Health insurance with a January birth/baby

Re: Health insurance with a January birth/baby

• kamays54 member

  October 2024

  Some things to consider if you change your insurance (sorry in advance for the long answer)
  
  If you are happy with your doctor/hospital make sure that they take the new insurance.  My daughter was born in February.  We changed insurance providers at my job in January.  At the first OBGYN appointment of the year, I showed up like normal and they asked if my insurance changed.  I gave them the new information and they told me that they didn't accept it.  Well being about a month away from giving birth I was freaking out and was trying to hold back tears.  I left the office and let it out.  My doctor came outside and comforted me.  She told me to come back in for the appointment and we'll do cash pay.  I found out that they actually take my insurance (there was confusion with the name of the insurance company) but then they were telling me that the hospital doesn't take it and that is the only hospital that she delivers at.  Turns out the hospital also took my insurance but I had to go back and forth with a lot of people, all they way up to about 2 weeks before she was born, to get that answer.  It was an extremely stressful time.
  
  Also, check the benefits after the deductible/OPM.  We have 2 different plans at work.  One has a higher deductible but pays more after the deductible is met.  We switched to that plan when we were trying to get pregnant with our first.  We paid more up front but only had co-pays after the deductible was met.  With the other plan we would have had to pay 20% of all the bills we received.
  
  I'm not really sure what a good OPM is but my current OPM is a little more than double what my deductible is.  The other plan's OPM is triple what the deductible is.
  
  It's a crazy time but try to find out who is in network before the administer care.  For my first, besides my doctor and the hospital, I saw an anesthesiologist and 2 on-call doctors and my daughter had to see a pediatrician before she was released.  Thankfully they were all in-network. 

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• strongishmom member

  October 2024

  kamays54 gives great advice! I'll also add: you can call your current insurance company and ask them to give you a cost estimate for birth at the hospital you're looking at. It's just an estimate, but should give you a better sense of how much the experience will cost you. Similarly, if you're considering switching to your spouse's plan, the member can call their insurance with the same questions. If you're thinking about switching to another plan through your employer, that can get a little harder to find the exact info because they can't look you up specifically - that's where I'd reach out to your HR team and/or benefits broker for help. Also, as kamays said, reach out to your OBGYN and hospital to confirm that they and all of the doctors involved in your care will take the potential new insurance plan.
  
  On my insurance, my deductible is $1,000 and my OPM is $4750. That's for an individual plan - the family plan has a $2,000 deductible and $9500 OPM. I'm lucky (I guess?) that I've already met my OPM, and my insurance doesn't run on the calendar year, so I shouldn't owe anything for my own care. 
  
  It's just now occurring to me that some charges might go to baby care... I hadn't thought of that. But baby won't be covered until their literal birth day, so anything before that will apply to you, the mom. I would expect though that it comes down to how the hospital codes the services. Now I need to research!

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• fk18 member

  October 2024

  Thank you both! Great advice to contact my current insurance and get an estimate of birth at that hotel. Also so appreciate you giving me the specifics of your OPM. @strongishmom, you are so lucky it doesn’t reset at the new year! 
  
   Luckily I have tons of good options through my work (VA Hospital/federal) that both my OB and the hospital take. 

  
  

  I’m trying to figure out those nitty gritty financial considerations. Like is it worth jumping to an insurance that has only 70% coverage after deductible but for a more affordable monthly cost and some things in the hospital stay are covered 100%? So confusing lol.
  
   I’m also motivated to switch because my therapist stopped taking my insurance and she’s been awesome and I want to be set to with MH care during the postpartum time. 

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