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Insurance issues :(


Forum: September 2013 Playroom

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  • 1 Post By ValyntineG
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  #1  
April 3rd, 2013, 04:35 PM
321abc
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So my husband is switching jobs. Not necessarily by choice but it has turned out to be a good thing for the most part. Our insurance will cut off on may 1st. We had good insurance with only a $1000 deductable and the company paid 80% of mine and our sons premiums. We are talking about doing COBRA but I don't know the details of that. My husbands insurance with his new job kicked in automatically but mine won't until after 90 days. And it has a $5000 detuctable

I'm not sure if I understand detuctables, apparently we always met our deductable with our old insurance because I never even thought about it.
What's in my head is that we have to pay $5000 out of pocket before insurance will pay anything is that correct? Does that include doctors visits?
I think our total bill after having our son was less than $2000
Or does it mean insurance will cover everything after $5000 when we have this baby?
I am so confused and a little worried.
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  #2  
April 3rd, 2013, 04:51 PM
ValyntineG's Avatar Based on a True Story
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Ours is $5,000 too and it blows. What that means exactly will depend on your provider, but for us, that deductible needs to be met before they'll pay for ANYTHING. Doctors appointments, blood tests, ultrasounds, even prescriptions. It feels like I don't even HAVE insurance most of the time. I had to pay 150 bucks for an antibiotic last week. I don't even want to KNOW how much my anatomy scan is going to be.
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  #3  
April 3rd, 2013, 05:03 PM
321abc
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Yikes!!
It will be blue cross. I think we are going to get cobra for my son and I until after the baby is born since we have already met our deductible
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  #4  
April 3rd, 2013, 05:21 PM
Alpha_allie1010's Avatar Platinum Supermommy
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Location: San Antonio TX
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We have BCBS and personally...I hate it. We have a 3k deductible and we have to pay it first before insurance will pay anything WITH THE EXCEPTION OF well visits and meds. Well visits are 100% covered and meds just have a co-pay. FYI the Deductible you paid toward your other insurance SHOULD go toward your ded. with your new ins. We switched from Humana to BCBS and our old 1K ded. was applied towards our 3K one with the new ins. You just need to call to verify!
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  #5  
April 3rd, 2013, 05:50 PM
321abc
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I appreciate the information. I still think I'm gonna extend our united health care until this baby is born. Or maybe I'll shop around for different insurance
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  #6  
April 3rd, 2013, 06:31 PM
Super Mommy
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Posts: 755
I have Oxford with a 2k deductible. The deductible is only on special testing, things at the hospital, etc.

My regular dr appts and specialists appts are just a copay.

My nt scans, anatomy scan are all done at the hospital and not my ob, so they Re subject to deductible, then covered 100%.

Found out the hard way that genetic screenings done at my ob office are subject to deductible. I'm fighting with them now.

Good luck! Insurance is such a pain to deal with.
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  #7  
April 3rd, 2013, 06:35 PM
321abc
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I'm wondering if I should just get insurance separate from my husband.
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  #8  
April 3rd, 2013, 07:51 PM
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COBRA may not be worth it, once you find out how much it would cost to continue it. Like for us, if my husband were to get laid off right now, we would pay $1800 per MONTH to keep our insurance. I would imagine yours is lower, since your deductible is higher but it can get REALLY expensive.

But then, the cost of not having insurance would get pretty high, pretty quick, too.

