Insurance question for mommies!

[luckystar112]

Well...I will FINALLY have health insurance pretty soon!

We have to apply for me to be put on FI's insurance 15 days before we get married, and then everything will be all set.

So I was talking to FI today about the plan and what it will entail, and he told me some stuff about pregnancy that I thought was interesting and wanted to run by you girls real quick.....

Basically, when we are going to TTC, we have to let the insurance company know so that they can set us up on a "rider" (or something), where everything will be included.

If we have an unplanned pregnancy, even though we are married, we better hope that it's a perfect (vaginal) delivery because the insurance company won't pay for a c-section or any other complications...baby illness, any illness I could get...etc.

Is this normal?

Forgive me if that's a stupid question, but I've never had health insurance before!
It just seems weird that I'd have to tell an insurance company that I'm going to try for a baby before I tell my own parents...
and if we happened to concieve after a wild party or something we're sh*t out of luck?

FI "doesn't remember" the name of the insurance company....

Everything else he remembers about the plan sounds amazing though....so I guess I don't get this part.

Any incite?

 

[Tacori E-ring]

You *NEED* to call them and talk with them. We are self-employed therefore buy our own insurance and I have to add the rider BEFORE I am preggo. They have a few weird rules too like they didn't want to cover some complications we had b/c the hospital didn't call for permission

The best thing I did was chose a pay down HSA with 100% covered after so I didn't really care (since I met my deductable already). You can dispute a bill but not sure how that works.

ETA: if I get preggo w/o the rider (or before it goes into effect) we have to pay for everything 100%. They will not cover ANYTHING pregnancy related. It sucks but that's the way it is.

 

[luckystar112]

Thanks Tacori...

Wow, I can''t believe how strict that is. I mean, I "get" it, I guess...but still.

The hospital calling for permission thing...just....wow.

I''m going to have to read up on an HSA....

 

[gailrmv]

I am so glad you are getting insurance, but this is definitely something to get more information about pronto! I would ask your FI for his official booklet of benefits, and if he doesn''t have it, call the insurance company and request it. Review carefully what is covered and not. If there is ANY chance of you conceiving, go ahead and add that maternity rider. You do NOT want to have to pay your maternity care out of pocket!!!!!!!!!! Also, if the insurance coverage sounds really crummy re: maternity care and potential complications, look into buying your own insurance privately or through your work or school before TTC. It is really important to have good coverage (or be sure that you can pay for what is not covered) because medical bills add up FAST. If you are a student, see if you can purchase insurance through school. If you are working, compare the coverage through your employer (or buying independent coverage through Blue Cross Blue Shield or similar) to what your FI''s plan is. Compare the fees and also what is covered.

 

[chrono]

Don''t mess around when it comes to health insurance (especially with pregnancy). Costs can add up quickly. Make sure you read all the details (DON"T guess) and make sure you are covered for your hospital stay, all the bloodwork, C-section or vaginal delivery and drugs that might be given during your delivery, doctor visits, etc. Also, make sure your new little one will be covered too. My delivery alone costs around to $8K for a regular vaginal delivery (but I stayed at a very luxurious top notch women and babies hospital).

 

[pennquaker09]

I ***strongly*** echo the statements already said. The insurance is one of the biggest costs from our surrogacy. We''re lucky in that Nate has pretty good insurance through the hospital, but we''re still paying an extra $500 a month.

 

[Delster]

Oh wow. I am speechless. An insurance company can insist on a hospital asking permission before administering a treatment??? Tacori I hope you sorted them out, that's awful!

I am so grateful we have free healthcare over here. I have insurance with excellent cover by choice. I don't really need it - I have it because without insurance access to diagnostic healthcare here is very slow and that frightens me. My insurance costs just over €700 a year, and it's the third one up from basic on my insurer's list of plans. In terms of maternity, all it does is guarantee me a private room (in a public hospital) and a consultant in the room at delivery, providing I've been able to find one to take me on (most of them are booked up). Without insurance I would still receive full maternity care for free in a public hospital (VB or C-section). I wouldn't have to pay a penny. Now, I might not get a delivery room to myself, and I for sure wouldn't get a ward with less than five people in it, but I would get excellent medical care.

Gosh when I read posts like this I feel so sad

 

[lyra]

Date: 4/25/2008 8:11:07 AM
Author: Delster
Oh wow. I am speechless. An insurance company can insist on a hospital asking permission before administering a treatment??? Tacori I hope you sorted them out, that's awful!

