Strategies for handling not-great insurance and high risk pregnancy

[gillamnstr]

Hi all!

So I'm in a bit of a bind and would love any advice you can offer. Thanks in advance!

The situation:

-40yr old, very healthy, husband and I have zero debt (at the moment)
-Due to my luckily excellent health, I've always erred on getting the cheapest BCBS plan offered through my union
-Currently 29 weeks pregnant. We thought we were infertile, so this came as a major surprise and I did not plan my health insurance in advance accordingly, which has been really sucking now that the bills are coming in
-Husband has good job, I work freelance in film and will be on unemployment when current job ends until I can figure out next step (it's complicated - my house is 3 hours from where I work)

Health insurance plan:
-$3000 deductible
-$3000-$6500, insurance pays half, above that, insurance pays 100%
-talked to BCBS and they said they do NOT cover any anesthesia because they are always out of network
-Thus far, I've met $1900 of deductible
-Will be delivering in smaller town in Louisiana
-Mama and baby super healthy and doing great so far - mom would really like to get some physical therapy though for aches and pains but has been holding off due to cost

So thus far, my health insurance has paid nothing towards this pregnancy. I won't get started on how infuriating the American health care system is, considering I've been paying thousands of dollars into it for decades while never using it.

My question is, is there anything I can do to work the system and make this delivery more economical or am I just screwed and it's going to cost what it costs and there's nothing I can do but maybe ask for a discount from the hospital? I've considered going without anesthesia (please god no), I can't use a midwife because I'm high risk, is there anything else through the hospital perhaps I should be checking into?

Thanks!

[Sibley]

Short answer: You're screwed.

More useful info:
You need to look into the details of your plan. Things you're looking for:
-deductible (individual and family)
-out of pocket maximum (OOP max)
-look at these BOTH for in network and out of network.

My understanding is that once you've hit your OOP max, you're done and insurance pays all, regardless of in or out of network. Confirm that however.

Also, make sure you're very clear on how to get baby covered - what paperwork, deadlines, etc. Your SO is the one who needs to know how to do this, since you'll be busy with a baby. Thus, SO needs to take care of that piece as much as possible.

Assuming that you will be hitting your OOP max this year, it's also a great year to get anything else taken care of. Any elective things?

[Briarly]

Are you only high risk due to age? Many hospitals in our area have nitrous for anesthesia which would be your cheapest option for sure.

[gillamnstr]

I'm only high risk due to age - all else is good.

My OOP is $6500, and they're telling me they don't cover anesthesia due to them being out of network, but then I've heard that anesthesia is ALWAYS out of network and they get billed as in-network anyway?

[CindyBS]

I would appeal the anesthesia.  Insurance companies like to make people jump through hoops. 

Insurance can still deny things even if you have hit OOP max (we hit every year).  Sometimes they are very picky on brands or who provides the service. 

Also - it will be hard with a new baby, but this year is the time to get everything done.   I wouldn't hold off on PT, with delivery you will be hitting the $6500, so you are not saving any money by skipping it.  Don't forget mental health - Have you ever wanted to go to counseling?  Now is the time it will all be covered.

[bogart]

Congratulations on your growing family (I am assuming/hoping you are finding this a blessing even if an unplanned one).

If you become unemployed before baby arrives, can your DH add you to his insurance?

Medical care expenses above 7.5% of AGI are deductible this year if you itemize, so it may be worth looking into that and including checking things like married-filing-separately if that would make a difference (not sure how that works, just worth exploring).  You may also want to look at whether it makes sense to add baby to your DH's insurance or yours, and whether and how he can adjust any flexible spending account contribution once baby arrives.

Beyond that I will say ... pregnancy, childbirth, and early motherhood are hard.  There are places to pinch pennies, but if you have the option of not doing that, this is the place not to do it.  Certainly argue with the insurance and talk with your doctor and hospital, but also -- just pay for what you want (e.g. anesthesia) if you can afford to (which it sounds like you can, even if you're not rolling in $$$).  And yes, once you get to the relevant limits, get all the care you can get this year, covered.

[brycedoula]

While not American I have several American Internet friends who have provided tips over the last few years, relating to hospital stays. The biggest takeaway for hospital births always seems to be TAKE YOUR OWN THINGS.