As far as the deductible, it will just depend on your insurance. Generally, I believe you pay the full deductible before insurance kicks in and then even then, you may still have to pay a certain percentage until your out of pocket maximum is met. For example, our family deductible is $320 or $340 but our out of pocket max is $1500, so for certain things, we still have to pay 10% until we reach $1500 out of pocket in a calendar year. My mom's, on the other hand, is $8800, so each year, she has to pay for $8800 worth of treatment before everything is covered 100%. After the OOP max is met, everything will be covered completely, except prescriptions, which are generally on a different plan.
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  #9  
April 3rd, 2013, 08:15 PM
iCathy's Avatar Mega Super Mommy
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I'm no help. Since getting out of the military, I transferred to DH's insurance which is UHC, and they have been pretty great. All this civilian health care still confuses me! Good luck!!
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  #10  
April 3rd, 2013, 08:45 PM
321abc
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UHC is fantastic. Our deductible only applied to hospital stays or surgeries. And we only had to pay 20% out of pocket. I am so sad that we wil be losing that great insurance.
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  #11  
April 3rd, 2013, 09:00 PM
babybatax2's Avatar Platinum Supermommy
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We also have a $5,000 deductible. We meet it easily in a month so it works out for us!
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  #12  
April 4th, 2013, 06:12 AM
L-SBB's Avatar Bébé Cowgirl
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Quote:
Originally Posted by skye10 View Post
I appreciate the information. I still think I'm gonna extend our united health care until this baby is born. Or maybe I'll shop around for different insurance
If you do this make sure that the individual/private policy includes pregnancy coverage and that your existing pregnancy is covered. I don't know if anything in Obama Care changed this, but a few years back there were a lot of stories discussing how difficult it was for pregnant women to get private health insurance - either being excluded as a pre-existing condition or just cost prohibitive to had maternity coverage added to a standard private policy.
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  #13  
April 4th, 2013, 07:14 AM
jensma's Avatar Katie: mommy to Ty & Em
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we pay for private bcbs for our kids and its worth it for them. their well visits are covered 100%, the only pain is we have a $200 rx deductible. but if its a generic rx its usually not bad. the only thing i have paid a lot for was zofran when my dr was on an antibiotic and it was like $41. :/ It might be worth a look for just your son until your insurance kicks in instead of cobra. we pay $400 a month for myself and kids for that coverage where cobra when i've been offered it is anywhere from 700-900 a month.
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  #14  
April 4th, 2013, 08:04 AM
Keakie's Avatar Learning to walk in faith
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I'm going to try my best to explain ours a little bit, although I'm from Canada and am still adjusting to y'all's crazy insurance so parts of it are still a little confusing for me.

Our deductible is $2250 for the entire family, and we're actually fairly close to using it up for the year already. Like other posters' insurance, regular visits just require a co-pay and special things like my ultrasounds, blood work, etc. go towards the deductible. We would have hit it already (or been less than $200 from hitting it) if it wasn't by calendar year because dh had to have an MRI done on his back in December, but what can you do? I was really freaked out by the big bills for the blood work, but he explained how the deductible worked and I think I'm understanding a little better though.

I'm still not totally sure - ultrasounds go towards the deductible but we only had to pay like, $21.00 for our 10w ultrasound, and insurance covered a good chunk of the blood work but we'll still have to pay $700.00 out of pocket for a couple of those tests by the time this is over (and I didn't do any genetic pre-screening blood work either - just regular blood work).

I'm sorry you're losing your awesome insurance. I hope you find something alright for your family. This insurance stuff is so nuts.
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  #15  
April 4th, 2013, 09:41 AM
321abc
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Quote:
Originally Posted by L-SBB View Post
If you do this make sure that the individual/private policy includes pregnancy coverage and that your existing pregnancy is covered. I don't know if anything in Obama Care changed this, but a few years back there were a lot of stories discussing how difficult it was for pregnant women to get private health insurance - either being excluded as a pre-existing condition or just cost prohibitive to had maternity coverage added to a standard private policy.
I've been looking online and I can't going anything that covers maternity

