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Can you help me understand this (re: insurance)?

Toots_popToots_pop member
in 3rd Trimester

My brain can not process this today...

I am 90% covered for my/our hospital stay, after deductible is met.  My ded is $350 individual/$700 family.

Soo...FFS, say my bill comes to $10,000.  Do I pay $1000?  Or do I pay $700 for the ded, and $930 to cover the 10% of the remaining balance ($10,000 - $700 = $9,300).

Am I over thinking this?  Of course I could call and ask, but it's not a big deal, I wanted to get an idea of what we are in for.  I can't for the life of me remember how much it was with DS.

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Re: Can you help me understand this (re: insurance)?

  • saturdaynightdoubletreesaturdaynightdoubletree member

    Sounds like you'll pay... $700 for the ded, and $930 to cover the 10% of the remaining balance ($10,000 - $700 = $9,300)

    Don't be surprised if LO ends up costing more though - I got thrown off by nursery fees and all kinds of things nobody told me about beforehand.

    Call your insurance company -- they are usually very helpful and insightful.

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  • themissizzthemissizz
    You would pay the deductible first, then you would pay 10% of the remainder of the balance.  So your example of paying $700+$930 should be correct.  You may have already paid toward your deductible though (many times labwork and diagnostic testing goes toward the deductible when it resets at the beginning of the year) unless the deductible is one that applies only to inpatient hospital stays.
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  • mrsf123mrsf123 member
    It sounds to me like you'll pay your deductible of $700 plus $1,000.
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  • MissNikki007MissNikki007 member

    imagecrazystace:
    You would pay the deductible first, then you would pay 10% of the remainder of the balance.  So your example of paying $700+$930 should be correct.  You may have already paid toward your deductible though (many times labwork and diagnostic testing goes toward the deductible when it resets at the beginning of the year) unless the deductible is one that applies only to inpatient hospital stays.
    This.

    Your coverage sounds just like mine. I have already paid toward my deductible, though. My co-pay is $300 and I responsible for $10%. I had to pay $1,100 today at my pre-op.

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  • mhazel1204mhazel1204 member
    I would call the hospital and get a predetermination, that's what I did. I was able to prepay and save 25%. Also, they made me aware that the doctors and anesthesiologist would be billed separately. What I paid were the hospital charges.
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  • locashlocash

    Also, look into whether or not you have an out of pocket max. Usually it's a couple grand and after it's met, you're covered at 100%.

    It's probably worth a call just so you know what you're getting into.

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  • Toots_popToots_pop member
    Ahh, you ladies are wonderful!  Thanks for the help and great suggestions! :)
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  • brittlandkbrittlandk

    Some insurance companies also consider LO to be part of mom until after discharge, so your copay might cover you both.

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  • Toots_popToots_pop member
    imagebrittlandk:

    Some insurance companies also consider LO to be part of mom until after discharge, so your copay might cover you both.

    I literally JUST found this to be true for the deductible...so that saves us some moolah!  Thank you!

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  • TiggerLuv80TiggerLuv80

    Being that I am a medical biller I can kind of explain this. First of all it sounds like you're only responsible for whatever has NOT yet been paid towards your deductible of $350 (LO will be covered under you until after you're discharged from the hospital). If you've already paid on services during the year (labs, ultrasounds or anything you have had to pay out of pocket other than a copay) then this will bring down the amount of your responsibility on the deductible due.

    As for the 10%, this is based off of what the insurance will allow. It is not necessarily what the hospital bills the insurance. Also, the hospital cannot technically  request the money towards your coinsurance prior to them billing your insurance company since there is no determination as to how much your insurance is going to allow for each individual charge.

    Also, the hospital bills separately from the anesthesiologist and the actual physician who delivers.

    You can always call your insurance to have them explain this in detail to you if you don't understand.

    I hope this helps. 

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