I am so grateful we have free healthcare over here. I have insurance with excellent cover by choice. I don't really need it - I have it because without insurance access to diagnostic healthcare here is very slow and that frightens me. My insurance costs just over €700 a year, and it's the third one up from basic on my insurer's list of plans. In terms of maternity, all it does is guarantee me a private room (in a public hospital) and a consultant in the room at delivery, providing I've been able to find one to take me on (most of them are booked up). Without insurance I would still receive full maternity care for free in a public hospital (VB or C-section). I wouldn't have to pay a penny. Now, I might not get a delivery room to myself, and I for sure wouldn't get a ward with less than five people in it, but I would get excellent medical care.

Gosh when I read posts like this I feel so sad

Wow, I'm truly shocked too. I'm in Canada. My first delivery was such a nightmare, and mostly the doc was to blame, but if we'd been saddled with having to pay for *that*, well we would have been bankrupt very early on. I had 2 c-sections.

I honestly can't believe you have to take out a rider when you're TTC, and that they won't cover you if it's "unplanned". What if you get the rider, but it takes a year or more to conceive? Do they then start saying you're not covered because maybe you have a fertility issue? Don't mean to cause fear, but I just can't wrap my head around this health insurance stuff. Mostly because I've required a lot of medical care in the last 15 years, and it boggles the mind that we never could have afforded it if we lived in the US. With the maternity stuff, to me that borders on sexism or something. I dunno, it just doesn't seem right.

 

[Independent Gal]

Health care in America never ceases to shock me. It''s like a horror show.

 

[neatfreak]

Wow. That just seems crazy. I called our insurance company a few weeks ago and they said that I didn''t need to tell them anything, that EVERYTHING was covered as long as the delivery was in-network(but even then I can deliver out of network if there is a family emergency or something), and the baby would automatically be added to our policy upon it''s birth.

I am so sorry to hear that your insurance is such a PITA!!! I was very pleasantly surprised when I called mine and found out there isn''t even a copay for anything!

 

[robbie3982]

Date: 4/25/2008 10:46:25 AM
Author: neatfreak
Wow. That just seems crazy. I called our insurance company a few weeks ago and they said that I didn''t need to tell them anything, that EVERYTHING was covered as long as the delivery was in-network(but even then I can deliver out of network if there is a family emergency or something), and the baby would automatically be added to our policy upon it''s birth.

I am so sorry to hear that your insurance is such a PITA!!! I was very pleasantly surprised when I called mine and found out there isn''t even a copay for anything!

This is how our plan was (I''m hoping how it still is!), but I need to call and check if anything has changed since the last time I called (which was the last time this topic got posted and I freaked out, LOL). When I look online it looks like something about our plan changed in February, but I can''t view any details. It just tells you to look in your plan book which I don''t have. We''re still with the same company, but I know we recently started having to pay a bit more each month. I''m hoping that''s the only thing that changed because I was pretty psyched about the coverage we had (hopefully still have!).

 

[luckystar112]

Yeah. I''m starting to get freaked out a little now.

Here''s what else I know about the plan (coming straight from the words of FI who I''m sure doesn''t know much about insurance either).

-They will take $70 out of his check every week (his employer also pays $70)...when I''m added, they''ll take out $90 from his check.
-Apparently we pay $50 one time a year...after that we don''t have to pay anything for any doctor''s visits
-If we had an accident such as a broken leg or something, they''ll cover it. But if we develop an illness or disease or something, we have a $2500 deductible.
-Generic medication will cost anywhere between $3-$15

apparently this is "good"??

IF could be wrong about some of this...he was just speaking from memory.
I need to find out more!

 

[curlygirl]

Date: 4/25/2008 10:46:25 AM
Author: neatfreak
Wow. That just seems crazy. I called our insurance company a few weeks ago and they said that I didn''t need to tell them anything, that EVERYTHING was covered as long as the delivery was in-network(but even then I can deliver out of network if there is a family emergency or something), and the baby would automatically be added to our policy upon it''s birth.

I am so sorry to hear that your insurance is such a PITA!!! I was very pleasantly surprised when I called mine and found out there isn''t even a copay for anything!

Same here. I didn''t have to do anything with my insurance company when I got pregnant. Fortunately, my doctor and hospital are in-network so I had no copays for my monthly appointments but I did have small lab bills here and there that weren''t fully covered. And when I gave birth, I think I ended up paying maybe $1200-1500 out of pocket but looking at the bills, without insurance it would have been over $20,000 for a regular vaginal birth! The US healthcare system is completely screwy.