I don't think I could qualify for Medicaid though I did read that they make it easier for pregnant women
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  #16  
April 8th, 2013, 04:58 PM
Cccbb61013's Avatar Veteran
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Posts: 467
Obama care has changed this but unfortunately it doesn't go into effect until 2014 (I've checked since my husband may be getting laid off). Right now it is impossible to find an individual health insurance plan that will take you on when pregnant. I even read an employer sponsored health plan can deny you (until 2014) bc it's a pre-existing condition! Which is very scary.
Having previously worked for an insurance company I am pretty well versed on the whole process but even for me it can be confusing. First of all, your insurance company does not set your deductible, your employer does when they pick the plan for you. So somebody with a $5000 deductible through BCBS may think they suck, but I had them for many years (no deductible, then $250, then $500.....all chosen by our employers) and I was happy for the most part. I currently have united health care with a $500 deductible per person and a $1000 family deductible. What that means is each member of our family has to pay $500 towards our medical services until the plan will cover 90% of the costs. The $1000 family deductible means once we spend the $1000 between us towards the deductible it is satisfied, rather than every single person having to pay $500. For example if only I used the coverage, I'd have to pay the full $500. If both my husband and I needed it and we each paid the $500, then my son wouldn't need to pay it. Or I could pay the $500 and my husband and son each $250 and we'd meet it. If that's not confusing enough, certain services may not apply to the deductible. So if I go to the doctor and have a $30 copay, that's all I pay but that copay doesn't get applied towards the deductible. My bloodwork for this pregnancy has not been applied towards the deductible. I'm not sure if the delivery will be. If so, I will pay $500 plus my 10% coinsurance. Unless there's some special maternity coverage I missed (fingers crossed!).
You will want to see what the coverage is on your insurance after you pay your $5000. And to throw another monkey wrench in the whole mess, sometimes employers do things like give you a health card (like a credit card) you can use to pay for some of your coverage, or my dad's employer pays all of their $2500 deductible, the employees just have to submit proof of the bill. I saw somebody else say their employer allowed the portion of the deductible they paid with one insurance company to roll over to another. That is extremely rare. I think I saw maybe 2 employers do that during my time working with insurances. But it's one of those weird, confusing things that can happen.
Have you considered looking into CHIP for your son? That may save you some money.
Good luck with everything, trust me, I am in the same boat and know how stressful it is.

P.s. I was lurking from October DDC
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  #17  
April 8th, 2013, 04:58 PM
Cccbb61013's Avatar Veteran
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Posts: 467
Obama care has changed this but unfortunately it doesn't go into effect until 2014 (I've checked since my husband may be getting laid off). Right now it is impossible to find an individual health insurance plan that will take you on when pregnant. I even read an employer sponsored health plan can deny you (until 2014) bc it's a pre-existing condition! Which is very scary.
Having previously worked for an insurance company I am pretty well versed on the whole process but even for me it can be confusing. First of all, your insurance company does not set your deductible, your employer does when they pick the plan for you. So somebody with a $5000 deductible through BCBS may think they suck, but I had them for many years (no deductible, then $250, then $500.....all chosen by our employers) and I was happy for the most part. I currently have united health care with a $500 deductible per person and a $1000 family deductible. What that means is each member of our family has to pay $500 towards our medical services until the plan will cover 90% of the costs. The $1000 family deductible means once we spend the $1000 between us towards the deductible it is satisfied, rather than every single person having to pay $500. For example if only I used the coverage, I'd have to pay the full $500. If both my husband and I needed it and we each paid the $500, then my son wouldn't need to pay it. Or I could pay the $500 and my husband and son each $250 and we'd meet it. If that's not confusing enough, certain services may not apply to the deductible. So if I go to the doctor and have a $30 copay, that's all I pay but that copay doesn't get applied towards the deductible. My bloodwork for this pregnancy has not been applied towards the deductible. I'm not sure if the delivery will be. If so, I will pay $500 plus my 10% coinsurance. Unless there's some special maternity coverage I missed (fingers crossed!).
You will want to see what the coverage is on your insurance after you pay your $5000. And to throw another monkey wrench in the whole mess, sometimes employers do things like give you a health card (like a credit card) you can use to pay for some of your coverage, or my dad's employer pays all of their $2500 deductible, the employees just have to submit proof of the bill. I saw somebody else say their employer allowed the portion of the deductible they paid with one insurance company to roll over to another. That is extremely rare. I think I saw maybe 2 employers do that during my time working with insurances. But it's one of those weird, confusing things that can happen.
Have you considered looking into CHIP for your son? That may save you some money.
Good luck with everything, trust me, I am in the same boat and know how stressful it is.

P.s. I was lurking from October DDC
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  #18  
April 8th, 2013, 07:09 PM
321abc
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I appreciate the info! We got a letter a about COBRA and its going to cost $1500 a month to keep our family insurance. My husband is a salesman in the oil field so I'm concerned that we will end up making too much money to qualify for chip or Medicaid but $1500 a month is ridiculous. It will work out though!
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