- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
July 2011 Moms
Saltina11
member
S/O: Delivery Cost: Who's Your Insurer?
Saltina11
member
For those of you that have awesome plans where you are going to owe like $500 or less for EVERYTHING out of pocket, would you mind rec'ing your plan? We have several choices at work and I think I picked the bum one this time around... I want to switch next enrollment period if I have one available that would have been so great. Obviously I wasn't thinking I'd be having a baby this year when I picked an 80/20 PPO!
__________________________________________________________________________________________
This discussion has been closed.
Re: S/O: Delivery Cost: Who's Your Insurer?
Medica Choice. It's also 80/20. Holla for med-free vag births.
We've changed from an OB to a MW and a different delivering hospital, so I'm a little nervous to see how the differences pan out.
DD1, Kathleen 9/15/2007
This is what I'm hoping for! My mom had no problems delivering me or my brother so I'm crossing my fingers that I'll take after her!
I have GEHA (which no one has ever heard of, I was told it is under medical mutual)Maternity care(Prenatal, delivery, and postnatal) is covered 100% as well as routine and well checks for adults and children. Routine exams for children up to 22ys are covered 100% as well as all immunizations. Otherwise everything else is 85/15.
Susan & Mark ... Married June 14, 2008 ... Chicago Area
James Tomasz born 1-5-10
Grace Dorothy born 7-13-11
PROJECT BALANCING ACT: BIO and BLOG- yeah... needs to be updated.
This question is a little bigger then just "What policy do you have?" Depending on how you plan to obtain your policy has a lot to do with what your benefits/coverage are. It sounds like you are on a group plan that is offered through your employer. If that is the case, you'll probably have several choices, each a little more expensive based on your level of coverage.
There are few things that are really important to look at. Deductible, co-pay/co-insurance, out of pocket, and specific benefit limits. A deductible is what you will have to pay out of pocket before your insurance company will begin to contribute to the cost of your health care. For example, I have a $1,500 deductible that I have to pay before my insurance company will pay for anything.
Second, figure out if you have a co-pay or co-insurance. Co-pays are generally a set dollar amount that is required each time you recieve a service in a given time period. You may have a co-pay that is only required once for maternity care, or you may have one that is required each time you are seen by your doctor. Co-insurance is percentage amount that you pay for each service. It may be 75/15 meaning your insruance company will pay for 75% of the total services, and you will be responsible for the remaining 15%. Co-insurance usually kicks in after you have met your deductible, but not always.
Third, how much is your out of pocket going to be? Out of pocket refers to the total amount of money you can expect to pay in a given year (whether you policy runs though a calender year, or a plan year.) It really depends on your policy as to what this number is. Sometimes it's low ($1500) or sometimes it's high ($20,000.) In the most recent past a few companies have started using an unlimited out of pocket, meaning there's no cap on what you have pay in a year. I would run as far away from those policies as I could. So once you've met your OOP for the year, you wont pay anything else unless you max your benefit.
Benefit limits are also important. This is how much your insurance company will pay for a specific group on services. ie- maternity, radiographic, mental health, office visits, etc. Usually, specialty benefits have a certain dollar amount that your insurance company is willing to pay out. For example, your insurance company may cover up to $50,000 of maternity related care. Once they have paid out a total of $50,000, that's it. They aren't paying out anymore even if you've already met your OOP. After you've maxed your benefit you will owe 100% of the cost. I would check very carefully the benefit limits you know you will be using for the year and if it's even close to your OOP, I would pick a different plan.
Also, you need to check your options for HSAs, FSAs, HRAs or any combination of the such, as well as how many providers participate with your plan, how/when pre-authorization is required, and about a million other nuances. I work in the insurance industry, and even I get confused on a regular basis. I hope this helps give you an idea of what to be looking at.
We have United Healthcare Choice Plus plan through my employer. My premiums are about $450 a month for the both of us.The total I will pay for this pregnancy is the $20 copay at my first appt.
Coverage:
~Declare it..Claim it..It will be!!~
5/9/09
Here We Go Again!!
Don't apologize!!! That was very helpful, and I'm sure not just to me.
Don't apologize - it's GREAT information!
I have TriCare, which is insurance for military members and their families. I have a plan that allows me to see civilian doctors, but I pay 30% out of pocket. I have a supplemental through the Military Officers' Association of America, which covers that 30%. Things are fully covered (other than my deductible) if I see in-network providers.
We have BCBS of FL and it's a PPO plan. We will end up paying about $700 to have the baby, including all OB appts, perinatologist appts, and delivery (I thinkl!) and then we've had some small bills here and there, having to pay 20% until we reach our deductible.
The great thing for us though is that our premium for the whole family is $30/month, which is insane. We're used to paying over $300/month. So, even though we do have to pay some bills, we are still in a really good place because we only pay $30 a month for family coverage. I'm a state employee and while the pay in my particular job isn't great, this is a HUGE benefit and easily makes up for the pay.
Yes, this is incredibly helpful. I'll be looking for a new plan soon as well. Thank you!
I DO TOO!!! although I had to pay $300 out of pocket to my OB prior to the birth. I wonder why??
I used to have something else and I cant remember what its called (starts with a P) and I just shredded my old card yesterday too. I had this coverage when I first got pg, an donly had to pay a $30 deductable for the ENTIRE pg. But my company dropped the coverage with them and I switched to GEHA
For full disclosure, I am an attorney specializing in insurance coverage.
The previous "book" is very helpful. You are really going to have to look at the plans and see what is best. Unfortunately, the summary information your employer usually provides you with during open enrollment lacks much of the important information if you want to get into the nitty gritty. And it is often quite an undertaking to be able to look at the actual policies (and many don't understand what they are looking at).
With that said, we have United Healthcare PPO 90/10 with a $1000 out of pocket max per person. Baby is considered part of me unless there is NICU time involved. We will pay approximately $320 for a vaginal delivery and probably the whole $1000 if it turns into a c-section.
Every policy is different and, depending on your company, the company itself may choose what benefits to provide. Seeing what everyone else has and what they are paying is interesting. However, even if you have the option of a United Healthcare PPO, it will likely not have the same coverage as my United Healthcare PPO.
Can I hug you? I love people who understand insurance.