Bad day re: health insurance

KDR1979 · January 2012

I had a level 2 ultrasound on Monday and had a 19% discordance. My OB isn't worried. Baby A is in the 43rd percentile and Baby B is ~63percentile. She thinks they'll measure more on track at the OB office in 2 weeks. She said the local perinatal center is often off on fetal weights.

My husband and I have a high deductible HSA plan. Our OOP max is $7,000/year! Our deductible has always renewed on Jan 1. I scheduled my eye doc appt for early Jan and planned many healthcare things according to that. We hardly touched our deductible in 2011 b/c IVF/infertility doesn't count on our insurance plan. I've been logging into united healthcare to keep track of our medical bills & I noticed that our deductible didn't appear to renew on Jan 1. I got home from work early enough today to call united healthcare and found out that our deductible now renews on April 1. I am 37 weeks on April 23. So, we will likely spend $7K OOP on pregnancy medical bills AND then the deductible will renew in time to get the delivery bills-which means we'll hit our deductible AGAIN 2012-2013. I am so bummed & frustrated. We worked so hard to get good educations, racked up student loan debt, make good salaries, but have jobs with high liability risk, crappy health insurance & pay outrageous taxes. Is it even worth it to get professional jobs??????????????????????

UsedToBeGoldie · January 2012

oh, man, that sucks.

Our OOP deductable is $3700... which we hit in 2 months last year b/c our kids were so sick and one had tube surgery.... then everything was "free" the rest of the year- so it felt good... but now, with it back at Jan 1st it's hurting to pick up Rx's, etc... my migraine meds are about $500... thankfully my doc gives me lots of samples. Ugh.

it's so hard... and it is only harder once you are paying for kids. I'm sorry your insurance is screwing you in taht way.

E&RMommy · January 2012

KDR1979:

I had a level 2 ultrasound on Monday and had a 19% discordance. My OB isn't worried. Baby A is in the 43rd percentile and Baby B is ~63percentile. She thinks they'll measure more on track at the OB office in 2 weeks. She said the local perinatal center is often off on fetal weights.

My husband and I have a high deductible HSA plan. Our OOP max is $7,000/year! Our deductible has always renewed on Jan 1. I scheduled my eye doc appt for early Jan and planned many healthcare things according to that. We hardly touched our deductible in 2011 b/c IVF/infertility doesn't count on our insurance plan. I've been logging into united healthcare to keep track of our medical bills & I noticed that our deductible didn't appear to renew on Jan 1. I got home from work early enough today to call united healthcare and found out that our deductible now renews on April 1. I am 37 weeks on April 23. So, we will likely spend $7K OOP on pregnancy medical bills AND then the deductible will renew in time to get the delivery bills-which means we'll hit our deductible AGAIN 2012-2013. I am so bummed & frustrated. We worked so hard to get good educations, racked up student loan debt, make good salaries, but have jobs with high liability risk, crappy health insurance & pay outrageous taxes. Is it even worth it to get professional jobs??????????????????????

I hear ya.

hunt2005 · January 2012

Try to find out if it is the date of the bill or the date of the procedure that counts for the OOP cap. Some insurance companies count the date of service provided, so if you deliver by Mar 30 all delivery expenses would count in this year. Not that I want you to deliver at 33 weeks by any means, but maybe see what their polices are?

LnA5909 · January 2012

Is your deductible also 7,000? If not, you may not necessary meet your OOP. For our plan, once deductible is met, you are only responsible for copays and it would take a LOT of copays to make up the difference between the deductible and the OOP max. Also, the copays are limited to dr visits and Rx's, there are not copays for procedures. Does that make sense?

MrsLnt · January 2012

Oh that's awful. I had a similar-ish situation. I got PG in March, right after I switched to my office's high deductible health plan. Obviously was not planning on getting PG, nor was I planning on twins. Between March and June, I hit my deductible of $2500. In July I went part time at my office and lost my benefits and went onto MH's insurance, and our deductible started over. I had hit my deductible on my plan the day before my benefits ended. The DAY BEFORE. I was sick over it. The individual deductible was $2500 and family $5000. I of course hit that $2500. Fortunately, the babies came home with me and their hospital stay was covered under my individual deductible. It was nice to get a bill for my c-section showing charges of over 30k and my portion was 0.00.

For us, our plan is $2500 individual, $5000 family, $7000 out of pocket. So if you hit $2500 on my plan, you would be covered 100% after that, and you only pay toward the out of pocket max on things like prescriptions. So it may not be a full $7000 you are paying out after April 1. But I get it, it sucks and is super frustrating.

Kb103109 · January 2012

We are having a similar issue. Our deductible is $5000.00 for the year. We for sure have hit that for last year and are working out the OOP expenses. We got hit with everything so close together along with buying a house and me not working. But anyway, I would check with your local and state programs to see if you qualify for anything to help cover your OOP expenses. I qualified for a few, but never got around to getting over to the office to apply and I regret it now. Take advantage of everything you can.

Long=journey · January 2012

I'm so sorry! I don't have experience with similar plans, but I know what you mean about school loans. We are paying on grad school for both of us and although we both love our jobs, sometimes I think we would have been better off finding alternate careers and skipping the grad school thing.

klr210 · January 2012

My OB billed all pre natal visits with the delivery. However all NSTs and U/Ss where date of service.

I know what you mean though, we also have high deductible ($3k) and a $7k OOP max and planned our pregnancy around getting most (if not all) of it in one plan year.

Do you have an HSA or FSA? If you do and can participate you can at least play for the medical expenses pre tax and if you pair that with a payment plan then maybe it will be more manageable.

KDR1979 · January 2012

The deductible is $5K then 10% until we reach $7K OOP. The only thing we don't pay for is preventative visits-like my well woman annual & pap are covered and well child visits should be covered. We pay for all other MD visits, labs, prescriptions, ultrasounds, etc. I think we'll come pretty close to the $7K with all of our ultrasounds already. I KNOW we'll hit the $7K with delivery, epidural, twins, etc hospital bills. I do not want to deliver before April 1...I want to keep them in there as long as possible, but if they were early, I would be covered on this years deductible.

Switzerland87 · January 2012

Ooooh, I feel ya! I actually have decent insurance, but when I got pregnant and called for a referral to an OB, they informed me that they do not acutally cover prenatal care under my policy. I ended up having to apply for medicaid to avoid having to pay massive out of pocket costs. Both DH and I have good jobs, minimal debt, and have been very healthy, but our insurance company just screwed us over.

JennP03 · January 2012

Health insurance is just ridiculous. We have great health insurance for the two of us through DH's work but we pay $9300 per year just in premiums plus a $2000 deductible per person. Our costs will almost double when the twins show up. It's so frustrating, but what are you going to do? You have to pay it. The risk of not having it is too great.

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