Make sure you double and triple check everything and as others have said, read all the fine print.

 

[luckystar112]

Another silly question.....what does "in-network" mean?

Is it certain doctors that you must use?

 

[icekid]

Date: 4/25/2008 9:17:03 AM
Author: Independent Gal
Health care in America never ceases to shock me. It''s like a horror show.

I agree that healthcare in the States leaves a lot to be desired. However, I don''t think we are ready for a nationalized healthcare system. Americans are way too entitled. Wait 6 months for a MRI? No way. What, you won''t replace 95 year old granny''s knee?!?!?! I''ll sue! Crap, doctor better order 20 extraneous tests. Just in case! CYA (cover your a**) medicine, at it''s best. Costs soar... it''s a vicious cycle. In addition, I don''t think our government does much of anything well. Let them run healthcare? No thanks. Medicare is a huge PIA for docs. Regardless, there needs to be at least some basic coverage in place for those who are currently uninsured.

Lucky- it sounds like your FI''s employer opted for a less expensive plan. But still, it''s better than nothing! It''s pretty annoying that they don''t cover OB without the rider, but hopefully one of you will get a job in the future that will offer better benefits.

 

[icekid]

Date: 4/25/2008 12:04:37 PM
Author: luckystar112
Another silly question.....what does ''in-network'' mean?

Is it certain doctors that you must use?

It''s usually not a MUST, but your insurance will cover a (much) greater amount of costs if you are seen by someone who is in your "network." Basically they work out deals w/ these docs. Since they''re getting a more volume from your insurance, they''ll charge less. Something like that. My network is quite extensive though, so I can more or less see whomever I choose.

 

[neatfreak]

Date: 4/25/2008 12:14:10 PM
Author: icekid

Date: 4/25/2008 12:04:37 PM

Author: luckystar112

Another silly question.....what does 'in-network' mean?

Is it certain doctors that you must use?

It's usually not a MUST, but your insurance will cover a (much) greater amount of costs if you are seen by someone who is in your 'network.' Basically they work out deals w/ these docs. Since they're getting a more volume from your insurance, they'll charge less. Something like that. My network is quite extensive though, so I can more or less see whomever I choose.

I can see most dr.s in my city too, but some networks are much more restricting. A list will come with your insurance, or else your insurance CO should have a website where you can look up providers they cover.

If you've been seeing a dr. for awhile that you like, before you continue to see him/her, you'll just need to make sure your new insurance will cover it.

 

[luckystar112]

Well, it doesn''t surprise me that FI''s boss opted for a less expensive plan.

Still, I can''t help but be annoyed because this is after over two years of impatiently waiting for insurance....and a raise that FI still hasn''t gotten (a condition of his employment that should have been implemented within 6 months of being hired).

Grrr.

On the bright side, we really aren''t planning on TTC until I graduate and we are back on the east coast. It''s just frustrating to think that if life were to throw a curveball at us we won''t be covered.

Lyra, you bring up a REALLY good point about taking a while to concieve=fertily issues. I would put money on us not being able to concieve immediately. Part of the reason I wanted this insurance so bad is so I could get to the bottom of my girly issues.

 

[neatfreak]

Date: 4/25/2008 1:03:20 PM
Author: luckystar112
Well, it doesn''t surprise me that FI''s boss opted for a less expensive plan.

Still, I can''t help but be annoyed because this is after over two years of impatiently waiting for insurance....and a raise that FI still hasn''t gotten (a condition of his employment that should have been implemented within 6 months of being hired).


Grrr.


On the bright side, we really aren''t planning on TTC until I graduate and we are back on the east coast. It''s just frustrating to think that if life were to throw a curveball at us we won''t be covered.


Lyra, you bring up a REALLY good point about taking a while to concieve=fertily issues. I would put money on us not being able to concieve immediately. Part of the reason I wanted this insurance so bad is so I could get to the bottom of my girly issues.

Unfortunately I think that half-as* insurance like what your FI has is the norm rather than the exception. Part of the reason my DH and I are wanting to start our family now is that we happen to have fantastic insurance! It can be very expensive otherwise.

Just make sure you read ALL of the stuff that comes with the plan, and feel free to call them as many times as you need to to get the answers you need. With an insurance plan that has so many exceptions you want to make sure you follow the rules exactly.

