Labor & Delivery & Insurance

[StitchesGr8Fan]

DH and I are on separate insurance plans brought our employers. We are trying for baby #1. I'm tying to figure out when baby will start getting its own medical bills and will need to be added to insurance. Also tying to figure out which annual out of pocket maximum will apply to labor and delivery bills - individual or family. Any advice from parents out there?

 

[Pstecker]

The baby will start getting medical bills the day it is born. Usually that is an unknown date, and our insurance just wanted us to notify them after delivery. As far as labor and delivery it should go towards individual , but I would verify how it all works with each insurance.

 

[cmwade77]

Usually most insurance pays for the newborn for the first month or until they are checked out of the hospital after being born (which ever is longer), but check with your insurance companies.

 

[RachaelA]

Babies start having their own bills pretty much the second they are born. You have 30 days to add them to whatever parent's plan, you want them on. You'll have to call the hospital/clinic and have them bill it all to insurance.

DD has a room charge from the hospital, a exam from the pedi on the day she was born and then a discharge exam from the pedi. Then I had more normal L&D and OB charges from my labor, her birth and my PP stay.

All my L&D charges counted towards my deductible amount and then my individual OOP max and our family OOP max.

 

[danceintherain]

You have 30 days to add them to whatever insurance you want them on. It works retroactively at that point, so you can pick one or the other.

We have Tricare, so I'm blissfully ignorant about a lot of insurance stuff, but from what I understand the individual vs. family shouldn't matter. Some of the expenses will be classified as for the baby, and some of them will be for you. None of the expenses will be coupled as "baby AND mother." So both you and the baby will count towards your own individual part and the family part.
So if it's something like this:
Mother: room, epidural etc = $5000
Baby: room, pediatrician, light for jaundice etc = $5000
$5000 will go towards each of your individual deductibles and $10000 will go towards the family if you choose to put the baby on your insurance.
The complicated part here is choosing between your insurance and your husband's for the baby.
Chances are it probably makes more sense to put the baby on your insurance initially, because a lot of the deductible will have been met by your maternity appointments.

Definitely call both insurance companies, because I know Tricare, at least, automatically covers newborns for a month.

 

[taaren]

It really depends on your state and insurance ... when DS5 was born in the state of California, he was automatically covered by my insurance for the first 60 days. That being said, we wanted him on DH's for his first shots since we wanted one consistent medical record, and since they were an HMO vs my PPO, getting him on their plan when he was born in a PPO hospital was tough, a lot of phone calls and paperwork when I was just exhausted from the relief of finally not being pregnant. My PPO had a maximum OOP annual cap of $1K, check your insurance policy for an annual "not to exceed" amount.

Good luck!

 

[ssawka]

You will want to look closely at both your insurance and your husband. When you have children, it is generally better to have a Family plan on one insurance rather than you and DH keeping separate policies. Most employers will add a little back to your pay if you choose not to be covered. Also, you do not need to wait until open enrollment if you choose to go with a family policy. Having a child is a "life changing event" (in more ways than 1! ) and qualifies for a mid-year change.

 

[StitchesGr8Fan]

Thanks for all the good advice everyone! Hubby and I decided to stay on separate insurances for now because I'm a regular at the doctors office and he's not, so I have a higher premium/lower deductible and he has the opposite. Plus our employers both charge us extra on top of the premium if we add our spouse and the elect not to take coverage through their employer. So it comes out to be the same $ a month either way, no savings.

 

[HM]

When I had my children, they were covered under my benefits while at the hospital. We added them to my husband's insurance after that. We went with a family plan on his insurance. I still have individual insurance on me from my work (no choice...but it also doesn't cost me anything), so I'm double covered.

 

[mistysue]

I also strongly recommend you know exactly what the details are for premiums and OOP expenses. Look into what each policy covers for shots and well visits- there are a TON the first year) Then when the baby is born, you will know if there are extra hospital things going on. Both of my sons had unexpected hospital stays, blood work and extra doctor visits and while a healthy baby would have made my company's insurance make sense, we saved thousands by having the baby on DH's insurance. Higher premium, but much more was covered. If you know all the information about both policies going in it will be easy to pick what to do when the time comes.

I am always for having a plan that covers everything for having babies. My first pregnancy everything was completely normal- until the day it wasn't. That day, I went from a pregnancy that would cost a couple thousand to one that would have cost close to a million if I hadn't had insurance! It was completely unpredictable and just from crazy random baby positioning. At 30 weeks, out of nowhere, her foot got stuck in my cervix- which if you ask any doctor can't happen. Hello hospital bedrest with specialists visiting constantly, constant monitoring, testing and medications to stop labor. Next two pregnancies were normal and then the babies got sick.

 

[100acrewoodsfan]

We had our first in December. Our plan paid out according to the employee plus spouse up until the day he was born. As soon as he was born we were switched to the family plan which raised our deductible and oop rates. We had already hit our deductible and were 400 shy of the oop before he was born. Once the plan switched over, we owed about another 1500 to hit the oop amount. This will most likely happen whether you put him on your plan or your husbands, but I agree with the pp that said adding him to yours will most likely be the cheapest since you have already been paying against the amounts.

On a side note, since you are still trying you might want to pay attention to when your due date will be. I know you don't have a lot of control over it but it can make a difference. Our insurance rolls over on Jan. 1. Thankfully our DS was born the very end of Dec, but if he had been born even 2 days later it would have cost us an extra 6000 dollars. We were very lucky that the pregnancy was covered under one calendar year.

