Anyone have Humana insurance and had a baby?

[disneypolybride2008]

Hi. I had an individual plan and it said that all charges of having a baby were covered. It listed in my explanation of benefits that all the services involved in prenatal,delivery and postnatal care were covered. It even had a chart with sample charges of 'having a baby' which listed mother and baby charges and the deductible of $3600. It was just what i signed up for. BUT Then once i actually delivered, they say it changed my policy to a family policy which has double the deductible. Now nothing is getting paid up to $7300! I don't feel this is correct and after numerous calls and having supervisors agree with me and submit claims for review, and then i sent in two letters to Appeal and Grievance. The letters say under indiana state law the newborn must be covered, but that at the day she was born it switches to a family deductible. Now i'm speaking with a representative again to discuss it. She agrees with me and said that the state of indiana says newborn charges are to be covered under my plan. YES!! The last supervisor had said that the newborn was added and that it was an error how it made it go to the family deductible, and that it cant be fixed.

Is there anyone out there who can help? Anyone who had a baby and got the charges covered without being a family deductible? I had Anthem 3 years ago with my first child and charges were as i believed to be covered, under me and my deductible, no problems.

The explanation of benefits also shows 100% coverage after deductible for an ambulance both for in and out of network and yet they are then making a max allowable fee and making me pay the rest, and then not paying an ambulance charge of $750 for the newborn who was born it in, not paying because it has to go towards this family deductible.

 

[aprilchem]

Every time I've had a baby I've had to pay the deductible for both me and the baby. And I've had 3 kids on three different insurance plans.

 

[disneypolybride2008]

ty looks like i have to pay it

 

[Lilliputian]

I'm a mom of 5. I've always had to pay a deductible for myself and for the baby, but not much is charged toward the baby, so I never met the deductible. (Note that this would be quite different if there were medical issues with the baby.)

Usually the basic hospital charges are all charged to the mother. The room and board, the basic materials that include diapers and such, and those basic things that every birthing mother gets charged for are charged to the mother. Things that are specifically for the baby (exam by the pediatrician, hearing test, heal prick, etc.) are charged to the baby. It's a chunk of change, but it shouldn't reach your deductible.

I'm guessing that if the baby had issues and needed extra care, you could easily reach your deductible. I don't know where the line would be. It may vary by hospital. My first was a preemie and spent his first few hours in the regular nursery (not the NICU) on monitors, and I don't think I paid anything extra for that at all. It was 12 years ago, though, and I've paid a lot of health bills since then, so I could have forgotten.

 

[DSNY4ever]

Ugh, I feel your pain! I did not understand this the first time either, and we had the same thing. Both our kids had jaundice too and were treated as a "separate patient". We had to pay the family out of pocket and it was so expensive. Everyone talks about the costs of having a baby...the crib, the diapers, the stroller, but the real HUGE expense is the birth! My two kids are the two most expensive things in our house, and my mom always goes on and on about how my sister and I were both completely free...my how times have changed!

 

[MandiC]

Yep, deductible for both mom and baby here also, I do believe only one of my babies ever *met* the deductible right away though (and she had to go to the NICU).
The thing I am not understanding is when you say the plan changed with the birth of the baby. I can see how that would happen with a first baby but since you already have another child not sure why your plan would change since you would already have the family plan with her on it?

 

[Habbott]

It sounds like you could benefit from talking to a consultant in your state's department of insurance. They have law books for your state to refer to, plus they can inquire on your behalf to get the details of your policy.

 

[SandyinMonterey]

I don't know if this will help (it's not related to delivery). Anyway, I had a huge problem with our medical coverage related to our daughter (2 at the time). It involved a lot of money that was going on at the present time and for at least the next couple of years or more. The run arounds, the mis-information, giving me extensions of people who didn't even exist...I can go on and on. I called HR department who got me in contact with the people who assist in selecting coverage for the company my husband works for. They were a big help and not only resolve the issue, but got it covered.

 

[disneypolybride2008]

yes the most expensive part is the medical cost to have the baby. i had the baby in the ambulance, thank god all went fine and we didnt need anything extra. just a healthy baby and i never had any iv or drugs, nothing and the billed charges are 14K, but then they negotiate with them and get it down for me to pay 7K, but that is still 2x as i anticipated. then they said i nearly met the 'family' deductible months ago, and i just got the ambulance bill reworked. It still is all my responsibility to pay since it is going towards my deductible. It doesnt make sense that it is all my pay. I was nearly at my deductible back when i inquired about the whole problem in October. LaSaria said i only had $62 to go. Now it says i still have $43 left after applying $942 of the ambulance charge towards it. NEVER get Humana!

 

[Raenstoirm]

It doesnt make sense that it is all my pay. I was nearly at my deductible back when i inquired about the whole problem in October. LaSaria said i only had $62 to go. Now it says i still have $43 left after applying $942 of the ambulance charge towards it. NEVER get Humana!

Was your baby born in 2015? The deductible resets on Jan 1.
I am having twins so I just assumed their birth will eat through my entire out of pocket max for 2015.

I can do you one better with insurance issues though. My husband and I are self employed so we buy private insurance. We purchased a plan that specifically included maternity since we had planned to start a family in a year or two. Fast forward that year or two and I get pregnant and head to my first OB appointment. Get the bills a few weeks later and my insurance no longer covers maternity. They claimed they had sent me a notice. Um, don't you think i would have changed insurance before intentionally becoming pregnant if I knew this? They did not notify me. My pregnancy was planned. After a week of panic, I managed to secure new insurance with Carefirst and have had no issues so far. I received the denied EOBs from the old insurance, but never a bill from the lab that did the very expensive bloodwork, so i keep waiting for the $2000 bill to show up. I am not sure how long the lab has the right to bill me, but it was over the summer and no bill yet.

 

[Mousemommy1]

Was your baby born in 2015? The deductible resets on Jan 1.
I am having twins so I just assumed their birth will eat through my entire out of pocket max for 2015.

I can do you one better with insurance issues though. My husband and I are self employed so we buy private insurance. We purchased a plan that specifically included maternity since we had planned to start a family in a year or two. Fast forward that year or two and I get pregnant and head to my first OB appointment. Get the bills a few weeks later and my insurance no longer covers maternity. They claimed they had sent me a notice. Um, don't you think i would have changed insurance before intentionally becoming pregnant if I knew this? They did not notify me. My pregnancy was planned. After a week of panic, I managed to secure new insurance with Carefirst and have had no issues so far. I received the denied EOBs from the old insurance, but never a bill from the lab that did the very expensive bloodwork, so i keep waiting for the $2000 bill to show up. I am not sure how long the lab has the right to bill me, but it was over the summer and no bill yet.

If it was genetic testing like Panorama, it can take forever! I had the testing done in July and didn't receive an EOB from insurance until November! The whole $2900 was covered but geez it took a long time to process...