another insurance question...

Autumn&Ryan

so if purchased a health insurance policy effective 1/1/2011 will I have to pay two deductibles, one for 2011 and one for 2012 if my child is concieved in say April 2011, born in January of 2012? How does it work?

aghhggh

In my experience, I've always had to pay the deductible with the first applicable visit of the year. On our old plan, we didn't have to pay a deductible before they would cover preventative care visits, but we did for specialist visits. We had to take DD to an audiologist in early December a few years back, insurance kicked in after we paid the copay & deductible. Follow up visit 2 weeks later, just had to pay the copay. One more follow up in January, and we got stuck with paying the deductible again. Ugh.

mommylove

Yes you will. DP is an insurance broker so I kinda know my way around the insurance world.
Deductible applies per year regardless of the condition start/end date...this includes pregnancy.

Autumn&Ryan

Bummer!
@mommylove-so if I have most of my prenantal care in 2011 and the actual delivery in 2012 I will have pay two deductibles even though the hospital/doctor will bill it all at the same time? Is there any way around that?

mommylove

@ Autumn&Ryan - there is NO way around it...sorry to say! I even checked with DP just to make sure though I was certain myself.
And most OB's will bill separately for their prenatal care and then for the delivery along with additional hospital charges. Regardless, two deductibles for sure.

lavina

Many OB's charge for individual services like initial physical, blood work and ultrasounds as they happen. Then they charge for prenatal care and delivery in one charge at the end. It beneficial for both the patient and the OB. The patient only has to really worry with one years deductible and the OB has a better chance of preventing being stiffed with the bill. My current OB actually waits 21 days after discharge to submit his claims so the hospital has time to submit their claims first. Ideally the hospital bill eats up the deductible and he gets paid by the insurance company and the hospital is financially able to be flexible in setting up payments with patients where he couldn't since he has a smaller income pool to pay overhead out of.

mommylove

Just to add to the last persons scenario...
You'd still be held responsible for two deductibles regardless of how the OB bills due to treatment dates falling within two different calendar years. The Insurance Co will not let this slide regardless of how the OB or Hospital bills for services.

Autumn&Ryan

Thanks ladies for the great advice, @mommylove-thank you for asking your dp about it for me

Shanny

Just FYI you will also need to pay the deductible for your baby too. I hadn't factored that in at all and that was an additional $1,000 when Kate was born. Although if you are talking about purchasing an individual policy I don't think you can get maternity coverage?

Autumn&Ryan

@Shanny-actually I think it varies from state to state. In my state maternity coverage is mandatory with any individual insurance policy as I understand it. I believe, once my deducible is reached...my pregnancy, labor and delivery and the baby are all covered. The baby, I believe is covered by my policy for 30 days after the birth.

Shanny

Wow! What state do you live in? I'll have to move there if I ever want to have another baby! Kate was automatically covered but with that coverage came her own $1000 deductible too. Sounds like you are getting a much better deal than I ever could have.

Ronna71

On a deductible plan, each covered member is subject to the deductible, which generally renews on Jan 1st. that means that not only mom, but baby is subject to the deductible, before the insurance benefits kick in.

Once the deductible is met, your insurance kicks in, generally with a coinsurance of anywhere from 10 to 30 % (I have found 20% to be the most common conisurance), or sometimes, a copay per day (sometimes up to a 5 day maximum per hospital stay - meaning that if you stayed 6 days, you'd only pay for 5). Usually, there is an individual and a family maximum out of pocket for the benefit year - once you reach your personal maximum out of pocket, you don't have to pay anymore copays or coinsurance-which of course, depends on the plan. Good luck!

mommylove

I second what Ronna71 and Shanny have said...yes baby will be covered under you for the first 30 days but regardless baby will have its own deductible that you will need to meet as well.