 

[PrincessSuzanne]

I work in a hospital with registration and billing and they usually combine the mother and baby's bill and file it under the insurance on file. You then have 30 days to add the baby to whichever plan you choose.

Our hospital advises you to go in a preregister around the 4th or 5th month, they will check with your insurance company to see what your benefits are and approximately what you will owe and you can start paying then or at delivery. The biggest reason they encourage this is so when you come in to deliver, you don't have to stop and register, you can just go on up to Labor and Delivery and registration doesn't have to bother you while you are being prepped.

 

[PrincessSuzanne]

We had our first in December. Our plan paid out according to the employee plus spouse up until the day he was born. As soon as he was born we were switched to the family plan which raised our deductible and oop rates. We had already hit our deductible and were 400 shy of the oop before he was born. Once the plan switched over, we owed about another 1500 to hit the oop amount. This will most likely happen whether you put him on your plan or your husbands, but I agree with the pp that said adding him to yours will most likely be the cheapest since you have already been paying against the amounts.

On a side note, since you are still trying you might want to pay attention to when your due date will be. I know you don't have a lot of control over it but it can make a difference. Our insurance rolls over on Jan. 1. Thankfully our DS was born the very end of Dec, but if he had been born even 2 days later it would have cost us an extra 6000 dollars. We were very lucky that the pregnancy was covered under one calendar year.

I have never heard of anyone's kicking in that quickly. How did the insurance company even know you had delivered on that day?

 

[100acrewoodsfan]

When we notified them of the birth they back dated everything to the day he was born.

 

[BubMunkeyBles]

I have never heard of anyone's kicking in that quickly. How did the insurance company even know you had delivered on that day?

Retroactively changed probably.

 

[Crazy4Disney06]

DH and I are on separate insurance plans brought our employers. We are trying for baby #1. I'm tying to figure out when baby will start getting its own medical bills and will need to be added to insurance. Also tying to figure out which annual out of pocket maximum will apply to labor and delivery bills - individual or family. Any advice from parents out there?

Not sure what insurance company you have but we had Blue Cross Blue Shield with last pregnancy. The insurance covered him for 30 days but we notified them sooner so that there was no hiccups in the system.

 

[Betsy82]

I had two forms of insurance when my first was born. I carried a single policy and whenever insurance became available to my husband at work, we added a family policy. I still had approximately 4 months left on my single policy, though, which happened to cover the birth.

This is where it got confusing. Baby was automatically covered under my policy for 30 days. Like a PP said, the hospital lumped the bill for the both of us.
I had a csection and a $0 OOP for surgery or inpatient stays. So I knew I shouldn't have to pay anything.

Insurance paid MY bill and kicked baby portion back to my husbands policy because his birthday was first and technically baby actually had coverage on that plan.

Hospital fought it because both insurance companies took their write off for their portion of the bill they paid. It was a MESS. They kept trying to bill me for the write off amounts. DH's policy even had 100% maternity coverage, so still no OOP there either.

So. Is good you're doing your homework now. Try to make sure you know exactly how itsgoing to work (which insurance is baby getting?) so you don't have the same headache I did.

 

[dryvithome]

For the first baby, we had him at a hospital, with blue cross blue shield as the insurance provider. Hospital tried to bill us $1700 when our out of pocket was only supposed to be $500. Thanks to the slow pay by them, we almost got stuck with that. Insurance required that we notify them ahead of time about the birth (which we had done). And had 30 days to add the newborn to the policy. For the second birth, we did a homebirth with a midwife. No problems with insurance then. Gladly covered a midwife or a birth center second time around. (different insurance carrier). Best of luck!

 

[*Seanaci*]

When I was pregnant with DS in 2007, I had an individual insurance plan. Found a great OBGYN whom I saw a dozen or more times before DS was born. For whatever reason, the place I worked at changed/updated insurance yearly in Sept/Oct, rather than Jan like most places. So while I was looking forward to a labor and delivery at my hospital of choice with my OBGYN that I'd been seeing for the last 9 months, my work threw me a curve ball and changed to Kaiser insurance. Ummm...hello? I'll have to change doctors at the END of my pregnancy (my due date was Oct 10th) and deliver at a place I had never toured/been to before. My bosses sentiment "well, at least you'll only pay $25 for the birth of your kid this way."

DH and I ended up claiming common law marriage (life changing event) and submitting paperwork to his HR lady and adding me to his insurance so we could stay with my OBGYN and original hospital.

It's really great that you're looking into all of this now. But what blows my mind is that whether you change to your DH's insurance and drop yours altogether or vice versa, you're not saving any money. I would think that by dropping one and being on the employee +1 until baby comes along (and then switching to family) it'd be cheaper because one of you is not having health ins deductions taken out of your check anymore.

 

[malibuconlee]

One thing I haven't seen addressed is the "Global Maternity Fee". This is generally the charges an OBGYN charges the patient for all of the appointments leading up to delivery as well as a normal ******l delivery. Ours charged an extra $500 for a C-Section, which I had.

Mine charged at the very end of my pregnancy. Some as I understand charge as the pregnancy progresses.

Every employer and insurance is different, but I would definitely look into the different plans offered by both insurance companies. What makes sense and is cheaper for you when it's just the two of you can change when the baby comes along. It might be cheaper then to be all on one policy. Especially when it comes to deductibles and out of pocket max.

And, honestly, the HR dept or the insurance company you each have will be your best place for info on how your plans work!