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May 2016 Moms
swflJD
member
Healthcare Costs and Insurance Questions
swflJD
member
Let's talk healthcare costs and insurance coverage. I touched on some of these questions on today's TW Tuesday thread, but I think it got buried, and I don't see where we have had a thread directly on this topic.
DH and I have what I think is a decent health insurance plan through DH's employer, but I still feel like we're paying so much out of pocket. Since I'm a FTM, I don't know what are considered "standard" costs associated with prenatal care, labor & delivery, etc. A little background: my health insurance plan is a PPO through Anthem BCBS with $1,600 individual or $3,200 family in-network deductibles. We also have maximum out-of-pocket costs of $3,600/individual or $7,200/family.
So far, I have been paying my OB's office for my $40/visit co-pays + the US fees of about $215 each + a $350/month "global payment" (which I understand to be a fee for the delivery that they charge above and beyond what they can bill to my insurance company). I will also owe even more for the delivery in the event I have to deliver by c-section (not counting hospital surgery fees, etc.). I have had 3 US so far, and I had to pay $215/each for the first 2. They didn't charge me for the US at the 20 wk. AS last week (I am assuming because that one was covered in full by insurance, but who knows...I may be getting a bill for it soon!). For the delivery, I will also have a $500 hospital admittance co-pay, and insurance only covers 80% of the hospital fees and costs (until I meet my deductible/out of pocket maximums).
We also decided to do genetic testing with the Harmony test. I was low-risk, so it was elective. I was told that it would be less expensive to pay for it out of pocket at their "discounted" rate of $350 than what we would owe if billed through our insurance. I was glad I did it because I found out that I am a carrier for a rare disorder that could be terminal to LO, but LO could only be affected if DH was also a carrier. We then opted to have testing done on DH, which cost somewhat less (not sure why), but it still cost us about $150. As it turns out, DH is not a carrier, and it was nice to have that peace of mind, but now we are out another $500 in medical bills. I am going to have to check with my insurance to see if those out of pocket costs can be counted toward my policy maximums, but I doubt it since it was not billed through our insurance.
My Questions:
DH and I have what I think is a decent health insurance plan through DH's employer, but I still feel like we're paying so much out of pocket. Since I'm a FTM, I don't know what are considered "standard" costs associated with prenatal care, labor & delivery, etc. A little background: my health insurance plan is a PPO through Anthem BCBS with $1,600 individual or $3,200 family in-network deductibles. We also have maximum out-of-pocket costs of $3,600/individual or $7,200/family.
So far, I have been paying my OB's office for my $40/visit co-pays + the US fees of about $215 each + a $350/month "global payment" (which I understand to be a fee for the delivery that they charge above and beyond what they can bill to my insurance company). I will also owe even more for the delivery in the event I have to deliver by c-section (not counting hospital surgery fees, etc.). I have had 3 US so far, and I had to pay $215/each for the first 2. They didn't charge me for the US at the 20 wk. AS last week (I am assuming because that one was covered in full by insurance, but who knows...I may be getting a bill for it soon!). For the delivery, I will also have a $500 hospital admittance co-pay, and insurance only covers 80% of the hospital fees and costs (until I meet my deductible/out of pocket maximums).
We also decided to do genetic testing with the Harmony test. I was low-risk, so it was elective. I was told that it would be less expensive to pay for it out of pocket at their "discounted" rate of $350 than what we would owe if billed through our insurance. I was glad I did it because I found out that I am a carrier for a rare disorder that could be terminal to LO, but LO could only be affected if DH was also a carrier. We then opted to have testing done on DH, which cost somewhat less (not sure why), but it still cost us about $150. As it turns out, DH is not a carrier, and it was nice to have that peace of mind, but now we are out another $500 in medical bills. I am going to have to check with my insurance to see if those out of pocket costs can be counted toward my policy maximums, but I doubt it since it was not billed through our insurance.
My Questions:
- I know costs will vary from plan to plan, but are these costs at least somewhat in line with what you (United States) ladies are paying/expect to pay?
- Is it standard practice to be charged a "global payment" for the delivery, above and beyond what the doctor's office collects from insurance. Is this standard?
- How much do you anticipate your total out of pocket costs for prenatal care to be? For labor and delivery?
- For you S+TMs, when should I contact my insurance company to add LO to our insurance policy? Is that something I should do at the hospital after he is born, or can it be done earlier?
Re: Healthcare Costs and Insurance Questions
I have Federal BCBS through my work.. I'm not sure how much that makes a difference with it being federal but I do know I pay a lot monthly for my coverage and I have a 25 dollar co-pay each OB visit and I get random things in the mail for left over payment that they did not pick up such as labs and U/S but I've never paid for the entire U/S. I also know that ER visit are RIDICULOUS! I went to the ER at 11 weeks and had to pay 300 some dollars before I stepped foot out the hospital. Set up your my blue account with them online, it should give you more information on your plan or when in doubt call them up and get explanations for things you're not understanding or that don't seem correct.
At the end the office will file the claim. If I owe more (which I shouldn't, but my insurance has been crap lately so who knows) I will get a bill. If they owe me money back bc I went over my deductible I get a refund.
Honestly right now I feel like I've been paying a lot, even with a HDHP. I'm supposed to get negotiated rates on things I have to pay for and while I am... It's still expensive. Thankfully we have all of our medical stuff being paid for out of an HSA account where we've been saving for the past 3 years.
We have no copays at all...at least I've never paid any for anything...my drs visits or the kids visits.
We have a health savings account, which is super helpful.
Our individual yearly deductible is 2,500 and the family is 5,000.
