January and deductibles

Josie400 · August 2014

I'll be contacting my insurance company for specific answers related to my plan, but I was just wondering how many people will be paying their deductibles twice since the new calendar year starts right before baby is born.

I'm trying to figure out as many financial specifics as I can since we are getting close to the half way point.

Jessie_ea · August 2014

Well you don't get billed by your doctor until after the baby is born (at least that's how it is here) so I imagine you'll probably have next year's deductible to pay when baby is born. It's kind of a bummer, but then at least it's all paid for next year I guess.

Josie400 · August 2014

Jessie_ea said:
Well you don't get billed by your doctor until after the baby is born (at least that's how it is here) so I imagine you'll probably have next year's deductible to pay when baby is born. It's kind of a bummer, but then at least it's all paid for next year I guess.

That's the part that worries me because I've already started making payments for my visits this year.

BookitBoo · August 2014

I also don't get billed until after Baby is born and will meet our deductible in the first month.

I'm just really glad to have insurance, honestly, even if the deductible is crazy.

Jessie_ea · August 2014

Josie400 said:

Jessie_ea said:
Well you don't get billed by your doctor until after the baby is born (at least that's how it is here) so I imagine you'll probably have next year's deductible to pay when baby is born. It's kind of a bummer, but then at least it's all paid for next year I guess.
That's the part that worries me because I've already started making payments for my visits this year.

Really? Hmm...then I'm curious to hear what your insurance company says.

FitmomJess · August 2014

My Dr. already gave me a bill showing what my insurance covers and wants a deposit by November.

nah82 · August 2014

I'm lucky, my deductibles are up in July with my insurance being through a school district.

JerseyHopeful · August 2014

I am very fortunate that I don't have a deductible. I paid $15 copay at my first prenatal visit and that covers me through the birth and the first postnatal visit.

kayham12 · August 2014

I had the same situation and called about my insurance company. They told me that even though I prepaying for my doctor (I received a letter not a "bill") that I won't actually be billed until Jan. So the amount I paid will be applied to my actual bill in January.
I was calling because with my payments I should have already met my deductible and I was wondering why I was still paying. That was my expierence at least.

TXUltraRunner · August 2014

I'm very lucky that 100% of anything prenatal or having to do with delivery is covered. I've not paid anything out of pocket since being pregnant.

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peggels24 · August 2014

TXUltraRunner said:

I'm very lucky that 100% of anything prenatal or having to do with delivery is covered. I've not paid anything out of pocket since being pregnant.

This is me. I am so very lucky (and it's one of the reasons that I made DH think long and hard before switching jobs)

JessHy2012 · August 2014

My doctor and hospital don't bill for anything prenatal related until after baby is born...so only next years deductible to worry about.

Milagros315 · August 2014

I don't have a deductible either (but I pay a high premium). My co-pay for specialist care is $20, but so far I have only paid that when I have had an ultrasound.

My out-of-pocket maximum is fairly low, but that's what I'm worried about. So far this year, I've paid about 1/4 of that amount. Unless something major happens, I don't expect to pay much more. In January my plan starts over, but I don't think I'll have to pay much more than the hospital co-pay. I probably won't reach the OOP max whether I had the baby in December or January, so it actually might not be that bad for me. I need to find out though. I've asked a few questions regarding insurance so far, but I keep thinking of new ones.

motherboy · August 2014

Yeah I called because I had similar questions as you. We won't have paid that much this calendar year toward our deductible--as of now we've paid $105 I believe, so it's not much. The birth, assuming it will br in January, will be paid in 2015. My husband really wants me to go into labor "just a little" early so he gets the 2014 tax credit. Whatever, hubs. Baby comes when baby wants to, not you.

@CrazyMonkeyBear‌ I was on Cigna for my last pregnancy and also found them seriously unhelpful. They covered breast pumps buy only through medical suppliers. The only problem is that the medical suppliers they had me call were all prosthesis places. I ended up just buying it. I think they make the system purposefully difficult.

lavet22 · August 2014

$5K x2. Yep. I'm super pissed about it. I'm due Jan 4th and there is a question as to whether I'm actually 1wk farther along (early ovulation-I was on the pill and traveling overseas and I didn't take a pill until 18hrs after it was due, thus bringing on ovulation). This is my 4th pregnancy and my last one took 40min from the time my water broke til he was here. Since my hospital is 40min away, my doc has already suggested we induce, but I was induced with DS2 and swore I would NOT do it again. However, to save $5K, I may reconsider...

Also, My 1st labor with DS1 took 18hrs from the time I was admitted to the hospital, 10hrs after my water broke. Quick labors like mine are not typical of first pregnancies, as mine have gotten much quicker from pregnancy to pregnancy. From the time my water broke, DS1-10hrs, DS2-3hrs, DS3-40min. I don't want any FTM's to freak out that they will have a super quick delivery. It is NOT the norm.

SpaceGirlSpiff · August 2014

It sounds like you are probably making upfront payments on your deductible, but if it's like my plan (I'm doing the same thing... I have a high deductible PPO), the payments you are making will be held as a credit to your account and applied at the final billing once baby is born.... then you'll get a final billing for the difference. In my case, I'll probably pay my Max OOP which is $5000 total...so whatever left over after they apply my upfront payments will be my final bill (3000-whatever maybe, I have no clue)

What you DO stand to "lose" are any payments you make for labs or ultrasounds, as that is not a part of the final billing...those are usually due at time of service which is during THIS year. Sucks, but ... it's not two FULL deductibles that you'll pay at least

The financially conservative side of me is kind of hoping for a Dec. 30th baby (I'm due 01/04) so that for the 30th and 31st when I'd ideally be in the hospital it will be counted in THIS year...then I don't lose the money for labs/US :P ... but of course, it matters more to me that baby bakes for as long as she needs.

