High Deductible Insurance and Maternity

[readyin07]

A friend of mine is newly pregnant and considered high risk. She has already had a bunch of ultrasounds etc. and she said they cost her $200 a piece but it is ok b/c it's going towards her $2200 deductible so her delivery will be mostly paid for b/c she'll have already paid off her deductible. Except her birth will be in January 2016.

I also had a January baby in 2009. In my experience, insurance wasn't billed for the delivery/maternity care charges until the year of birth in 2009 (obviously ) but I had to prepay for those charges by the time I was like 6 months along in 2008. Things like bloodwork and ultrasounds were not included in the delivery/maternity care charges and  I paid for those immediately in 2008 when services were rendered and they applied to that year's deductible.

I am concerned for her that her dr will run her insurance and see she has met her 2015 deductible b/c of all the work-ups she has had to have done and they won't make her do her full pre-payment b/c she's met the deductible THIS YEAR. BUT then when she gives birth in 2016 they will run it through her insurance and she will have to pay b/c she hadn't yet met her 2016 deductible.

Is what I am saying making sense? I was trying to explain this to her and she was basically like no all I'll have to pay is the $2200 this year and my birth next year will be included in that. And maybe her plan works that way? Is that possible?

It wouldn't be a big deal except for they are in a very tough financial situation and I want to make sure she feels well prepared for the costs. I know her well enough to know that she will flip her lid if she gets an unexpected bill for $2k.

[Deleted]

Yeah, most insurance, even HD plans do not work the way she thinks it does. She will have to meet her deductible in 2015 and again in 2016. They don't carry over. She may not owe her OB any more for her routine visits, but the hospital bills will apply in the new year and she will be charged for that.

[AHappierHour]

My Doctor didn't bill anything till I had the baby. They collected the estimated costs for the delivery for the doctor before hand and I paid that monthly. The hospital billed separately but also didn't bill before I had the baby. Anything like labs and ultrasounds were billed during that time.

I think your friend should call her insurance company and have them explain it to her.

[emb9907]

I was due the end of the year too -- my doctor ran the numbers as if I had the baby in 2014 and if I ran into 2015 i was going to have to pay the deductible for 2015 too.

[underwaterrhymes]

It also depends on when her insurance renews.

Our open enrollment is in November each year and that's when the deductible resets.

[VeryViolet]

Are you sure her deductible runs on a calendar year?

But yeah my high deductible plan would not work that way. I would be out the $2200 this year and then $2200 plus 20% co-insurance after in January.

For reference I gave birth in October so all on one deductible (which I hit long before giving birth) and for hospital, doctor, anesthesiologist, etc. I paid around $2k.

[ninjabridemom]

I was told that it was for the plan year I gave birth. My plan at the time went from Oct-Sept (or Nov-Oct) so it worked in my favor, but if she's on the calendar year yes, she will most likely have to start at 0 in 2016.

Which sucks. I do think maternity care needs to be treated differently.

She needs to contact insurance and ask these questions, though. Ask about everything!! They are usually happier to help ahead of time than to try to solve a problem after the fact.

[karmasabiotch]

I didn't have to prepay anything. How does that even work? If you don't have the money they won't deliver your baby?

[georgie]

I actually just got off the phone with my insurance company regarding maternity care and didnt think to ask this so I am going to ask a question in here too.

I have a super low deductible, like $500.00, but when I called my insurance today they said I had only reach $188.00 towards my deductible. Now, I have had maybe 4 doctors appointments this year but also a good bit of blood work (3 betas and some other blood work) and 1 ultrasound for the baby so far and I guess I just thought I would be closer to my deductible. So, what types of things go towards meeting your deductible?

[Birdie]

There are a lot of factors in this. Are all of her ultrasounds done by the OB and not a third party? If it's a third party, they'll bill right away. If it's her OB, he/she may wait until the baby is born to bill. Does she know when her OB will bill her for everything? Mine told me that a percentage was due by the time I was 7 months pregnant, but never actually asked or billed for it. Everything was billed in February 2014 when DS was born. However, I had ultrasounds and tests outside of "regular" maternity stuff that was billed separately.

She also needs to see if her insurance covers ultrasounds for medical reasons. Mine only covered one ultrasound unless they were coded for a medical reason. If she's high risk and getting more ultrasounds because of that, that would probably be considered a medical reason (but again, she needs to find out - every insurance plan is different).