Once the deductible is met for the individual, everything is covered for that individual. Once the family deductible is hit, everything is covered for everyone on the policy.
Ob/prenatal appointments as well as child well checks are 100% covered whether the deductible has been hit or not. Vaccines are also 100% covered.
Any extra scheduled appointments carry a small fee (my son's last sick visit coat us 30 bucks).
I do get bills for any lab work and my 3 hour glucose screening was not covered at all. They only cover one 1 hour and because high risk for gd I have to take it twice. They covered it at 16 weeks, they won't cover the one at 28 weeks.
So far I've paid less than $100 out of pocket. It sounds to me like we have some really freaking great insurance.
I expect that you'll find a very wide range of coverage types and costs within the US.
My company used to pay the entire premium, but stopped doing that..but I'm not complaining because the coverage is excellent.
I switched to a regular PPO plan for 2016. I did some number crunching and I should be better off with a lower deductible and higher premium for a delivery. My new premium is $339/month for my H and me with a $750 deductible per person or $1500 max per family. My breast pump should use up about half of my deductible, then I'll easily use the other half during delivery. We don't have any admittance fees, but have a 10% coinsurance until out of pocket max is met ($2000). I maxed out our HSA last year, plus did a healthy flex contribution for 2016, so I'll easily be able to pay for everything with pre-tax dollas.
One baby arrives, our premiums pretty much double once we upgrade to the family plan. This bugs me so much that we would have the same premium as a family of 8. Annoying.
My OB has split her fee into 5 payments of $560. I don't know what the hospital bill will be. We had to pay a percentage of most of the blood tests at the beginning. Most were about $150 to $200 for us. Except for the DNA type test. That was $750 for us. I think we pay %20 for those kind of things.
I haven't paid anything out of pocket so far. Our insurance has covered all routine prenatal exams, quad screening, three ultrasounds (dating scan, NT scan, and anatomy scan), glucose test, and -- if everything goes smoothly -- labor and delivery, including a two-day stay for recovery.
I haven't asked about infant circumcision or breast pumps yet so I don't know if those will be covered.
You need to call you insurance prior to your due date to get pre-authorized for the hospital stay but you can't add the LO to you plan until after they are born. The LO will be covered under you for the hospital stay and a little while afterwards. I added my LOs to my insurance when they were about a week old.
@swflJD, my insurance sounds very similar to yours. I think the deductible and OOP max are slightly higher (I want to say 3500/8000), and coinsurance after deductible is met is 30% instead of 20%.
With regard to the global payment...my understanding is that you are essentially pre-paying what they estimate your contribution will be for their billings, based on your deductible amounts and insurance coverage. They should be billing this to your insurance company, but until you meet the deductible, payment is your responsibility alone. Also, they typically won't bill until after the birth for their standard prenatal care, so it helps them to have you make payments along the way. My global billing amount is lower - about $120 per month spread over 7 months - but my OB referred me out for my anatomy scan since they don't do those in office, and that came in at a whopping $588, ugh. I also opted for the panorama test and have yet to see an EOB or bill for that, so I have no idea what it will cost me, if anything.
A few things you may want to clarify with your insurance, if you don't know already. Are you responsible for 100% of costs before you meet your deductible, or just a portion? (Typically it is all costs, but you mentioned 80% when you were referring to hospital costs above.) Also, are your deductible and OOP max applied on an individual basis or an overall plan basis? My company offers two different plans - one applies them on an individual basis, and the other on an overall plan basis. I'm on the one with the overall plan basis, so I have to meet the full family deductible before insurance kicks in at all, and the only OOP max that applies is the $8K family max. With the other plan, once one participant meets the individual deductible, future costs for that participant are covered by insurance (with coinsurance) - same for the OOP max. And finally, you may need to consider plan year - most are calendar year, but not always. Your deductible and OOP max generally reset at the beginning of each plan year. Mine was October 1, so luckily most of my costs were this same plan year.
For budgeting purposes, I'm planning to end up paying the entire OOP max, plus my doula's fee (not covered by insurance). If we end up less than that, great, but if not, I'm not scrambling to come up with the funds. My costs for early ultrasounds not covered by the global billing were about $140 each (and were in a prior plan year), and labs have been mostly small amounts here and there. I don't anticipate more prenatal costs unless something goes wrong, other than minor labs, so most of the cost will be labor & delivery.
First Pregnancy
Second Pregnancy
- BFP: 09/11/2015
- EDD: 05/25/2016
Baby Born04/15/2016
PGAL
According to my insurance company and my HR department the baby will be covered under my social for 48 hours for a regular delivery and 72 hours for a C/S. After that I have 30 days to change our insurance and at that point they'll back date the baby's coverage to his birth date.
The only question I have left to ask the insurance company is costs for a circumcision.
I was so fortunate that I changed my job when I did. The last place I worked at changed their health insurance from an HMO to a high deductible plan. The max OOP for us would've been $16k and that was paying more per month than I currently pay. It's one of the reasons why I left my last company.
Btw I don't know if it has changed at all, but NYU offers three different room types based on availability. Standard is covered by insurance entirely, but semi-private and private are not.
My OBGYN office come up with an amount saying that we owed 1,150??? Before the baby was due. $750 being a deductible and then like $320 Co-insurance.
Our insurance company told us we only had to pay the $750. I paid an initial visit payment, and that's been it. Told us all labs and US were included in maternity. Wellll, someone else told us we didn't have to pay anything and pay office visits.
Then, we have another person tell us we don't have to pay anything, not even the deductible.... but got a bill for an US......
It's all too confusing