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anyone w/ state health plan (esp if you delivered at CMC?

groovygrlgroovygrl member
in North Carolina Babies

just curious how much it ended up costing you OOP (or maybe how much the bill to your insurance co was). I know there are a lot of variables in terms of how much you paid into your coinsurance max already, vag vs CS, what you needed done, etc. Not including the baby (who will be on MH's insurance in our case). A friend of ours was saying he heard $5 or $6K but if my individual coinsurance max & deductible are $3350, how can it cost that much more?

Also, same friend talked about people getting charged for every Motrin, pack of diapers, supplies needed, etc and I have never heard that before- I thought that stuff was all lumped into the hospital fee for a vaginal or C-S birth as a set fee? Am I mistaken?

Thanks!?

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Re: anyone w/ state health plan (esp if you delivered at CMC?

  • ACC2BACC2B

    I can't answer how CMC charges.  However, my assumption below assume you are due in July or after and are on the 80/20 plan based on your combined max of $3350.  And, that CMC is part of the BCBS network.

    First you'll meet your deductible of $600.  Thereafter, the SHP will be responsible for 80% of the covered charges, and you'd be responsible for the other 20%, not to exceed $2750 in the plan year (7/1 - 6/30).  So, if the cost of the stay and delievery is $10,000, you'd be responsible for $2,000.  And, you pay coinsurance based on the negotiated rate between BCBS and CMC, which is likely to be closer to $7,000.

    Therefore, you shouldn't assume that you'll meet your coinsurance maximum. 

    Also, be sure to save all of your EOBs (the statements that come from BCBS after they process your claims) and match them up with what the providers bill you.  Also, the estimates from your OBGYN, the hospital, and possibly the anesthesiologist will assume you haven't met your deductible yet.  So, be careful not to let all 3 charge you for it.  BCBS will apply the deductible to whichever claim they receive first--which is why you'll want to be sure to match up the statements to the EOBs. 

    DS, June 2, 2008, 8 pounds, 4 ounces, 21 inches DD, May 21, 2011, 9 pounds, 21 inches
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  • ACC2BACC2B
    Also, the birth of a child is considered a qualifying event, and you'd be able to add or increase your medical flexible spending account based on this event.  This could also save you some money as you would not be paying taxes on what you set aside.
    DS, June 2, 2008, 8 pounds, 4 ounces, 21 inches DD, May 21, 2011, 9 pounds, 21 inches
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