Health Insurance and Co-pays.... $$!!

mels823 · July 2014

Hey all,

I've been blessed with a pretty healthy life. The only time I ever needed any major type of medical care was when I was younger and still on my parents insurance. I know healthcare can get expensive, but isn't that what good insurance is for?

I've started getting some bills in for this pregnancy (my first, so I really don't know what to expect). I've gone in for one ultrasound so far. $200??? really? That seems so high to me! Thank god I am having a very normal pregnancy so far and won't have too many ultrasounds. Some people go in for ultrasounds every few weeks! Are they spending that every few weeks? I have very good health insurance, and am just surprised at that bill I guess. If you all don't mind me asking, is that normal for ultrasounds? I'm terrified at what the total cost after my hospital stay will be!

Can anyone help me understand what I should expect as far as all this goes? I will definitely be calling my insurance company to see if they can give me an estimate or some information to go on, but I guess I just am curious as to other's experiences. We will have the chance to change our health insurance before the baby is born and I'm not sure if that will be something we look in to. We currently have Tufts Navigator.

I appreciate any help you guys can give me!!

Mom2DrG · July 2014

I just got my OB bill. $270 for the u/s - all paid by insurance and $500 for OB care - this is what I will pay out of pocket plus the hospital costs.

Neesey · July 2014

My u/s were $225 when we were doing treatments because we don't have IF coverage. Now that I'm pregnant, they are just $25. Can you ask your doctor's office if they submitted to your insurance company? I'd also ask you insurance company about it too.

ConstanceGoodspeed · July 2014

Have you met your deductable?

mahalo3 · July 2014

My ultra sound was $20. I have an appointment on Friday where they will go over the cost and what insurance will cover for the dr. I know the hospital is separate and we will owe that after the biryh, I think.

junebugjam · July 2014

I have paid nothing so far this pregnancy. With Amelia, I paid nothing except copays to specialists. All my regular OB appts were covered 100%, along with all ultrasounds and tests done at specialists. I also paid nothing for my hospital stay when we lost her (outpatient, but still to the tune of $6000). I have great insurance, though. I think it really depends on your insurance plan. A phone call wouldn't hurt.

boxerrrmama85 · July 2014

I haven't received any bills yet, however, one of our second appts. after our viability scan was with the financial counselor at the hospital where we plan to deliver. The counselor broke down all of our out of pocket costs with copays/deductibles etc. We have to pay $3600, 60 days before our due date. FUN! But, I'm glad we went for the appt. and now have an action plan so that come February we aren't broke with a baby.

Ducktale · July 2014

ConstanceGoodspeed said:
Have you met your deductable?

This. Until you meet your deductible, you pay 100% out of pocket, and then your insurance kicks in. For most plans, insurance pays most (70%, 80%, or 90%) and then you pay the rest (coinsurance). Some very good plans pay 100%. Most plans also have a out of pocket maximum that you won't pay more than that per year. Remember in 2015 it starts over, and you'll have to meet you deductible for you again and baby has it's own.

I suggest you get very familiar with your plan, and call your insurance company for them to spell out your responsibility. And remember that even with "good" insurance, paying 10% of a several thousand dollar bill adds up.

mels823 · July 2014

Thanks so much for the quick responses everyone! I very well may not have met my deducible yet for this year since before finding out I was pregnant had not had to go to the Dr for anything. Hopefully that is my main problem here! I will be calling them first thing on Monday! Thanks again!

alyssamskeens · July 2014

I have insurance through the hospital I work for, and see a provider there as well. All of my labs, ultrasounds, etc are performed there. At my first appointment, we met with a financial planner who broke down all of my costs- what insurance will pay and what I will be responsible for out of pocket, including setting up an OB "budget"- paying $125 per visit to cover my delivery expenses. I almost never go to the doctor, I'm not on any medications, therefore I've not met my deductible. I owed $18 for my initial lab work and like $194 for my dating ultrasound. Hubby's secondary insurance should be picking up soon and will *hopefully* pick up what my insurance doesn't cover.

AF9211 · July 2014

We have Blue Cross now. Our plan has no deductible, just copays. Our ultrasound copay is $250. My hospital stay has a $400/day copay up to a max of $2000...so we are looking at $2250 out of pocket, plus whatever else we may have to pay for. I think all lab work is covered at 100%, and I only have to pay the OB copay of $40 or $50 at my first visit.

When I was pregnant with DD1, we had an Aetna high deductible plan with a $5000 deductible, which means we had to pay for everything out of pocket up to $5000 before the plan paid for anything. So we basically paid for everything but my daughter's care in the hospital since by that point we had reached the deductible. My ultrasound then was $400.