There's also the case of the hospital and possible anesthesiologist charges. They won't bill until the baby is born in 2016.

[cabbagecabbage]

My sister has an insurance policy with a July-June year so you never know if it might carry into January. But I'm confident she will owe the deductible for both years if her pregnancy spans two billing years. Duh.

[AHappierHour]

May 28, 2015 15:48:10 GMT -5 karmasabiotch said:

I didn't have to prepay anything. How does that even work? If you don't have the money they won't deliver your baby?

My doctor estimated the cost of a normal delivery and based off my insurance what it cost. They broke it down to 7 payments. I paid about $250 a month. I know there was a line in it if I had a c-section I would pay xamount more.

I have no idea what would happen if I didn't pay. I fortunately never had that problem. I liked it. One less bill to worry about after the fact.

I also have a very high deductible and I have never met it. I always have to pay.

[lust2hart]

May 28, 2015 15:50:00 GMT -5 georgie said:

I actually just got off the phone with my insurance company regarding maternity care and didnt think to ask this so I am going to ask a question in here too.

I have a super low deductible, like $500.00, but when I called my insurance today they said I had only reach $188.00 towards my deductible. Now, I have had maybe 4 doctors appointments this year but also a good bit of blood work (3 betas and some other blood work) and 1 ultrasound for the baby so far and I guess I just thought I would be closer to my deductible. So, what types of things go towards meeting your deductible?

You'd need to look at your plan. In my experience, a lot of preventative services are covered 100% by insurance, and so then you're only paying for the extra bloodwork or whatever. Sometimes co-pays go toward deductibles but not always.

[lust2hart]

May 28, 2015 15:52:38 GMT -5 AHappierHour said:

May 28, 2015 15:48:10 GMT -5 karmasabiotch said:

I didn't have to prepay anything. How does that even work? If you don't have the money they won't deliver your baby?

My doctor estimated the cost of a normal delivery and based off my insurance what it cost. They broke it down to 7 payments. I paid about $250 a month. I know there was a line in it if I had a c-section I would pay xamount more.

I have no idea what would happen if I didn't pay. I fortunately never had that problem. I liked it. One less bill to worry about after the fact.

I also have a very high deductible and I have never met it. I always have to pay.

Did they just hold the money in your account and then when you were billed, just apply your account balance to the bill?

[Velvetshady]

May 28, 2015 15:50:00 GMT -5 georgie said:

I actually just got off the phone with my insurance company regarding maternity care and didnt think to ask this so I am going to ask a question in here too.

I have a super low deductible, like $500.00, but when I called my insurance today they said I had only reach $188.00 towards my deductible. Now, I have had maybe 4 doctors appointments this year but also a good bit of blood work (3 betas and some other blood work) and 1 ultrasound for the baby so far and I guess I just thought I would be closer to my deductible. So, what types of things go towards meeting your deductible?

It depends on your insurance plan and how your doctors coded the visits/blood work. Are you  not getting statements from your insurance company documenting what was charged/covered/not covered?

[AHappierHour]

May 28, 2015 15:55:06 GMT -5 lust2hart said:

May 28, 2015 15:52:38 GMT -5 AHappierHour said:

My doctor estimated the cost of a normal delivery and based off my insurance what it cost. They broke it down to 7 payments. I paid about $250 a month. I know there was a line in it if I had a c-section I would pay xamount more.

I have no idea what would happen if I didn't pay. I fortunately never had that problem. I liked it. One less bill to worry about after the fact.

I also have a very high deductible and I have never met it. I always have to pay.

Did they just hold the money in your account and then when you were billed, just apply your account balance to the bill?

Yes.

[Birdie]

May 28, 2015 15:50:00 GMT -5 georgie said:

I actually just got off the phone with my insurance company regarding maternity care and didnt think to ask this so I am going to ask a question in here too.

I have a super low deductible, like $500.00, but when I called my insurance today they said I had only reach $188.00 towards my deductible. Now, I have had maybe 4 doctors appointments this year but also a good bit of blood work (3 betas and some other blood work) and 1 ultrasound for the baby so far and I guess I just thought I would be closer to my deductible. So, what types of things go towards meeting your deductible?