$12.00 per pill for hospital-administered ibuprofen? No thanks, I have my own bottle of generic.
$15.00 per box of Kleenex? Have some in my bag, thanks.
$20.00 per pair of postpartum panties? Bought some already from Amazon/local medical supply store.

As far as anesthesia goes, it is totally (but maybe not necessarily desired ;) ) to give birth sans pharmacological relief, even for a first-timer! Look into "natural childbirth" classes, get yourself a copy of The Birth Partner by Penny Simkin, check out HypnoBirthing CDs from your library, etc. Obviously in an emergency situation (unplanned c-section for whatever reason) anesthesia is required, but if you really need to save $$$ on your bill then avoiding "elective" pain meds is a way to do it.

[TheWifeHalf]

I am proof that a woman can have 3 babies, separate births, without drugs.

This will sound weird, I know, but I was thinking, if our dogs do it, so can I! This was back when they kept the moms 3-4 days though.

[me1]

I also just had a baby at 40. No anesthesia or any meds. It was totally fine. Also didn't exactly know this will be happening, so had shitty insurance, not that the other option would have been much better. Know what I did? Started credit card churning. If this baby is gonna cost me through the wazoo, it may as well pay for my trip to Europe! still sucks but makes me feel  little better.
also i talked to the medical staff about the high risk bit. A lot of them were of the opinion that that 40 used to be considered high risk, but is so common now, that it should be reconsidered. so don't let it worry you, if you are going to your appointments and all is looking fine.

[Paul der Krake]

Is your plan HSA-eligible? If so, funnel money into it. Instant savings of whatever you put in times your marginal tax bracket.

[Bourbon]

Can you pull your benefit plan document?  Sometimes the out of network deductible will apply to the in network deductible as well.

But yes, generally anesthesiologist do not contract.  In the past you could get them treated as in network as you don't have a choice of provider. Payment is probably still large with no contract, but still may keep it under your 6500 limit.

[bogart]

Hi again.  I just want to chime in with one more thing ... a number of posters have commented that you can have a baby without anesthesia and of course this is totally true and great if that's what you want.  But you expressed a desire for it and that's also great. 

I had wanted/planned to go the no-drug route and ended up with a (non-emergency but medically recommended due to signs of fetal distress) c-section. I now wonder (well, truthfully, I don't think about it much, but when I do think about it, I wonder) whether if I'd had an epidural I might have progressed more quickly and avoided that (I labored for 36 hours, no pain relief until maybe 32 hours in at which point I did have an epidural, never had much progress and baby was blocking my ability to pee, so I was catheterized during much of that.  Had the c-section when his heart rate started decelerating).  Anyway, key point, pain relief can be great and I am one mom who does now wonder (when I think about it at all) whether making more use of it would have resulted in my having less need of invasive medical care.  Of course, I'll never know (and it's not a worry), but ... do what's right for you.

[Dee18]

A colleague of mine was very frustrated by being charged for things she didn’t even use when having her first child, so when she had her second she and her husband kept track of every single thing in a little notebook.  They especially kept track of things she was offered and declined (such as the above mentioned ibuprofen, Kleenex, and even a water bottle.)Then she contested those charges.  She also questioned every denial by BCBS. During the first birth she thought some things were “free” like a “new mom’s”pack of of goodies including slippers and a water bottle, but they were all charged.

My own experience with surgery for a broken bone was the anesthesiologist charged for both general anesthesia and a nerve block, the latter of which I had declined.  Fortunately I had witnesses to my declining that as the doctor insisted he always did that with this surgery. ( I actually called a doctor friend while I was in pre-op to ask if I needed the nerve block and he said, “no, it’s just another way to make money...you’re going to be under general, you won’t feel any pain.”)

It’s great that you are planning ahead.  Best of luck!

[radram]

Short answer: You're screwed.

29 weeks ago, apparently :)

Seriously though, congratulations Gillamnstr. I don't really have any insurance advice, other than it might be advantageous at this point to calculate how much you have SAVED on healthcare. You mentioned you have bought the cheapest insurance for years, and are in excellent health. Calculating each years savings compared to paying for a more expensive plan should take the sting out of this years costs.