 

[rockzilla]

Three words: Health Savings Account

Basically, you have them deduct a certain amount per year (say $1,000) and they deduct it PRE-TAX from each paycheck. That money can then be used for medical expenses...but the sweet part is, you can pull it from your account BEFORE it is actually deposited. So, when I got invisalign, I put $2k in the health savings (signed up in Sept I think). I got the ortho stuff done in Jan, paid it, then got reimbursed within 2 weeks...I ended up paying ~$120 per paycheck, but it was much easier than paying $2k at once...

Something to think about - when my grandfather died, my mom and I were going through my grandparents old things, photos, papers etc. She came across the cancelled check he had written to the family doctor for her to be delivered - $20!! Granted, this was 50 years ago, but still. No insurance, just $20 for a baby to be delivered!

 

[mrssalvo]

i''ve heard of needing to have a rider in place and it''s common for them to require it to be in effect 9 months b/f pregnancy. one reason is so people to buy coverage, get preggo, use the insurance to cover the pregancy and then drop the insurance. it''s a way insurance company''s try and cover their cost. we don''t need a rider with our plan, but we had to have it for 9 months b/f i got preggo for it the maternity coverage to kick in. i have never heard that a company would only cover a picture perfect delivery. that''s crazy. just check out the preggo thread and see all the unexpected with the gals there. you just can''t know. I''d suggest looking into buying your own insurance and opting out of the company provided one. In my state you can join the farm bureau and buy health insurance through them and it''s really good coverage. we pay less for our family of 7 than they are taking out of your fi''s paycheck, although we do carry a higher detuctable on certain things.

 

[robbie3982]

Whew! I called my insurance company and everything is the same. I told DH he can''t change jobs until we''re done having kids. LOL.

 

[miraclesrule]

Date: 4/25/2008 11:07:43 AM
Author: robbie3982

Date: 4/25/2008 10:46:25 AM
Author: neatfreak
Wow. That just seems crazy. I called our insurance company a few weeks ago and they said that I didn''t need to tell them anything, that EVERYTHING was covered as long as the delivery was in-network(but even then I can deliver out of network if there is a family emergency or something), and the baby would automatically be added to our policy upon it''s birth.

I am so sorry to hear that your insurance is such a PITA!!! I was very pleasantly surprised when I called mine and found out there isn''t even a copay for anything!

This is how our plan was (I''m hoping how it still is!), but I need to call and check if anything has changed since the last time I called (which was the last time this topic got posted and I freaked out, LOL). When I look online it looks like something about our plan changed in February, but I can''t view any details. It just tells you to look in your plan book which I don''t have. We''re still with the same company, but I know we recently started having to pay a bit more each month. I''m hoping that''s the only thing that changed because I was pretty psyched about the coverage we had (hopefully still have!).

Add me into the shocked beyond belief category. I think it''s appalling that an insurance company would require a rider or prior notice of a pregnancy. I think that most of these exclusions would be found on private policies or joint powers authority policies, but you won''t find this with normal group insurance through your employer. Heck, Medicaid and Medi-cal for those who have no income provides for better coverage than the plans you are describing. That''s despicable. It allows for discrimination and cancellation. Unbelieveable.

 

[Tacori E-ring]

My insurance sent me a list of everything they paid....it was around $23,000!!!! I had a VB (though baby and I both had slight complications). I agree, do not guess. They are the only ones that can help you with your questions. It is so confusing!

 

[luckystar112]

Thanks everyone for your replies.

I still don''t really understand our insurance, but here is what the handout says (FI said we''re supposed to get a more detailed list in the mail).
I added some commentary in case anyone wants to chime in and explain anything...but I know to get the real answers I probably need to contact them myself. Grrr this is annoying.

This optional benefit provides coverage for expenses incurred as a result of normal pregnancy and childbirth, including prenatal care. According to FI, "Normal" means a planned, no complications pregnancy...he thinks.

You and your covered dependant spouse are eligible for coverage under this rider if purchased

Choose your benefit (per pregnancy/childbirth)
Maximum for months in force 0-24
50% coinsurance What is coinsurance? Actually I don''t get what either of these two plans mean.
a. $1000
b. $ 2000
c. $3000

Maximum for months in force 25+
100% coinsurance
a. $2000
b. $4000
c. $6000

Once selected, the maximum benefit cannot be increased. Is this bad?

