February 2013 Moms

question about deductibles

My MW's bill for all prenatal care and delivery was about 3,200$. Insurance covered most of it and we paid about 500$ out of pocket. We did this when they gave us an estimate from the insurance company in October or November.

Billing called yesterday about the fee for the birth center. They said our deductible this year is 4,000$ and a vaginal birth will be 5,000$ out of pocket. If we prepay, we get a 5% discount. So I just prepaid the deductible to get the discount.

Now I'm wondering, does the money we paid to the MWs count toward this year's deductible or last year's deductible? We paid it last year and obviously the bulk of my prenatal care was in 2012 (I'm due a week from tomorrow) but the delivery will obviously be in 2013.

We have the same insurance company we had last year, but we switched plans. The only thing that changed was our deductible went from 500$ to 4000$ and our out of pocket maximum went from 3,000$ per person to 10,000$ per person (this wasn't our choice, DH's company stopped offering the plan we had before but it is the same company with the same benefits, etc).

How does this usually work? How do I even find out? Do I call the MWs billing office or the insurance company? How did yours work? Maybe I should have waited to pay the MWs until 2013.

Re: question about deductibles

  • I *think* that since you paid the MW bill last year, that only counts towards last year's deductible and not this year's. The only thing that would make me hesitate is that the delivery will be this year- if the MW bill for $3200 included her services for this year, maybe some of that would count. If I were you, I would call the MW's office first to see if they could answer that question, and then the insurance company (once you have the information about whether or not you've already paid for some of this year's services) to ask about which deductible it would apply to.

    I haven't paid my OB anything yet. I met with the patient representative before my first appointment, and she explained that they would bill me about a month before my due date. That would include the remainder of my out-of-pocket max for in-network providers for 2012 (which was $500), and then the same for 2013. I haven't gotten a bill yet though. 

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    First round of Clomid in May 2012= BFP #1, DD born January 2013 
    BFP #2 in January 2014, DS born September 2014

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  • This is tricky, and I am in a similar situation.  My understanding is that it counts when the expense is actually incurred.  You basically paid the MW a deposit and they are billing insurance as you go and what should be paid OOP by you is taken from the deposit as you go.  Majority of the expense should be for delivery, which is a 2013 expense and should count toward this years deductible.
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  • In my case we were paying $450 every month last year that I was pregnant and all of the charges will be billed to my insurance company when I deliver the baby. So this makes all of my $450 payments that I made last year apply to this years deductible which is good for me since I have such a high deductible.... $6000. It is nice for me since I will actually max out my deductible and they will pay the rest. But since I have already paid a lot toward the deductible I will actually not have to pay very much when I deliver the baby!  :) I would call your MW office and check with them. I figured this out because I was paying all of this money monthly but it wasn't being applied to my 2012 deductible and the insurance company said to call my OB office.
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