Home Health Insurance Plan Question

[luckystar112]

Dh got a new job, and we are looking at the multiple health plan options. We are taking into account that we will probably be TTC in the next year or two. One plan looks very promising, but when you get to the maternity section is says "payable as any other expense". Does anyone know what that means?????
I was guessing that it meant that pregnancy is treated like every other "sickness", but then why not just put "80% after deductible" like they did in every other category? That is what is leading me to believe that it means something totally different. DH thinks it means they don''t pay for anything...so, clearly we are confused.
Any ideas?

 

[Tacori E-ring]

I would call the company and ask.

 

[luckystar112]

That would be the obvious thing to do, huh?

I was hoping maybe someone had run into the terminology before. I will definitely call tomorrow unless someone responds with the answer.

 

[Hudson_Hawk]

LS, definitely call the ins company and ask. I''ve never read a schedule of benefits that I actually understood as written. It always takes in-depth verbiage analysis or calling the ins company for clarification.

Additionally, if you don''t have it already, look into short term dis plans for when you''re out on Maternity leave. You might want to consider getting an independent plan if your company doesn''t offer one. Most ind plans have prerequisite time periods before they''ll pay out for a claim so you want to make sure you enroll well enough in advance to make the benefit worthwhile. Also, unlike health plans, STD plans CAN consider pregnancy as a preexisting condition so you''ll want to sign up well before you''re pregnant to ensure you can realize the benefit.

 

[Loves Vintage]

Hi LuckyStar,

I worked for a major insurance company as my first job out of college. I was responsible for coding benefit plans into the system and also for putting together summary sheets, similar to what you are looking at, but which we shared with the HR departments of our customers. They would then put together their own information to send out to employees/members. There would often be several iterations of these plan sheets, with input from several different people. I am nearly certain, based on what you stated, that the maternity benefits would be covered same as any other medical expense, which you state is 80% after deductible. The fact that different language is used in the box next to maternity is likely due to someone having copied and pasted that from another chart so that language gets carried forward, but it means the same thing. There is A LOT of information to manage, and this sort of inconsistency, which may seem odd to a consumer, is actually rather unintentional. You should call the insurance company for your peace of mind, of course, but I would be very surprised if maternity was covered at any lesser rate. I would be shocked if there was no maternity coverage at all!!!!

Are there any 100% coinsurance plans available? Since we are TTC, we selected a plan that pays 100%, no deductible, for in-network expenses. The amount we contribute toward the plan each month is higher, but when we (err, DH really) calculated out the potential costs under the less expensive plan (which I believe was 100% after a 1k deductible) we decided to go with the more expensive plan because we are actually paying out less. Of course, you can change your plan selection at open enrollment (usually Jan. 1) each year, so you would likely want to hold off on a more expensive plan until the year you expect to conceive.

Fun stuff!

 

[MichelleCarmen]

Yes, you should call and find out. When dh and I decided to begin a family, because my DH was self employed, I called around and found the best I could, which was 80% of expenses. After 2 c-sections (one an unplanned so it was more than the usual), we still owed a lot! If I were you, I''d look for a plan that covered more than that so you''re not stuck with owing thousands!!!

 

[luckystar112]

Thanks everyone.

I''ll have to look at the different plans again but I''m pretty sure that 80% was the highest amount covered. But, a couple of them have a pretty low annual out of pocket maximum, so paying $3000 or so to have a kid doesn''t seem THAT high. I mean, you get a kid out of it, right?

But what do I know? For I know it could mean "we will pay 80%, but only if you have a perfect pregnancy and delivery with zero complications and you and the baby are out of the hospital within 24 hours".
I guess since we will be able to change plans in the future we should just go with the cheapest option for now. Thanks for your help!

 

[Hudson_Hawk]

Date: 4/9/2010 12:17:37 AM
Author: luckystar112
Thanks everyone.


I''ll have to look at the different plans again but I''m pretty sure that 80% was the highest amount covered. But, a couple of them have a pretty low annual out of pocket maximum, so paying $3000 or so to have a kid doesn''t seem THAT high. I mean, you get a kid out of it, right?

But what do I know? For I know it could mean ''we will pay 80%, but only if you have a perfect pregnancy and delivery with zero complications and you and the baby are out of the hospital within 24 hours''.

I guess since we will be able to change plans in the future we should just go with the cheapest option for now. Thanks for your help!

LS I probably should have mentioned that I have a PPO plan that pay out at 80% but for maternal care and deliver it''s 90%. My out of pocket co-insurance (I have no deductible) is $3k. Honestly, knowing how big some of the bills are from pregnancy and labor I feel like $3k is nothing. So if you can find a plan that is manageable in that regard, go for it. Just call and ask them to walk you though the prenatal/delivery aspects specifically. And then when you are actively pregnant and going for appointments/labs, check your bills carefully to ensure that you''re not being billed incorrectly. I just got a $180 bill because my insurance didn''t cover the genetic testing for CF even though I have a family history of it. The doc didn''t code it as Medically Necessary so now I''m appealing it with the insurance company. The bill isn''t the end all be all and you can have adjustments made when needed if there''s really a mistake.