pick up 90% of all costs. You will be responsible for that remaining 10% up to $2,000. On my company's insurance plan, newborns are covered under the mother for the first 30 days, so I do not think you will have to pay the family deductible or out of pocket maximums until after the baby is 30 days old. You may want to check with the insurance company. If you call the general customer service number on the back of your card, a rep will answer any questions you have. I hope this helps.

bingham101

You should check with your insurance provider about whether LO will be covered under you or have their own deductible. It could go either way. Sounds like you have some pretty good insurance though I have a 2500 deductible .

Moneypenny424

I would also contact your insurer and/or read your Schedule of Benefits.  It will break down what is covered, etc.  Certain things may be covered in full and not counted toward your deductible, but your deductible is low, so 90/10 should kick in once you've met it, as PPs have said.

l_elizabeth

Call your insurance provider-- they can provide you with an estimated out of pocket amount. My guess is you'll end up paying around $2250, but it's hard to say. When I had my DS, I got two bills-- one for me and one for him.

Soph13F

Thanks for all the good information!  I'll definitely call the insurance company.  It'll help now that I have better understanding.  Thanks again.

christinak22

marissabarone:

I am the benefits administrator for my organization. Once your $250 deductible is met, your insurance will pick up 90% of all costs. You will be responsible for that remaining 10% up to $2,000. On my company's insurance plan, newborns are covered under the mother for the first 30 days, so I do not think you will have to pay the family deductible or out of pocket maximums until after the baby is 30 days old. You may want to check with the insurance company. If you call the general customer service number on the back of your card, a rep will answer any questions you have. I hope this helps.

I'm a benefits administrator, too!  You have really great benefits, by the way.  I agree with marissabarone, except I would expect to pay the deductible and 10% on LO, too.  Unless LO is in NICU, you won't owe too much more than the deductible--they don't charge you as much for the baby as they do for you.

sunnyday016

l_elizabeth:

Call your insurance provider-- they can provide you with an estimated out of pocket amount. My guess is you'll end up paying around $2250, but it's hard to say. When I had my DS, I got two bills-- one for me and one for him.

Insurance confuses me to, but I thought I'd add in that I also got separate bills- one for myself and one for DD from the hospital.