Most likely:

a) your doctor has not billed for those appointments yet
b) it's part of a pre-set cost for maternity care by your doctor and you will be billed at the end
c) the ultrasound was covered by insurance. I have Anthem and they covered one ultrasound. If it's a covered expense it won't go toward your deductible. Only money you pay out does.

The $188 is most likely just your blood work. But you'll need to check your bills to see what you've been charged for so far (assuming you've received them). If you haven't received a bill, you can either call back and ask what the charges are for the $188 or go online if your insurance company has records online for you.

And you should probably get clarification from your insurance company. Every insurance plan is different on what does and doesn't go towards your deductible. Low deductible PPOs are treated different than high deductible HSAs, etc.

I think the only thing that DIDN'T go toward my deductible was that one covered ultrasound. The rest was all billed to insurance.

[lust2hart]

May 28, 2015 15:36:46 GMT -5 readyin07 said:

A friend of mine is newly pregnant and considered high risk. She has already had a bunch of ultrasounds etc. and she said they cost her $200 a piece but it is ok b/c it's going towards her $2200 deductible so her delivery will be mostly paid for b/c she'll have already paid off her deductible. Except her birth will be in January 2016.

I also had a January baby in 2009. In my experience, insurance wasn't billed for the delivery/maternity care charges until the year of birth in 2009 (obviously ) but I had to prepay for those charges by the time I was like 6 months along in 2008. Things like bloodwork and ultrasounds were not included in the delivery/maternity care charges and  I paid for those immediately in 2008 when services were rendered and they applied to that year's deductible.

I am concerned for her that her dr will run her insurance and see she has met her 2015 deductible b/c of all the work-ups she has had to have done and they won't make her do her full pre-payment b/c she's met the deductible THIS YEAR. BUT then when she gives birth in 2016 they will run it through her insurance and she will have to pay b/c she hadn't yet met her 2016 deductible.

Is what I am saying making sense? I was trying to explain this to her and she was basically like no all I'll have to pay is the $2200 this year and my birth next year will be included in that. And maybe her plan works that way? Is that possible?

It wouldn't be a big deal except for they are in a very tough financial situation and I want to make sure she feels well prepared for the costs. I know her well enough to know that she will flip her lid if she gets an unexpected bill for $2k.

I don't know that this is likely. The doctor knows she's due in January, right?

[readyin07]

May 28, 2015 15:48:10 GMT -5 karmasabiotch said:

I didn't have to prepay anything. How does that even work? If you don't have the money they won't deliver your baby?

Yup. Hopefully you have a credit card.

DS2 was born in September. I had to prepay for everything but it doesn't count towards your deductible b/c the dr doesn't file insurance until after the birth. I had to have an amnio and a bunch of stuff AFTER I had paid the doctor so basically I kept paying until I met my $3000 to meet my deductible PLUS I had to pay the doctor like $1500 up front and prepay $300 for his circumcision. After he was born I was refunded that $1800 from the doctor's office. Shitty shitty shitty.

[Birdie]

Andplusalso things are changing too due to Obamacare.

[AHappierHour]

I also asked what would happen if my Doctor didn't deliver my baby because he was unavailable for some reason. They told me they would pay that doctor. I didn't have to worry about it.

[spankswife]

They can only bill at time of service, which will be the birth. She will pay whatever she pays for this year, plus $2200 in January.

Well visits are usually free/covered, so her OB may have her make payments towards her des throughout the year, that will go towards the jan bill. However she will pay the plan rate for ultrasounds, testing, and blood work this year up to $2200.

[lilafowler]

THANKS OBAMA

[spankswife]

Remind her to use Her HSA account to make it all tax free! She can deposit and reimburse herself what she has already paid this year so she can deduct that as well.

[lilafowler]

The Canucks in here are weeping for us.

[irishbride2]

Mine agreed to not charge me until Jan 1 2013. I was due in march, though.

I did have to pay lab fees earlier since that was not through my OB.

My deductible was/is 10k.

[riffraff]

My insurance runs April to April so she would be correct if that was the case here

[cville]

This sounds suspect. She needs better authority than what she has thus far.

[irishbride2]

Oh and my last insurance plan before this one ran Oct-Oct. So not all plans are Jan-Jan

[PeonyParty]

Our plan is March-March. There are so many variable here, she needs to call her insurance company and find out from them.