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The Good News and The Not-so-good News About Our Health Insurance

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Although we do have health insurance, there’s good news and not-so-good news about it when it comes to my pregnancy.

Good News: Overall, there is no deductible and we have to pay 30% for almost all services, up to the $2,500 out of pocket maximum. That’s not too bad, and quite frankly, that’s the best individual plan I could get with some sort of maternity benefit. It’s also with a trusted insurer that I have worked with before (Blue Cross Blue Shield). It will cover 70% of the delivery costs.

Not-so-good News: The plan does not cover prenatal or postnatal care. To me, this seems very odd because prenatal care is so important during pregnancy. With my son, near the end there were many tests and ultrasounds. I developed pregnancy induced hypertension and they wanted to monitor us closely. Add to that the fact that my son was almost two weeks late and I’m sure the costs were significant. I wish I kept all of the paperwork from our care, but I didn’t.

It would be nice if I can get an idea of what to expect for costs. This is my biggest problem with medical care. If you want to know the cost of something, you cannot get a straight answer. Even if you call to find out the cost of an office visit, they give you a run around answer about how many different things factor into a visit and they cannot possibly tell you the cost beforehand. Everything else I spend money on I can shop around wisely. Healthcare is a different story and it drives me crazy.

When I had my son, everything was covered 100% through my husband’s employer’s health insurance plan. I didn’t pay anything out of pocket. This time, I will need to be vigilant and apply some of the things I have learned:

– I will ask for detailed bills and go through them with a magnifying glass if needed to make sure the charges are correct.

– I will ask if there are ways to receive a discount (like pay in cash, perhaps).

– When it comes time to get prescriptions filled, I will shop around for the best price since prescription costs can vary wildly from pharmacy to pharmacy.

The last thing I want to do is to start putting medical costs on our credit cards. I will if I absolutely have to, but I won’t do it without a fight.

I can see it now…I’m 9 months pregnant and it looks like I am about to burst and I’m sitting there with the billing department arguing over a $10.00 overcharge. I’m laughing because I can see myself doing it! LOL.


14 Comments

  • Reply Jessica |

    Did you know about this beforehand when you chose your policy and was that a factor (i.e. the prenatal/postnatal would have been too much for the premium)?

    Are you going to save up a little each month to pay off the postnatal/prenatal?

    Sorry if these are bad questions to ask.

  • Reply Tricia |

    Hi Jessica – don’t worry, these are not bad questions. Sometimes I forget to include some details in my posts.

    I knew of the coverage when I obtained this policy. Of the policies that I had to choose from while shopping for health insurance, this was the only one that automatically included delivery. The others had an add-on you could purchase, but it had a limit as to what they would cover for a pregnancy. They also had a time limit (I think I had to wait two years to become pregnant for the full benefit). I’d have to look up the specifics, but the overall value was with the plan that we obtained.

    I do plan on using part of our savings that I have tucked away and also setting some more money aside to cover costs. I’m not sure how much yet.

  • Reply D |

    Hello Tricia,

    I paid cash for all my kids. No insurance.

    First of all, let me tell you DON’T LET MONEY keep you from prenatal care. When your Ob/Gyn or Midwife (I loved my midwife), first sees you and sends in the info to your insurance, they will see you are not covered. No biggie. Then, they will come back at you with a price. Sometimes, if the cost seems large you can negotiate. The next step, which their financial department will do, is work out with you a monthly payment. Be honest, if their amount seems too high, tell them upfront. They will appreciate your honesty and work with you from there.

    REMEMBER – YOU PAY THE SAME WHETHER YOU JUST SEE THE DOCTOR IN THE DELIVERY ROOM OR IF YOU TAKE ADVANTAGE OF A ZILLION PRENATAL APPOINTMENTS. This is very important to know. Doctors charge a set fee to deliver, regardless how often they see you. Did you get that?

    Now, that you are on the payment system, we move into – lowering fees at the hospital with self preparation. Okay, this is a little work so bare with me…….

    I want you to go to the hospital prepared. Speak with your doctor about ways to keep costs down. I had a midwife and she gave me a list. I brought my own Chux pads (those blue pads), my own kotex, my own tylenol, etc.

    Make sure your hubby is with you 100% of the time in delivery. Have him monitor what they give you.

    When you receive the bill, which Blue Cross will too, take your magnifying glass out, and save some money on your 30%.

    As I have said before, they will put in charges automatically, things that are normal for a delivery, even if you do not use it. It just pops on the bill. When you see those doses of Tylenol you did not take, cause you brought your own, chux pads, kotex etc… make a list, and call the hospital.

    Good luck, email me if you have any questions and think I can help. My last child without insurance was under $1500 out the door. I know how to do this.

  • Reply k |

    YES, you can negotiate for child birth. It’s profitable for hospitals, and they are happy to do this service. Here’s what you do: Make appointments well in advance (like now)with every possible hospital in your area. Tell them that you are shopping hospitals to find the one that will deliver your child, that you will be paying part in cash (you must do this to be able to negotiate) and that your insurance will cover the rest. Tell them that you will go with the lowest priced option. Like a person mentioned above, there are options where there is one fee for the whole package, so hopefully this will prevent you from being nickle and dimed for every test and prenatal service. Then start negotiating and pick the best one!
    Good luck.

