I have an HSA this year which has a $2500 deductible per individual. With an in-network family deductible being $5000. So I'm wondering how my plan will work with the delivery. I know that I will only have to pay $2500 this year, but once I have her will insurance apply her hospital stay under my deductible or her own deductible. Have any of you ladies called the hospital your delivering at about how they bill insurance for a newborn? My co-worker said it all went under her deductible, but she does not know if it was a fluke. Also her plan was for just her before the baby, it did not include a spouse like mine does.
For us, DD's birth was under my name, cause it was my procedure. I don't think they'd switch you to a family plan until after you submitted the health ins. form stating that your LO is now part of your family, kwim? And that would happen after the birth.
My insurance has an estimator online, and it showed that the costs would basically be billed all to me. As pp mentioned, I won't have insurance for baby until after I deliver...so I would think all the charges would be charged to me under my deductible and such.
I would call your insurance company just to make sure, but based on the information my insurance company had on their web site that is what it looked like to me.
Your ob's office may also be of some help. I got a letter from my practice last week about what my total estimated cost will be for all the office visits and expected l&d charges. I'm supposed to pay X amount each visit towards it through the end of my care.
Anecdotally, it may depend on what happens at the delivery. My sister's baby had some complications and had to be in the NICU for about 5 days, so once they discharged my sister without the baby, they had to pay a separate deductible for the baby. Otherwise it would have been covered under hers. The really crappy part was that she delivered in late December, so she had to start over the next month!
Our plan is is like that too. They told me everything leading up to delivery, and the delivery, is covered under my deductible/portion. Then the baby's hospital stay is separate and towards the family deductible.
However, the part that confuses me is that the baby won't be added to insurance until after the hospital stay, so I don't know how that part works.
I think in most cases, you have 30 days to submit whatever paperwork is required, and then coverage is retroactive.
Post by sillygoosegirl on May 6, 2014 11:20:41 GMT -5
Don't forget that you will probably owe co-insurance up to your out-of-pocket maximum after you meet the deductible.
Baby is a whole new person and baby's care will bill out to baby's insurance, which you should be able to buy retroactively at work within, I forget, either 30 or 60 days. Don't forget to do this! This would be immunizations, pediatrician exam, possible NICU stay, and probably more stuff I'm not aware of. A lot of this is preventive care though, so baby's insurance should cover most of it at 100%, provided the pediatrician who rounds on you is in-network (not guarenteed, even if the hospital is in-network). My plan has a separate deductible (and separate out of pocket maximum) for each family member, but I think some plans do have one deductible for everyone (I think I've also had plans where it was $X deductible per person but $Y deductible for the family, where the family deductible was--or could be if you ha enough children--less than the sum of all the individual deductibles). However, I think it's really important that baby's name get on the insurance in the required time, regardless of whether it's a separate deductible or not.
If your plan year renews during your pregnancy, you may have to pay toward your deductible twice. For my clinic, they bill all the standard prenatal care bundled with the L&D, so that bill will by on next year's insurance. But all my lab and imaging work, "problem visits" (when I came in for a UTI, if I were to see a genetic counselor, etc) all bill out separately and immediately, so they count toward this year's deductible and out-of-pocket maximum. I could have saved myself a bundle by getting pregnant in September instead of February. Oh well.
The clinic I'm at had me meet for like 20 minutes with a "financial counselor" after they had all the details about my insurance (after my 3rd visit, I think), which was really nice. Though unfortunately, she couldn't really answer my questions about the hospital changes because she doesn't know that side of it. Nor did the information she got from my insurance company include the fact that my plan year is ending mid-pregnancy, though she knew how that would effect things when I asked about it.
This has been super helpful. I didn't understand the retroactive part.
I keep hearing that baby's care (NICU, etc.) may be billed to baby's insurance, but also that you can't add baby to the plan ahead of time. From what I have seen, we will have 30 days to add her to one of our plans.
Post by JayhawkGirl on May 6, 2014 14:32:31 GMT -5
So DH's benefits coordinator or insurance company failed to add dd despite an email confirmation that it was done. Here's what we saw:
Her care in the nursery (basically inpatient there for monitoring for about 18 hrs) had its own bill, along with some meds she needed. That all was covered with her own deductible, but as part of the first 30 days coverage as I am a member.
Pediatrician visits during those first 30 days were also covered. Day 31 however was not covered. We happened to have several office visits days 31 through 40 and I caught online that they were suddenly being rejected although earlier claims have been paid in full. That is how I learned about the first 30 days coverage under mom, and that there was a clerical error getting her added to our policy.
They did get her added retroactively and covered the things that were rejected. We never did find out who was at fault but it was all covered/applied to deductibles as needed.