I just had a baby in April and found out about a little hiccup in our insurance I thought it would be good to share in case there are others of you who didn't know about this. When I got pregnant, I asked my insurance rep all about labor and delivery costs and what would be covered. After the delivery we got our bills and paid up to our deductible of $500 (a total of $16,000 without insurance...wow). Now, three months later we have gotten a bill for $5,000 with no insurance coverage. We noticed the patient's name was my son's whereas on the other bills it was mine. After doing some calling we found out that because we went on my husband's family insurance plan instead of mine (because his has much better benefits) after the birth, any bills under our son would restart the new deductible. Of course we knew the first office visits would fall under this, but what shocked us was from the very minute he was born, he was being billed separately than me at the hospital. So, when I had asked about labor and delivery costs the insurance people only told me about mine, not my son's. I had just assumed we were covered as one for those few days in the hospital. Some parts of the bill are super silly as well, like we are both charged $3,100 for room fees when we were in the same room!
I just wanted to get this out there so that when moms-to-be are talking to insurance people, make sure to ask about the baby's coverage from the moment they're born, especially if you're switching to a spouse's insurance.
Re: Insurance FYI
You may be able to fight some of your sons bills, but generally, yes, he's his own person, with his own deductible and out of pocket maximum to meet.
In some states and some health plans, he's considered a part of you for at least 30 days.
Insurance is a nightmare. Every bill I receive I have to fight for every penny.
DS: 18 months
Dx DOR AMH .2
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Yea I had worried about this. It's not the $600 deductible I'm worried about but the out of pocket max being raised once we are considered a 'family' which I have heard is right when they are born. So I think even if I am to stay on my own insurance and add baby it will still go up and will be paying everything double for baby too. Ex 4000 out of pocket max now becomes 8000 plus the $600 additional deductible before that. :-/
My manager who had a csection said her bill after insurances was $15k. Now csections are a few thousand more but it probably makes sense on an average insurance plan having to pay $6-10k out of pocket. She said they did a payment plan if you don't have that to shell out all at once. I was only planning for $4k which is my out of pocket max, but then when I heard this whole 'baby bill' piece, was then thinking it will be more like $9k all said and done.
I wish an insurance company would sit down and explain in simple terms but I have a feeling it won't be this easy to hear this sort of info from them! Will have to make some calls for sure...
The baby will be going on my fiancé's insurance! I just read this to him so he's going to check and find out if he'll have a deductible when he switches to family plan when our son is born.
When I asked my insurance what my hospital bill will be they just told me I have to pay the hospital fee listed on my card which is $250.
Now I'm wondering if it'll somehow come to way more than this.
Either way- I don't get how people think they are only going to be paying $250/500 to have a child if you don't have some sort of government plan or assistance. From what I have heard that seems very rare. And the fee on card is just a copay due at time of visit, that doesn't mean you don't have to pay anything else... Totally depends on your coverage. For instance mine is 80/20 which I think is pretty standard, but I know my parents who work for NY state had 100% coverage at some point.
The moment your child is born he/she will incur charges under whomever is the primary insurance carrier and will be subject to THEIR OWN DEDUCTIBLE. So if mom's deductible is $500 for an individual (and say $1000 for family), baby will now fall under his own deductible of $500 (which will total $1000 mom + baby family deductible).
Baby is automatically covered for 30 days on the primary's insurance policy and will DROP OFF if no contact is made with the insurance company. It happens automatically in most cases so be sure to submit official paperwork adding your child to your insurance plan to continue coverage past the 30 days. Some charges incurred in the hospital are NOT considered well baby and do not fall under preventative, so you will get a bill.
Just because he is on "moms plan" automatically does not in any way mean he falls under the deductible. A deductible is per person & once the baby is out, he's considered a person in the eyes of the insurance company.
The most important thing, again, is submit official paperwork within 30 days of date of birth so that you're baby will not loose coverage. I dealt with this a lot & it's a 50/50 shot if the insurance company will add the baby back outside that timeframe.
ETA: just want to add the a deductible is important but you really need to look at your out of pocket max. You'll receive bills regardless of meeting your deductible until you hit that max. Some folks are fortunate enough to have OOPMax amounts that are the same as their deductible so once they meet their ded they are done but that's not common.
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DD: 10/17/13
TTC#2 Actively: 10/14, NTNP: 01/14
Left-Sided Hydrosalpinx (cause: genetic abnormality, TREATED 11/16)
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And for anyone who only has to pay $500 to have your baby, you are so extremely lucky. This child will cost us at least $10,000 and that's not even counting premiums.
One thing we learned the hard way was the epidural is super expensive- like almost equal to the cost of everything else. It got billed as a physician fee plus by the hospital because it was administered there. I'll get another one all the same but that bill was a whopper.
Calendar policies run January 1st to December 31st.
Policy year plans are less common but run from whatever month the employer designated say, October 1st to the last day of September the next year and then resets October 1.
It should say on your SBC whether it's calendar year or policy, and if not you can call your insurance company and ask. Your HR should know as well.
If you have a calendar year policy, in no way would I allow them to apply end of the year charges to the next year deductible. I'd definitely fight that.
That just astounds me. I dealt with UHC frequently (as well as Aetna, BCBS & Humana) and not once did I ever come across them saying an employee only was allowed 4 days of coverage for their NB. I'm not saying you're wrong, but in the hundreds of dealings with them and other carriers I never came across this. I know that self funded groups can set a lot of parameters, but we didn't deal with many self-funded groups so that might be why I never came across that. We had groups with over 300 people and still had auto coverage for baby for 30 days. It's entirely possibly that it could also vary from state to state on what they require insurance companies to provide coverage for in regards to NB coverage. I'm in Texas so it could play a part.
The Newborn & Mother's Health Protection Act has a lot of good info if anyone is curious.
ETA: words
LFAF February Siggy Challenge - "Favorite TV/Movie Couple"
DD: 10/17/13
TTC#2 Actively: 10/14, NTNP: 01/14
Left-Sided Hydrosalpinx (cause: genetic abnormality, TREATED 11/16)
http://www.fertilityfriend.com/home/396b04
Thanks for this thread. It makes me realize that hospitals really are just about the $$. It makes me want to have a home birth.
The hospital where I had my first two always got preapproval in writing, so I knew a couple weeks before I had them what I would be owing. Be sure to get it in writing, just in case they try to change it on you.
Also, be sure and ask your hospital of they offer any discounts for paying early/before you leave the hospital. One hospital near us gives a 15% discount if you pay before you leave the hospital.
I also want to repeat what someone said about the epidural. We have excellent insurance coverage for our hospital network (paid just over $800 per kid) and if I had gotten an epidural it would have cost me almost $3000 more and that is after the insurance paid.