quick question

lolasmit · August 2013

my insurance told me that they cover 100% in my physician's office as long as she is in network. Now my confusion comes in with the deductibles. They said the delivery, or anything outside the physician's office has a $4,000 deductible and after that they cover 90%. After we have maxed $6,000 out of pocket they will pay anything.

Does the $4,000 deductible mean that in the year the baby will be delivered I will have to pay out of pocket $4,000 dollars before my insurance actually pays anything? Is that how thta works? Thanks.

kz's_girlygirl · August 2013

Sounds like it. Usually (from what I know with my insurance) any dr visits that go through your insurance and have a copay or cost share will be applied to your deductible. (if you and DH and any other children are on the same insurance, those would count as well.)

PrimRoseMama · August 2013

If I were you I'd call and get your policy explained to you by a rep. That is probably the best way to get it done reliably.

galv0515 · August 2013

Yes, I work in med insurance, tht is usually what it means. I would call back just to get clarification. Usually, the maternity benefits either have a copay or deductible. If yours is a deductible you will have to meet the deductible before they pay anything. Once u have met your deductible they will pay 90% of the contracted rate (u will be responsible for 10%) until you reach your maximum out of pocket of 6000.
If you call back, make sure to check if the deductible goes toward the out of pocket. Another good thing to check is if the baby will have their own deductible to meet (I've seen tht on some policies).
Lastly, most insurance companies cover breast pumps 100%!! I've heard a lot of ppl never know that!

Good luck!

lolasmit · September 2013

Thanks everyone!!

quick question

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