Yesterday I found out that my insurance through work will be completely changing as of February 1. Instead of a $1000 deductible plus 20% coinsurance after the deductible is met, they are changing to a set price-for-service system with no deductible. I'm trying to figure out if this will end up costing more or will be about the same - not to mention stressing out about dealing with a coverage change 6+ months into pregnancy.
So, if you are willing to share, how much were your out-of-pocket costs for your previous births?
I think that the total hospital bill was around $20K, which was for a 2-night stay and a non-medicated vaginal birth. We paid a little less than $2K OOP.
Mine was 100% covered so I only had to pay my deductible, which was also covered by our HSA (DH's work pays for the deductible by putting money into our HSA). So for me, zero dollars out of pocket.
My friend has something similar to your original coverage plan and they paid about $5,000 out of pocket on a $30,000 bill.
Just shy of $10k. That includes prenatal care, vaginal delivery, newborn care in the hospital, 6 wk follow-up visit, all labs and one ultrasound. If you take out the labs/ultrasound, probably about $9k.
We used a birth center so the total OOP bill including prenatal was about $1000. I have heard from others who have my same insurance that a normal hospital birth ends up being $3000 out of pocket.
About $4-5k, but only 1200 was actual birth, most was nicu stay, and the smaller costs like the epidural, circ and other misc stuff
POS+April 2009-M/c May 2009, POS+July 2009-M/c Aug 2009, POS+ Novemeber 2009 -Baby Boy Charlie DOB 07/06/2010, POS+July 2011-M/c and D&C Aug 2011, POS+Dec 2011 -Baby Boy Ethan DOB 07/27/2012, POS+Aug 2013-TWIN BOYS! Jack and Miles born March 23rd 2014!!
The bill for my delivery and care was in the $15k-$20k range and we paid about $1100 OOP. The bill for DD's care and NICU stay was in the $300k-$400k range and again we paid $1100 OOP. So a total OOP of about $2200.
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I think we ended up paying $2-$3k out if pocket (once we reached the deductible, it was covered 100% and so was baby). Our bill for a scheduled c/s, 5 day hospital stay for me, 7 days for DD (including time in the Level I and Level II NICUs) was around $300k.
I have a 5k deductible which my agency pays 50% of. So I will Have to pay $2500 out of pocket but everything after that (besides prescriptions which are no more than a $30 copay) will be 100% covered. So all of mine and the babies appointments will be fully covered after birth
The best way to do this is to call your insurance company and hospital and start digging around. Asking here will give you a dozen different answers that don't apply to you.
For instance my oop last time was $0 but tbe time before that it was $1500 or so. And that was with the same basic insurance, only minor changes.
Well, obviously.
I actually know exactly how much it is going to cost me now that my insurance is going to a fee for service system. I am just wondering how it stacks up compared to other people's coverage. I know that some people will pay nothing out of pocket and some will self pay tens of thousands of dollars -- I am kind of interested in the middle ground and feeling out what is average.
Thanks for the answers, ladies! It sounds like I will paying a bit more than most, but not an extreme amount. Much appreciated.
This has been a very interesting post to read, thats for sure! Ive always kind of wondered how my insurance stacks up. My deductible is $500, I am paying about $1,100 for my OB which includes my prenatal care (co-pays, doc visits, ultrasounds, lab work, etc), delivery and a couple post-delivery visits. My max OOP for the year is $2,650.
Birth center. 7k global fee for all prenatal and birth related expenses (lab work is billed separately, but I've never gotten a bill for it so my insurance must just cover it). I'll end up being OOP around 3k, but that's mostly because I have to pay a dedutiblefor me AND for the baby, since the baby is never technically inpatient.
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It's going to cost about 175 I believe. It cost 25 dollars to "confirm the pregnancy" and then after that it's all covered except for the 100 dollar fee for the hospital.
When my son was born we also had him circumcised and that cost an additional 80 dollars.
I wish I knew for sure how much my insurance is actually going to pay for this, I never bothered to add up the costs from last time. I know there was a recent report on NPR about how impossible it is to find out ahead of time how much even an uncomplicated, unmediated vaginal birth would cost for those people who have to pay out of pocket or mostly out of pocket.
It's going to cost about 175 I believe. It cost 25 dollars to "confirm the pregnancy" and then after that it's all covered except for the 100 dollar fee for the hospital.
When my son was born we also had him circumcised and that cost an additional 80 dollars.
I wish I knew for sure how much my insurance is actually going to pay for this, I never bothered to add up the costs from last time. I know there was a recent report on NPR about how impossible it is to find out ahead of time how much even an uncomplicated, unmediated vaginal birth would cost for those people who have to pay out of pocket or mostly out of pocket.