  • Reply mapgirl |

    Have you tried asking Planned Parenthood? They have sliding scale payments and might be able to work something out for your prenatal exams. They do general OB/GYN services from what I gather.

    Also my favorite trick if you need prescription medication is to ask the doctor if they have any samples they can give you. I got lots of free sample asthma inhalers that way.

    Sometimes there are programs for reduced costs on meds if there is an onsite clinic, say at a medical school hospital vs major chain drugstore. Depends on if you go to a teaching hospital or not.

  • Reply Kellie |

    Do you have prescription insurance? If you do, it won’t do you any good to shop around for the best price. Generally there are two types of copays: flat rate ($10 for generics, $20 for brand name) or percentage rate (really called a co-insurance where you pay 20% for generics 30% for brand for example). If you pay a flat rate copay obviously it doesn’t matter where you go because you’ll always pay the flat rate. If you pay a co-insurance (you pay a percentage of the cost) you should know that your insurance goes by the usual and customary charge on that drug. Not necessarily what the pharmacy sends as cost. For example, lets say your insurance lists the usual and customary charge of your prenatal vitamins as $30 for 30 tabs and the pharmacy submits a price of $40 for 30 tabs the insurance company will calculate your co-insurance based on their usual and customary charge – not what the pharmacy submitted. Same thing with the doctors office. If you don’t have prescription insurance by all means shop around. Also, check to see if your insurance penalizes you for going to certain pharmacies – by penalize I mean charge more. With my insurance they do.

  • Reply KMK |

    That sounds really odd to me. It is true- doctors get a set fee for prenatal care, delivery, and care within the first 6 weeks postpartum from most insurance companies. I can’t believe the insurance would cover delivery but not the other. I agree that you should negotiate with your doctor’s office, and at the very least have them tell you up front what the charges will be. They will be more than happy to do this because they don’t want to start taking care of you unless they know you can afford it. Good luck!

  • Reply Deb |

    Hello – I work in hospital billing. Most hospitals will certainly work with you as far as paying your bills, giving discounts, etc. I’m surprised that your insurance doesn’t cover pre-natal care- I thought that by law they had to (maybe that’s just in my state, but I thought it was federal). Call the hospital that you plan to deliver at, and as to speak with a finance person – explain your situation and ask what programs they have that you can take advantage of.
    Also, if you have a healthy delivery & baby, you don’t have to stay 2 nights in the hospital, you can actually go home the next day. If possible, this would save quite a bit of money. Obviously you don’t want to do this if you have a c-section. Good luck!

  • Reply Jane |

    I think it must be that time of year! There was recently a similar thread on FatWallet regarding this issue: http://www.fatwallet.com/t/52/688958
    While this primarily deals with those who have no insurance, situations such as yours are also touched upon.

    In fact, one of posters noted that he actually *saved* more money by neogiating his own rates than if he had just used his regular insurance throughout his wife’s pregnancy!

  • Reply Donna |

    My pre-natal was part of a delivery package with the OB-GYN office. Check how the doctors bill. I know I also got separate bills from the hospital, doctor and anesthesioligist but my water broke 5 weeks early and I ended up with a C-section. You will want to check if they want you to be looked at as a high risk pregnancy since you developed the hypertension last time. That would determine if you need more visits or if you just need to invest in a home blood pressure machine to keep your own records. You can have the doctor you choose to get copies of your past medical records to review so you can make that plan of action for visits or how you want to proceed. Remember your health and the baby’s is priority so the earlier you make the plan the more confident you will be in the care you choose.

  • Reply Tricia |

    Thank you everyone for your input! I had no idea that I might be able to negotiate a package deal.

    Because where I live is so rural, the only OB/GYNs available are through a hospital. There are none in private practice. I essentially have two hospitals to choose from. One is really close and a smaller hospital, the other is about 15 miles away.

    I think the best thing for me to do is to make a visit to both hospitals to tour them and to ask many questions about costs. I’ll then compare them and figure out what would work best for us.

    Thanks for the fat wallet thread. Perfect timing!

  • Reply J |

    Tricia,

    Regarding prescriptions, the freakonimics blog had a report the other day about prices. Costco and Sams Club had the cheapest prices on everything. Almost 400% less than the corner pharmacies. The best part, by law you do not need to be a member to get your meds filled there.

    Other tips for meds. If you live far from Costco or Sams club ask your doctor to prescibe for 3-months before refills. That should save on driving. Of course, as other poster said get FREE samples.

    I delivered my child without insurance. I paid the doctor a set fee. We set it up on a monthly payment plan. By the time she was delivered he was paid in full.

    The hospital, on the other hand, was a racket. I decided 18 hours in labor for an epidual. They insisted we pay in cash first. My DH had to drive across town to the anetheistlogist(sp) and pay with CC while I was about the deliver. I deleived about 5 minutes after the epidual was administered (before it kicked in) and my legs were numb for a few hours afterward. $700 down the drain!! I could have delivered without it.

    My point is I was not thinking clearly while in delivery. I had not decided whether or not to get an epidual before I delivered, I figured I would just wing it. I was only praying that I would not have to have a C-section.

    The good thing is that you have done this before!!

So, what do you think ?