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Insurance---ahhh!


Forum: January 2013 Playroom

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  • 1 Post By Lintu
  • 3 Post By Lintu
  • 2 Post By lovelyenchanted
  • 1 Post By alicia1984

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  #1  
November 27th, 2012, 04:26 PM
MelibearMom's Avatar Melissa--expecting #4!!
Join Date: Dec 2009
Location: Utah
Posts: 783
Having my 4th baby you would think I would know what I'm doing with insurance, but I honestly never really paid attention to it! Not until we had DS2 get an eye exam not realizing he wasn't even on our policy yet.

Next year we have the birth of a baby (she seriously better wait until January!), a vasectomy, eye surgery for DS1, and hopefully vein surgery for me (if it's medically necessary). Our insurance coverage just changed and I want to make sure I know how much this baby is going to cost! The only problem is all the hidden things that you don't know about!

Our MAX family out of pocket cost is $5000, which sounds pretty good to me! $5000 for all that stuff! But I know it's not that easy. So, tell me, how can I be sure that everything that happens in my labor and delivery and DS's surgery will be in our network and covered by insurance? I'm so paranoid by this. What can I do before I deliver to cover all my bases? I only want to pay $5000, that's it, no more! We have a basement we need to finish!!

In other news, I'm due the end of January, but I feel like my body just can't take it anymore!! Anyone else feel that way? I'm on pins and needles all the time thinking my water could break at any moment (since it did with my boys). I can't sleep, I have lots of aches and pains, I can't poop, and I can't move! This pregnancy is SO much harder than my others!
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  #2  
November 27th, 2012, 04:31 PM
kbpeanut's Avatar Scooter!
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Location: san diego, ca
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Is your insurance through yours or DH's work place? If so, I would talk to the benefits person there, and see if they can help you out. That's what DH has been doing with ours, especially since his company is switching insurance providers on Jan 1 - so everything we had figured out with our current insurance will change on Jan 1.

Talking to someone like that is probably way easier than getting straight answers out of someone at the insurance company.
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  #3  
November 27th, 2012, 04:36 PM
Sawyers_Mommy's Avatar Mega Super Mommy
Join Date: Oct 2011
Location: North Carolina
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I have no idea about the insurance thing but I'm sure someone else here could help some

As far as not being able to go much longer, yep I'm there!! This pregnancy has been a TON harder than DS's. I hurt soo much every where. I just don't think I can go 7 more wks!
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  #4  
November 27th, 2012, 05:32 PM
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If your max out of pocket is $5,000, then you will not pay more than $5,000 unless something is just entirely not covered. I'd just make sure everything is covered by your insurance by calling the insurance company to confirm everything.
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  #5  
November 27th, 2012, 06:05 PM
lovelyenchanted's Avatar Super Mommy
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Quote:
Originally Posted by Lintu View Post
If your max out of pocket is $5,000, then you will not pay more than $5,000 unless something is just entirely not covered. I'd just make sure everything is covered by your insurance by calling the insurance company to confirm everything.
Yes.

Also, there is sometimes an in-network maximum and an out-of-network maximum. Check with your insurance to make sure all of the places and doctors you will be seeing are in network.

I'm figuring birth alone is going to wipe out my deductible and coinsurance almost right away... pending I make it to 2013.

My insurance paid the hospital alone (not doctors) $1300 for my first trip to triage in L&D. I can only imagine what a surgery and a 3 day hospital stay is going to be.
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  #6  
November 27th, 2012, 06:36 PM
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I'm annoyed that I have to pay my deductible all over again if I deliver in 2013. Just seems wrong to penalize people for bad luck at conceiving!
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  #7  
November 27th, 2012, 06:40 PM
MammaWannaBe's Avatar Mega Super Mommy
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Quote:
Originally Posted by Lintu View Post
I'm annoyed that I have to pay my deductible all over again if I deliver in 2013. Just seems wrong to penalize people for bad luck at conceiving!
Plus no tax break for 2012! boo! lol
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  #8  
November 27th, 2012, 07:04 PM
mamaginger's Avatar Mega Super Mommy
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Its really annoying but basically all you can do is keep calling and badgering them. I've already had to call mine 3 or 4 times and we've only had it 2 months.
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  #9  
November 27th, 2012, 07:57 PM
kbpeanut's Avatar Scooter!
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I would try the benefits person at work (wherever you get your insurance)...MUCH easier than trying to get any sensible answers from the actual insurance company!
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  #10  
November 27th, 2012, 09:03 PM
Lucky Mama's Avatar Platinum Supermommy
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I second the in-network/out-of-network thing, too. Make sure that your hosptial is IN-network or you might pay a LOT more (or not be covered at all).