Our 2 children were the best possible delay to FIRE I could have ever imagined. We had our first after trying for about 1 month, then tried for 6 years for the second. We accepted the fact we would have an only child and stopped trying. 30 days after that our second was on her way. Still FIRED, just a little later. Enjoy your journey. When you are sitting there watching him/her graduate 18 years from now, my bet is that deductibles and OOP maximums are the least things on your mind.

[formerlydivorcedmom]

If you've truly considered going without anesthesia as an option that works with your birth plan, talk to your doctor about what that looks like and when/how to make the decisions on whether to ask for it.   Then be prepared to throw your birth plan out the window due to changing circumstances anyway :) [My second delivery went from "your labor is too fast for you to get drugs" to "you need a c-section under general anesthesia as soon as the pediatrician arrives" to "OMG, push now" in about 15 minutes.  As an FYI, I DO NOT recommend having a breech baby naturally.]

One thing that was tricky for me was that baby and I were on different insurance.  I covered myself; we put baby on my husband's plan.  The hospital usually automatically puts baby on the mother's plan, and it was a paperwork nightmare to get it all sorted out.  If you will be doing the same, warn the hospital ahead of time and keep on top of all of those bills.

Don't worry too much about the little costs (I know, I know, easy for me to say).  Your insurance will be most important if there is something catastrophic.  Several of my otherwise healthy friends with great pregnancies have had serious complications from childbirth and required extended hospital stays (all are okay now).  One of my babies was in the NICU for 3 weeks; another had to be Life Flighted to a different hospital. That costs big money, and I was grateful to insurance for covering most of it.  (Both my kids are fine now.) 

Good luck with the rest of your pregnancy!

[PepperPotts]

Do not pre-pay the hospital.  It's unnecessary and they cannot turn away a woman in labor when the time comes (EMTALA laws). Then, when the bills come, if you can't cash flow it, you can negotiate any cash discounts or set up a payment plan.  Ignore any collections threats as long as you are paying monthly.  They won't turn you over to collections as long as you are paying every month. 

[SimpleCycle]

So your OOP max is $6500 for in-network services?  The answer is you pay $6500 for a hospital birth, which is about a quarter of what it will be billed as.  Honestly it's not that bad.  You're lucky that it will all fall in one calendar year and not across two deductibles and OOP maxes.  You're also lucky that nearly all insurance is now required to include maternity coverage, as that was not the case before the ACA.  Honestly, it sounds like you have pretty good insurance and you just need to figure out the in-network/out-of-network issues.

I'd talk to the financial department at the hospital you plan to deliver at.  They will be able to answer most of your questions about coverage and payment policies.

There's little reason to ration in-network care at this point - you will hit the OOP max and so it doesn't matter what you spend pre-delivery vs. post-delivery.

Remember to add the baby to your health insurance - you have 30 days to do so.  They'll have their own individual deductible, but you might have a family deductible that kicks in as well.  Having a baby might be a qualifying event to change plans as well - ask your HR department.

[SimpleCycle]

Also, I think going without anesthesia is a fine plan...but only if it's what you want.  My birth did not go as I wanted, and it sucked to feel like choice was taken from me by forces beyond my control.  I definitely would not have wanted to be thinking about the bottom line when I wanted anesthesia.

Another option to think about is lower-cost anesthesia options.  At one point I was having trouble tolerating a procedure that I needed done and I got IV fentanyl because I wasn't ready for an epidural.  It wasn't nearly as effective as the epidural, but I wish I had considered it for later in labor instead of going full on epidural.

Finally, remember you may not have a choice about anesthesia depending on how your labor progresses.  If you need a c-section or extensive repairs, you'll need anesthesia of some sort.

[cacaoheart]

One thing worth looking into is if your child will be on your deductible while still in the hospital or if they'll be on their own. My insurance would have essentially treated our daughter as the same as my wife until discharge, with it all going towards her deductible while my wife's insurance counted them as separate people entirely with separate deductibles to fulfill from the beginning. I had to really dig through the insurance documents to find that out.

As others have said, it's fortunate that Obamacare made pregnancy/labor have to be covered as before if you were on individual insurance you would have had to purchase a maternity rider before getting pregnant and pay substantially more in premiums.

[mm1970]

So your OOP max is $6500 for in-network services?  The answer is you pay $6500 for a hospital birth, which is about a quarter of what it will be billed as.

I think this is what you are looking at, yes.