I know -- it's so crazy. This is a super interesting article about that exact topic:
With DS I paid a little under 1k for a natural, unmedicated birth, our hospital stay, my OBs portion, ect.. Total. For this LO my deductible alone is 1500 so I'm trying not to think how much OOP I'm gonna have to pay. (
Edit; typo.
Supposedly, I my plan "covers maternity care at 100%", and doesn't count towards the deductible. Yet I've paid about $850 for this pregnancy so far. I have no idea why this is, and neither could the poor Blue Cross member services lady when I called to ask. Her manager hypothesized that it was the ultrasounds and lab work. I would have thought that was standard maternity care, but whatever. I also have a $1100 deductible which I will hit pretty soon at this rate.
Either way, we budgeted for our out of pocket maximum, which is about $5k, so that no matter what there are no nasty surprises. I have given up trying to understand it all...when I spend too much time with the bills themselves and the ridiculous itemized charges I get all riled up.
Do you have an OOP max? Maybe just budget for that.
My midwife is out of network with our insurance this time. However last time I had such a great experience that we're staying with the same birth center. Last time i was uninsured $4500 plus $150 for the circ. this included all care through the 6 week post partum visit. The ultrasound was a separate facility and also OOP.
This time insurance is covering ultrasounds 100%, but since the midwife is out of network it's actually cheaper for us to be a returning cash pay client. Repeat customers get a discount! I estimate it's about $3800-4000 this time.
My first delivery was $18,000. It was a vaginal delivery with an epidural. My DD was born small and spent time in the NICU. I cannot remember how much out of pocket was. My second cost $28,000 for an emergency c-section and 3 days in the hospital. I honestly don't remember what our out of pocket was. I know it was not more than $3,000. Our insurance has changed so I am a bit scared this time.
I work in health care and have fairly decent insurance -- I'm still going to be paying $4000 - $5000 OOP when all is said and done. That is including prenatal care, ultrasounds, lab work, hospital charges, etc. It seems crazy and makes me depressed that in our country I am considered "lucky" to even have that kind of coverage. It just feels so wrong.
Our out of pocket maximum is $1200 per person or $2100 per family so even with the surgeries LO will have we shouldn't have to pay more than that. I'm expecting we will max it out though.
Nothing out of pocket due to insurance, but when we got the explanation of benefits paperwork (that never seemed to end, seriously), it totaled over $14k.
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My friend has something similar to your original coverage plan and they paid about $5,000 out of pocket on a $30,000 bill.
POS+April 2009-M/c May 2009, POS+July 2009-M/c Aug 2009, POS+ Novemeber 2009 -Baby Boy Charlie DOB 07/06/2010, POS+July 2011-M/c and D&C Aug 2011, POS+Dec 2011 -Baby Boy Ethan DOB 07/27/2012, POS+Aug 2013-TWIN BOYS! Jack and Miles born March 23rd 2014!!
ETA: my entire hospital bill not including prenatal care was 140K.
Have to pay $2500 out of pocket but everything after that (besides prescriptions which are no more than a $30 copay) will be 100% covered. So all of mine and the babies appointments will be fully covered after birth
I actually know exactly how much it is going to cost me now that my insurance is going to a fee for service system. I am just wondering how it stacks up compared to other people's coverage. I know that some people will pay nothing out of pocket and some will self pay tens of thousands of dollars -- I am kind of interested in the middle ground and feeling out what is average.
Thanks for the answers, ladies! It sounds like I will paying a bit more than most, but not an extreme amount. Much appreciated.
Ours was covered 100% - I had to pay our $200 deductable.
This time around I just checked our plan on KP.org and confirmed it will cost $250 out of pocket.
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When my son was born we also had him circumcised and that cost an additional 80 dollars.
I wish I knew for sure how much my insurance is actually going to pay for this, I never bothered to add up the costs from last time. I know there was a recent report on NPR about how impossible it is to find out ahead of time how much even an uncomplicated, unmediated vaginal birth would cost for those people who have to pay out of pocket or mostly out of pocket.
https://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?pagewanted=all
Either way, we budgeted for our out of pocket maximum, which is about $5k, so that no matter what there are no nasty surprises. I have given up trying to understand it all...when I spend too much time with the bills themselves and the ridiculous itemized charges I get all riled up.
Do you have an OOP max? Maybe just budget for that.
This time insurance is covering ultrasounds 100%, but since the midwife is out of network it's actually cheaper for us to be a returning cash pay client. Repeat customers get a discount! I estimate it's about $3800-4000 this time.
I don't know what the total bill was for delivery, I forget