Also, a LOT of insurance companies have a separate maternity deductible. I worked in hospital billing for 6 years and you would be surprised how many people never knew they had a separate maternity deductible until AFTER the baby was born. For example, our plan has a $2000 deductible and a $6500 maternity deductible.

Some companies require you meet your deductible completely before anything you pay goes toward your maximum out of pocket. Again, using our insurance as example, we have a $5000 max out of pocket, too. With our plan, however, we would have to meet our $6500 maternity deductible first, then we would be covered at 70/30 (we pay 30%, they pay 70%), and we would continue to pay that 30% until we had reached our max out of pocket of $5000. So, we could end up paying a maximum of $11,500 total since we have to satisfy that deductible first.

Now, of course, every plan is different, so your deductible may contribute to your max out of pocket, you may not have a separate maternity deductible, you may be covered at 80/20 (or better). I would talk to the rep for your insurance through your DHs work (or wherever) and the actual insurance company, just to be sure you get the same info from both. And it can be confusing, so don't stop asking questions until you feel like you really understand. Better to know your plan now than try to figure it out or fight the bill later.

P.S. Admittedly, our insurance is pretty crappy. Is it any wonder we opted for a home birth?
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  #11  
November 27th, 2012, 09:49 PM
MelibearMom's Avatar Melissa--expecting #4!!
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Wow, thanks you guys. I do know that our deductible ($1000) goes towards the out of pocket max. And I know my doctor and hospital are in my network. I'm just trying to think of things that I don't know about that might not be covered. DH said he will talk to the person at work tomorrow. I'm thinking I will call the hospital and say "How many different people will be sending me a bill from my labor and delivery." Then I will research and find out who (of those people/professions) are in my network and make sure I don't let anyone else touch anything if they are out of my network. Does that make sense? Our out of network max is $7000, but I don't know if that would be entirely separate from the $5000. Just more questions to ask I guess. It really, really irritates me that the message you hear on the phone while waiting to talk to someone from the insurance says "Anything we say is not a guarantee of benefits." How the he** am I supposed to find out what my real benefits are then?!!
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  #12  
November 27th, 2012, 10:18 PM
lovelyenchanted's Avatar Super Mommy
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"nothing we say is a guarantee of benefits. Benefits are subject to the terms and conditions rendered at the time of service."

I hear it all too much at work. Basically it means they can change your coverage at any time. Just be ause it's covered today doesn'tean it won't change shortly.

And usually in network max and out of network max are 2 totally seperate entities.

And I would expect bills from at LEAST the hospital, the pediatrician, anesthesia (if having epidural), your OB if they haven't charged you the "universal" charge yet (for delivery) and any other service you may have. Basically any time another practitioner comes into contact with you, other than normal nursing staff, expect a bill for it. If your hospital is in network, so should those practitioners. (Not always but they should.)
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  #13  
November 27th, 2012, 10:49 PM
alicia1984's Avatar Mega Super Mommy
Join Date: May 2009
Location: PA
Posts: 2,671
My insurance confuses the heck out of me and I work for the hospital I'm delivering at!! They claim they "Write off" certain things. Right.. still confuses me. I honestly don't know what's covered and what isn't.

Makes me almost wish I could be that poor college student again on the state insurance. I paid $8 for Jordin's birth... I felt guilty at the time for being on state insurance, but I worked to get off it and drives me nuts how I pay $150 every 2 weeks and then co-pays and a deductible and get billed ridiculous amounts for healthcare.
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  #14  
November 27th, 2012, 11:01 PM
Lucky Mama's Avatar Platinum Supermommy
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Location: Utah
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Quote:
Originally Posted by lovelyenchanted View Post
"nothing we say is a guarantee of benefits. Benefits are subject to the terms and conditions rendered at the time of service."

I hear it all too much at work. Basically it means they can change your coverage at any time. Just be ause it's covered today doesn'tean it won't change shortly.

And usually in network max and out of network max are 2 totally seperate entities.

And I would expect bills from at LEAST the hospital, the pediatrician, anesthesia (if having epidural), your OB if they haven't charged you the "universal" charge yet (for delivery) and any other service you may have. Basically any time another practitioner comes into contact with you, other than normal nursing staff, expect a bill for it. If your hospital is in network, so should those practitioners. (Not always but they should.)

In-network and out-of-network are almost always separate.

Like Lovely said, you will likely get bills from any practioners you see at the hosptial (not employed by the hosptial, like nurses and registrars). If a doctor or anesthesiologist is practicing at your hosptial they *should* be in the same network.

Insurance is such a pain in the butt!
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Last edited by Lucky Mama; November 27th, 2012 at 11:03 PM.
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