Insurance plans can be scary & confusing. I'd call them and ask for a Summary Plan Description and don't be afraid to ask them a million questions.

mamabisme · July 2014

For a low risk patient my OB only does two ultrasounds. One for dating purposes at the first appt and one at 20 weeks. I paid nothing for those with either of my previous pregnancies. I paid a portion of the delivery cost (I believe 15%) and a portion of all blood work (all small amounts). This time around our insurance provider has changed (from Aetna to United) and I have not had my first appt yet so I am not sure what we will be expected to cover out of pocket. We are paying about double what we did for Aetna and it is a much larger network so I will be pretty upset if the coverage sucks. I've not had to use the insurance yet, except for routine check-ups.

OmSweetOm · July 2014

My first thought was also about your deductible. The red flag was you saying you never really have to go to the doctor:) don't worry girl... You'll meet it before the hospital, that's for sure!

elephantsonpatrol · July 2014

Like PP said, it depends on your plan. I have great insurance, with no deductible and minimal copays. The trade off is its an HMO so there is bureaucratic nonsense everywhere. Check your plan policy or call them

starrynight1658 · July 2014

Definitely get to know your plan. I'm lucky to have fantastic insurance, but everything adds up quickly, especially toward the end of your pregnancy, and if some unforeseen issues arose with you or the baby before, during, or after delivery.

AF9211 · July 2014

If you DO have a deductible, make sure to double check when it starts over. Since our babies will be born January/February/March, if you have a deductible that starts fresh every January like a lot of insurance plans, you may have to begin paying out of pocket again come January.

Nlavender13 · July 2014

I did not have maternity insurance with my son and it was 14k out of pocket for a perfect pregnancy and delivery. None of that went to my deductible since it was not a covered expense. Now I have coverage and have had 3 u/s and not paid a dime for any of it. Also keep in mind that since you will be paying for most of doc visits this year and then your delivery next year your deductible will have to be meet twice. Also your baby's medical expense will have its own deductibal. My girlfriend with normal insurance and maternity paid around 4.5k totall in the end. Your insurance co should be able to give you a compleat rundown of $ for you. Good Luck!

lilybug319 · July 2014

I have really great insurance but there's a weird payment setup with the doctor I go to. We started off with a $300 deposit. That $300 goes toward our $1500 maximum out of pocket cost. Then they basically break up the $1500 into monthly payments and it covers delivery and office visits. We have a $500 deductible as well so after we reach the $500 we only pay 10% for office visits. It barely made sense to me so you should check and see if your doctor is doing the same thing.

lcwed · July 2014

We have a 2500 deductible and then insurance pays 100%. I called the other day and found out I pay for the first office visit and all u/s and lab work throuighout the pregnancy all toward the deductible. Subsequent office visits are free as they are considered prenatal wellness. From the other responses about what the u/s costs, we will probably pay out of pocket for most of this pregnancy as our plan renews in January.

mandamoochie · July 2014

I pay nothing for maternity. Period. I have blue cross blue shield. Everything is covered 100%.

amt0312 · July 2014

Yeah depending on your insurance, pregnancy can be reeeeaaaallly expensive. I've lucked out this time around because my entire family deductible has already been met this year (2k), so I'm only on the hook for my 10% coinsurance for everything with this pregnancy. Thank god because my first ultrasound was a Level 2 U/S at the MFM dept of the hospital and it cost a whopping $3500. I only owe $38 bucks, somehow. Most of the costs you will incur will be early on due to ultrasounds, lab work, etc and then later with the labor and delivery stuff.

amt0312 · July 2014

2013JEM said:

I have carefirst blue cross blue shield and paid nothing for DD. However, I did have to switch from my obgyn since the hospital she delivered at was not in network. Fortunately, I found my awesome midwife group (CNM) and it worked out perfectly.

I also have carefirst bcbs and definitely do not get covered 100%, but it really doesn't matter the insurer but rather what your employer specifically pays for in their insurance contract.

maltwin1 · July 2014

Luckily DH is in the military and we live near a very good military hospital. We pay nothing for everything, including all of our IF treatments and meds, ultrasounds, and the actual birth as long as we stay within our Tricare Prime network. One of the perks of military life.

chickyclg · July 2014

I am a little confused with mine it says maternity care is covered at 80% after deductible but routine prenatal care is covered at 100% w/ no deductible. Guess who's going to call the insurance company in the morning. LOL.

tinyhumantoe · July 2014

I'll try to give you an idea of what I paid.

We hit our max out of pocket with my first pregnancy. Normal delivery with epidural, 2 day hospital stay, no use of NICU or anything extra.