Josie400 · August 2014

I just spoke with the insurance company and the plan starts over on the first of the year, meaning for us we will basically be meeting the deductible double during the pregnancy. Ugh. What a difference 11 days can make in a due date.

But we will most likely have the higher premium plan for next year, so the deductible should be lower. This all makes my head spin. I understand having kids is expensive, but it's ridiculous how it differs from person to person, birth month to birth month, insurance to insurance.

cabbeeby · August 2014

Since our deductible is fairly low ($250) we already met it doing the nuchal translucency ultrasound and some doctor visits, so we will have to pay the full deductible again next year.

One year I had emergency surgery right after changing jobs and it just happened to fall on the last day of insurance from my old job. With all the follow-up appointments I ended up meeting the deductible for my new insurance in the first month as well. I had some pretty high deductibles at the time (4k and then 2k) so that was expensive!

Luckily with the pregnancy the cost is more spread out and we can plan for it ahead of time.

SpaceGirlSpiff · August 2014

Josie400 said:

I just spoke with the insurance company and the plan starts over on the first of the year, meaning for us we will basically be meeting the deductible double during the pregnancy. Ugh. What a difference 11 days can make in a due date. But we will most likely have the higher premium plan for next year, so the deductible should be lower. This all makes my head spin. I understand having kids is expensive, but it's ridiculous how it differs from person to person, birth month to birth month, insurance to insurance.

Yes but what we're trying to point out is the payments you are making now may not COUNT until next year so the only thing you're actually applying to a deductible right now may only be for labs and U/S

Yes it's still more than just one deductible, but not DOUBLE the deductible... you're paying for labs and U/S, but then the OB and hospital bill (the bulk of it), wouldn't be billed until you actually have baby.

You would need to clarify with your OB's billing office to see if they do in fact do "global billing" which means they don't ACTUALLY bill your insurance until the baby is born.... and clarify with them if the payments you're making now are just an upfront estimate that's being held as a credit to the final billing... have you talked to them about it?

The insurance will verify that indeed your deductible starts over each calendar year, but it's your OBs billing you would clarify with on how they will be billing you

lunamishka · August 2014

Insurance gives me a headache. The midwives that I see gave me a paper of what the prenatal and delivery cost will be and want me to make payments. I've calculated it so that I'll have it paid off by the end of December. But I won't recieve my hospital bill till after I deliver so around the end of January. I'll end up having to pay another deductible. I rather pay what I can now though and have less bills to worry about after baby comes. We've also calculated how much in wages I will lose while on maternity leave so we can save for that now.

sfgiantsgamerbabe · August 2014

I have a high deductible PPO so I will be paying the deductible twice. I'm $54 away from my deductible right now thanks to an ER visit. My 60/40 should kick in for the rest of this year until I reach my max out of pocket of $5,900. It all starts over January 1st and I'm due the January 16th. Bleh.

GromMom · August 2014

It depends on your insurance, my friend had to make a lot of payments for her pregnancy early but when she ended up moving, she was refunded a lot of it. I think that often practices pre-bill so that people do not go into sticker shock and balk at paying $5000 + all at once. She ended up paying at the new doctor in the new state, so it all worked out.

As for me I believe I'll switch during open enrollment to a higher monthly premium so that I can have a cheaper delivery (due at the end of January). Right now I have a high deductible, so yes, I'll have to pay full price for things like NIPT ($700 ouch) but it won't be so expensive when I actually deliver in January. When I called my insurance to ask about it, the sales person said yes you can change mid pregnancy as long as it's in open enrollment and she even pointed out that a life changing event like giving birth will actually qualify to change you again, so if you no longer need the higher coverage you can switch to another plan within 30 days, so that might work out pretty well...of course I'm going to pay quite a bit this year, but I think it will even out in the end.

rainbows · August 2014

I called my insurance earlier this week and found out that I am fortunate that my insurance doesnt roll over until July. So no double deductibles and coinsurance for me. But i also found out that since my plan was grandfathered in, no breast pump.

LadyXaverian · August 2014

FitmomJess said:

My Dr. already gave me a bill showing what my insurance covers and wants a deposit by November.

Same.

LaStella25 · August 2014

My deductible is $1,500, but my max out of pocket is $4,500.

I have met $2,100 due to a quack doctor who told me a needed to do a bunch of testing for a problem I didn't have in January. Long story.

I pay $50 whenever I get an u/s at the doctor's office. I don't pay anything for the monthly check ups or bloodwork.

My doctor claims that I have extremely strange insurance. I don't owe a dime for the delivery if everything goes perfectly. BUT, if I have a c-section or something along those lines, then I will owe my doctor $600, and the hospital an unknown amount (which would be the $3,900 since I'm sure it will reach my max out of pocket for 2015).

Latham12 · August 2014

I'm actually looking forward to having baby in January bc the place DH works at reimburses us for our deductible ($2,000), so it'll be cheaper than if we had baby in December. But we have an insurance meeting with the company next Thursday and I'm praying things aren't changing!

Shortstack06 · August 2014

Our deductible resets in July so mine might not be so bad..

LooneyLife · August 2014

TXUltraRunner said:
I'm very lucky that 100% of anything prenatal or having to do with delivery is covered. I've not paid anything out of pocket since being pregnant.

This for me as well.

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