-If any complications of pregnancy arise, as defined in the certificate, benefits will be payable in accordance with the certificate provisions, including the benefits, definitions and exlusions and limitations. What certificate? No idea what they''re talking about here.

- Benefits payable under the rider are not subject to the base plan deductible. So does that mean no deductible...or a different one????? Geeze.

-If childbirth should occur prematurely, benefits will be payable in that amount, in any, that would have been payable if childbirth had occurred at full time. That''s wonderful. So if my baby is born premature and needs added care, too bad!!! Let''s just pretend that baby is normal.

Am I reading that right? This is obviously bad...correct?

-This rider may be selected only at time of enrollment in the plan or when a dependant spouse is added to the coverage. Are they trying to trick us here....so I can''t add the rider later? Basically as soon as I am covered next month we need to purchase the rider too? That''s not what FI said, but that''s what I''m getting out of this statement.

-Benefit amounts may vary by state.

 

[neatfreak]

Honestly Lucky, it is wayyy to complex to analyze here especially with only tidbits pulled out. You really need to call them. But it does sound like you need to add the rider when you enroll, so I would be aware of that.

 

[Tacori E-ring]

I agree you need to cal b/c no matter what we say they are the only ones who know 100% for sure. My insurance is similar where you can go down in benefits at anytime but not up (unless it is a certain time during the year). Look into HSAs. Worked well for us. Also make sure you know how much YOU will be responsible for (like 20% while they cover 80%) We chose a plan where they cover 100% b/c even 20% can get pricey (I was in the hospital for 5 days and Tessa had to have a pedi team during delivery). Also we knew EXACTLY how much we were going to spend (100% until our deductable was met then 0%). Good luck.

 

[luckystar112]

Yeah, I know I need to call them. I''m going to wait until we get the additional info in the mail, and then I wonder if I can even ask those questions without being on the policy?

I don''t know....I''m thinking about telling FI to just keep me off his policy and I''ll try to find my own through school or something. I think I''d feel a lot better if I was going through a larger company. So far, I''m not liking his plan and I think it''s a huge waste of money.

What I really want insurance for is so I can get checked out and figure out if there is anything wrong with my fertility. Not sure if this is the case, but if they require that we get a rider for THAT...well, that''s ridiculous.

I hate insurance companies.

But yeah....I''ll be looking into it further.

Thanks for all your help ladies.

 

[neatfreak]

Date: 4/29/2008 2:50:18 PM
Author: luckystar112
Yeah, I know I need to call them. I''m going to wait until we get the additional info in the mail, and then I wonder if I can even ask those questions without being on the policy?


I don''t know....I''m thinking about telling FI to just keep me off his policy and I''ll try to find my own through school or something. I think I''d feel a lot better if I was going through a larger company. So far, I''m not liking his plan and I think it''s a huge waste of money.


What I really want insurance for is so I can get checked out and figure out if there is anything wrong with my fertility. Not sure if this is the case, but if they require that we get a rider for THAT...well, that''s ridiculous.


I hate insurance companies.

But yeah....I''ll be looking into it further.


Thanks for all your help ladies.

Don''t worry Lucky, you''ll get it figured out. And I am SURE you can get your questions answered without being on the policy, you''ll just need to give your BF''s information to them so they know what policy they are talking about.

As for school insurance, if you are in college and getting a student health plan, it might be worse. If you are a graduate student and can get the insurance that faculty gets, THAT is sometimes amazing (that is what my DH and I have). So if you are a graduate student and can get a fellowship/assistantship with insurance that is probably the way to go.

Paying for your own insurance outright could be much more expensive than even what your FI pays. My parents are self-employed and their insurance costs are insane and their coverage for basic stuff isn''t fabulous.

 

[just_looking!]

Seems like middle east is similar when it comes to riders?! I have to be covered by the medical insurance company for 1 year before I am eligable for any maternity costs and other companies choose longer periods of cover, whilst others just don''t cover maternity at all!!

I chose to pay for an international cover (eye wateringly expensive) in case I end up getting stranded back in the UK whilst visiting relatives. This is because I''m no longer eligable for National Health Service i.e. British expats who choose to be classed as not ordinarily resident waive their rights to medical coverage.

Have a feeling that we might not get pregnant quickly, but wanted to be covered just in case as medical bills out here can really mount up!! I heard $22,000 for ''normal'' delivery with a private room, not including any of the prenatal checks.