I pay all costs (the adjusted rates my insurance negotiates) up to my $4k deductible, which includes any prescription medication. Then my plan goes 80/20 where I still pay 20% of all charges up to another $4k. A couple things got rejected, so somewhere between 9-10k for DD's birth. The bills kept rolling in for a year and a half after she was born.

DD was more expensive because I had an amniotic fluid leak the day before I had her and went in to the hospital. Dr#1 was going to keep me and induce me, then there was a shift change and Dr#2 sent me home. I paid $10k extra just to sit in a room for 7 hours waiting for more fluid to leak while someone took their time looking at my underwear under a microscope. It would have saved me a lot of money if they would have kept me.

DD was born in Sept, then got very sick in March... So we paid the max out of pocket 2 years in a row o_o ouch!

tinyhumantoe · July 2014

Our monthly premium is $1k for me and DD. My employer pays half, thank god.

bookworm982 · July 2014

I paid about $1200 total for DD's pregnancy and delivery. We switched insurance and DS was $0. This pregnancy will be the same. It all depends on your plan and maternity coverage.

boxerrrmama85 · July 2014

Just another thought that I had ladies-- with our babies being born in February, I know my insurance plan will reset at the beginning of January, meaning that I have to start over in regards to my copays and deductibles....

AF9211 · July 2014

Nlavender13 said:

I did not have maternity insurance with my son and it was 14k out of pocket for a perfect pregnancy and delivery. None of that went to my deductible since it was not a covered expense. Now I have coverage and have had 3 u/s and not paid a dime for any of it. Also keep in mind that since you will be paying for most of doc visits this year and then your delivery next year your deductible will have to be meet twice. Also your baby's medical expense will have its own deductibal. My girlfriend with normal insurance and maternity paid around 4.5k totall in the end. Your insurance co should be able to give you a compleat rundown of $ for you. Good Luck!

This isn't necessarily true. If you're on your husband's plan, you have a family deductible and it usually doesn't matter who meets the deductible within the family...meaning if you have a $3000 family deductible, there is probably not an individual deductible (you have to meet $1500, your spouse has to meet $1500...or you, your spouse and your baby have to meet $1000 individually). As long as the $3000 is met (doesn't matter by who) then the plan will pay. Double check, but most (although I'm sure not all) plans with deductibles work like this now.

jovencita1224 · July 2014

I pay a $25 co-pay for my 1st visit, and the rest is covered. There is a $250 hospital co-pay for admission for delivery, but that is waived if I take a wellness class and get my teeth cleaned at least once while pregnant. My ultrasounds may have a $25 co-pay, but I am not sure yet because that depends on where I have them done. If they are done at the office with their tech, there is not a co-pay.

I am very very blessed with our insurance. It is the consolation price for my husband being on a salary freeze for the past 6? Years now. He makes crap income, so I guess his union negotiated a pretty decent benefits package to balance it all out.

tinyhumantoe · July 2014

My practice was aware of my high deductible and required me to make advance payments at every appointment for the 7 months they saw me.

You can figure out what your deductible is and your max out of pocket, and calculate a worst case scenario.

What I really wanted to add was that my deductible was $2500 ($5k max OOP) for me as a single and $4k ($8k max OOP) once I added DD. I was told that her birth would fall under the single person deductible. Nope... All went under the $4k, which is bullshit because a lot of those costs were prenatal care, plus the amniotic fluid visit and the epidural occurred before she arrived.

Anyway, I received poor advice from my insurance rep and it ended up costing more than expected. I tried getting clarification, like hours on the phone for weeks, and never got a straight answer. I just paid it and moved on.

Allie429 · July 2014

I paid $20 for my first visit and nothing for my second visit. With my daughter, I paid OOP $495 for the doctor-this included all doctor's visits and delivery (by the doc). We had scheduled payment of $99 up until a month before her birth. This was an "estimate" of what insurance wouldn't cover. My DD was born last Sept and in Dec, we received a check from the doctor's office for the full amount we paid. We were amazed and only have to pay the hospital for me and my DD. (Combined was under $2000-just can't remember complete total). Not sure how this one will go but my husband does have great insurance so hoping for a good outcome. If you ever have questions I would call the insurance company.

michelle142 · July 2014

Co-Pay on U/S is only $50 for me, so that's nice.

My MW lumps all routine appointments together into one big bill that I won't see until after delivery. It's nice, but it also sort of sucks. I don't see constant bills now, but I know come March, we will get several large bills - MW appointments, delivery, baby's care, etc.

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Health Insurance and Co-pays.... $$!!

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