https://boards.hellobee.com/ Pregnancy, Baby and Parenting blog, by Hellobee en Mon, 24 Aug 2026 13:50:29 +0000 https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1560850 Thu, 10 Apr 2014 17:56:15 +0000 snowjewelz 1560850@https://boards.hellobee.com/ <p>@LemonLong: Thanks! It does help to have someone in the field reconfirm what I'm told so I feel reassured! :) </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1560509 Thu, 10 Apr 2014 16:35:17 +0000 LemonLong 1560509@https://boards.hellobee.com/ <p>@snowjewelz: the way it works is that you would pay the first $700 of your non-routine medical expenses out of pocket (though you may receive discounts since your insurance may have negotiated rates with your provider on certain things), then after you pay that $700 deductible, you would get the 80/20 until you hit your out of pocket maximum. After you hit the out of pocket maximum, 100% will be covered. </p> <p>Hope this helps! Disclosure: I work for a major insurance company but the information above is my personal opinion and not the opinion of my employer (Sorry, we have a social media policy where I have to add that for anything insurance related. ) </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1560215 Thu, 10 Apr 2014 15:09:05 +0000 snowjewelz 1560215@https://boards.hellobee.com/ <p>Well I also just found out some good news from the OB! I totally forgot to call, but they actually called to confirm my appointment for tomorrow so I asked if tomorrow's u/s is part of their routine and whether it would be covered. This lady told me that they already ran my insurance from the beginning in order to come up with all these services &amp; anything that's not gonna be covered, they would tell me first. So that's a relief! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559820 Thu, 10 Apr 2014 13:43:29 +0000 2PeasinaPod 1559820@https://boards.hellobee.com/ <p>@snowjewelz: Since you said your fact sheet is a few years old, it's likely $4,700. The new law just went into effect 1/1/2014, so they probably updated the OOP Max to $4,700 to make your plan consistent with what it was last year rather than make it richer this year.</p> <p>Hah...I've been in this field for the last 11 years. As things change and new laws come out, we all learn together! Health Care is an ever changing area for sure... </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559705 Thu, 10 Apr 2014 13:23:15 +0000 snowjewelz 1559705@https://boards.hellobee.com/ <p>@2PeasinaPod: On the fact sheets it says $4000, on my EOB it says $4700. But I guess it really is $4000 since I already would have spent $700 that would be applied towards the OOP max then. How did you get your training in handle insurance?!?! It is the craziest thing! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559673 Thu, 10 Apr 2014 13:17:40 +0000 2PeasinaPod 1559673@https://boards.hellobee.com/ <p>@snowjewelz: Per ACA, your deductible does have to count towards your OOP max...so whatever they set your OOP Max at, the deductible will count towards that. It's just a matter of determining what the OOP Max is! </p> <p>@Boogs: An Ultrasound, labwork and tests of those nature are all considered diagnostic. It depends on if they're being billed as part of the "normal" course of action when it comes to maternity or outside of that. Usually, your first U/S at 12 weeks and one additional U/S after that is covered as part of a "normal, healthy" pregnancy. Anything outside of that is usually outside of what they consider "Normal and healthy".</p> <p>So you're likely going to be billed for those ultrasounds if you haven't met your deductible yet. If you want, I can take a look at your explanation of benefits (EOB) if you want to PM me! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559654 Thu, 10 Apr 2014 13:15:14 +0000 snowjewelz 1559654@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: I still feel effy about it, but if I've already talked to two people about it, I guess that's that for now. Since these calls are technically recorded, if they ever screw me over I'll force them to dig up the recordings and be like, 'but this is what they told me!!!!' </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559637 Thu, 10 Apr 2014 13:11:34 +0000 Mrs. Jump Rope 1559637@https://boards.hellobee.com/ <p>@snowjewelz: hmm, I always thought the deductible was part of the coinsurance. Maybe that's limited to our company and not standard practice?</p> <p>But I'm glad you got clarification! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559630 Thu, 10 Apr 2014 13:10:08 +0000 snowjewelz 1559630@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: @2PeasinaPod: </p> <p>I talked to a different person today, and she is saying the same thing; that I just have to meet my own deductible of $700 and the 80/20 will go into effect for me. But this woman did say that our OOP max is really $4700 instead of $4000, since I guess I have to spend 4k from scratch after I meet my $700 deductible? </p> <p>I'm just hoping they're not screwing me on this!! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559628 Thu, 10 Apr 2014 13:09:42 +0000 Boogs 1559628@https://boards.hellobee.com/ <p>@2PeasinaPod: My insurance is horrible and we are battling them right now and no one can give us a straight answer for our costs, but they are quick to send us big bills for regular stuff. So the ultrasound at your first appointment, and another at a following appointment because of the lack of the ability to find a heartbeat, should those be coded as "diagnostic ultrasounds?" If not, what should they be? </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559546 Thu, 10 Apr 2014 12:54:54 +0000 Mrs. Jump Rope 1559546@https://boards.hellobee.com/ <p>@snowjewelz: any update? </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1559485 Thu, 10 Apr 2014 12:45:29 +0000 2PeasinaPod 1559485@https://boards.hellobee.com/ <p>@Torchwood: Right...that's the part that annoys me too. They present it as if all you'll have to pay is 40% when they know darn well that the provider can charge pretty much whatever they want to...and that should be disclosed. It infuriates me that it's not. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1557261 Wed, 09 Apr 2014 17:28:39 +0000 Torchwood 1557261@https://boards.hellobee.com/ <p>I take that back. I get why they say there's a max (basically the max amount that could be included in our percentage of what they pay), but I don't get why they think it's okay to make it look like we're fine when we may not be. It's so deceptive. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1557207 Wed, 09 Apr 2014 16:49:34 +0000 Torchwood 1557207@https://boards.hellobee.com/ <p>@snowjewelz: Thanks. It's especially frustrating because the company chose to move us to TN, and if we were still in CO it wouldn't be an issue!</p> <p>@2PeasinaPod: I also still don't get why they even have a max out of pocket if it essentially has no bearing on what we'll be billed. None of this makes any sense! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1557015 Wed, 09 Apr 2014 15:21:44 +0000 snowjewelz 1557015@https://boards.hellobee.com/ <p>@Torchwood: I hope your DH is able to get some answers from his company! It is NOT cool that they switch you to something where you're forced to be OON! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1557004 Wed, 09 Apr 2014 15:17:48 +0000 Torchwood 1557004@https://boards.hellobee.com/ <p>@2PeasinaPod: We have no one in at least a 100 mile radius. That's the farthest out I can even check. I checked for Memphis (200 miles away), and nothing there either. So hopefully it'll be fine and they'll make an exception? It's so frustrating! Thanks for your help! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556999 Wed, 09 Apr 2014 15:16:14 +0000 2PeasinaPod 1556999@https://boards.hellobee.com/ <p>@Torchwood: Right....they say that they'll pay 60% of the reasonable and customary charges...and that's not always what the provider actually charges. Going out of network is always far costlier than going in network for that reason. If you don't have anyone within a certain mile radius of you, they may make an exception for you...but definitely something your husband wants to check into! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556876 Wed, 09 Apr 2014 14:43:13 +0000 Torchwood 1556876@https://boards.hellobee.com/ <p>@2PeasinaPod: So even though they specifically say they pay 60% of out of network costs for L&amp;D (and 100% for routine preventative care), they might turn around and basically not do that? What's the point of having deductibles and out of pocket maxes for out of network, if they're not going to pay what they say they will? DH is calling at some point today about all this anyway, both the insurance company and his company. I'm just trying to figure out what to expect and what he should ask. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556858 Wed, 09 Apr 2014 14:38:20 +0000 snowjewelz 1556858@https://boards.hellobee.com/ <p>@2PeasinaPod: I hope that really is the case and it's not aggregated! I'm going to call again tomorrow to ask to be on the safe side! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556847 Wed, 09 Apr 2014 14:35:30 +0000 2PeasinaPod 1556847@https://boards.hellobee.com/ <p>@Torchwood: The thing with going to an out of network (OON) provider is that they're not contracted with the insurance company. So they can charge whatever they want to, and the insurance company will pay what they think is "reasonable and customary" for your area.</p> <p>For example, when you go to an in-network (INN) provider for a doctor visit, they charge the insurance company $100. Because they have a contract with your insurance company, and the insurance says they'll only pay the doctor $80 for that service, the doctor accepts that amount and agrees not to bill you for the balance. </p> <p>When you go to an OON provider, there is no contract that the provider has with the insurance company that says they won't bill you for the remaining amount of their charge. For something like L&amp;D, that can get extremely expensive. So if the doctor charges $20,000 for the L&amp;D and the insurance company thinks a delivery in your area should only cost $5,000, you'll owe your OON deductible, then 20% of the $5,000...PLUS, the OON provider can bill you for the remaining $15,000 because they don't have a contract with the insurance company that says they won't bill you for the rest. It's called balance billing. That's what ends up burning people on the OON side of things. </p> <p>@Mrs. Jump Rope: Very good point. It does sound like @snowjewelz: has a plan where there's an individual deductible and a family deductible. So it should stop when she's hit her own individual, and her newborn will have it's own deductible and OOP Max. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556801 Wed, 09 Apr 2014 14:27:18 +0000 snowjewelz 1556801@https://boards.hellobee.com/ <p>@Mrs. Jump Rope: Wow. I better call back and re-check! That's pretty messed up that they explained it to you wrong even to make you feel like you're in a better place! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556773 Wed, 09 Apr 2014 14:22:55 +0000 Mrs. Jump Rope 1556773@https://boards.hellobee.com/ <p>@snowjewelz: yup, that's how ours works. </p> <p>The problem is it was explained to me (last year) the way you were told your plan works. It wasn't true. We got burned. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity/page/2#post-1556738 Wed, 09 Apr 2014 14:17:32 +0000 snowjewelz 1556738@https://boards.hellobee.com/ <p>@locavore_mama: I'm on DH's plan. EDD currently is early Dec (fx!) so I should be in the same calendar year. Yeah, I think at every appointment I just need to be a pain and ask... </p> <p>@Mrs. Jump Rope: Hmmm, I might need to call back. The way the lady explained (and I asked twice!) was that I just need to meet my own individual deductible, then I can get the 80/20 till the OOP max of 4k. I specifically asked her whether the max I will need to spend throughout this pregnancy plus L&amp;D is 4k and she said yes...<br /> For your plan, so the individual part is really only valid if there's just one person under the policy then huh? </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556693 Wed, 09 Apr 2014 14:09:41 +0000 Mrs. Jump Rope 1556693@https://boards.hellobee.com/ <p>@snowjewelz: First, find out if your deductible is aggregated.</p> <p>By looking at it, it SOUNDS like your entire family needs to meet that $1400. It doesn't matter what combination. One person, two, or even all three of you could have claims combined that meet that deductible level.</p> <p>Our plan is aggregated. That means prescription co-pays and our 90/10 does NOT kick in until that deductible has been satisfied in full. It isn't equally divided into threes (or fours, once this baby arrives).</p> <p>The key word is aggregated. Our plan also says individual/family, but since it's aggregated it the "individual" kind of throws you off! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556684 Wed, 09 Apr 2014 14:07:44 +0000 regberadaisy 1556684@https://boards.hellobee.com/ <p>@snowjewelz: so are you under a individual or family plan?</p> <p>It really depends on your insurance what you will or will not get billed for. Everyone told me that maternity should ALL be covered but under my ex employers plan it wasn't and I was paying pretty significantly OOP versus my previous employer's plan. I even called my insurance to make sure the OB wasn't billing incorrectly and they weren't.</p> <p>Does your plan year start before or after baby arrives? </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556672 Wed, 09 Apr 2014 14:04:42 +0000 Torchwood 1556672@https://boards.hellobee.com/ <p>@snowjewelz: Yes! I was picturing it being thousands and thousands if something went wrong. Our max is more than I'd *like* to pay, but well within our ability to handle. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556663 Wed, 09 Apr 2014 14:03:07 +0000 snowjewelz 1556663@https://boards.hellobee.com/ <p>@Torchwood: Nice!! For our insurance, out of network is double! </p> <p>It makes me feel so much better to know the cap that I'd have to pay so I can be prepared and know what to expect. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556647 Wed, 09 Apr 2014 13:59:04 +0000 Torchwood 1556647@https://boards.hellobee.com/ <p>@snowjewelz: Thank you for asking this! I've been completely freaking out/upset (yay hormones) because I just found out that the new insurance that DH's company switched us to has no in-network doctors in our state. It looked like that meant it was going to double our costs for l&amp;d. But, now that I've read through this, I went back and checked, and our deductible and out of pocket max are very close to the same for both in-network and out, and our max is very low. So odds are very high we'd be meeting the max either way, so it's only about $250 than it would have been, not doubled like I was thinking. Thank you for asking questions I didn't even know to ask! </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556508 Wed, 09 Apr 2014 13:15:13 +0000 MrsBeluga 1556508@https://boards.hellobee.com/ <p>I did not pay for prenatal appointments, but I did pay for every ultrasound, blood work, non stress tests, etc. The only other bill we received was for labor and delivery, with a separate bill for babies first doctor visits.</p> <p>We have a high deductible PPO if that helps. </p> https://boards.hellobee.com/topic/question-about-insurance-for-prenatalmaternity#post-1556486 Wed, 09 Apr 2014 13:08:55 +0000 snowjewelz 1556486@https://boards.hellobee.com/ <p>@2PeasinaPod: Ok so I think I got more clarify and some good news. I was looking at an older chart, and my individual deductible is $700, then I pay 20%. My individual OOP max is $4000. So I'm really happy that the most I'd have to pay 4k! </p> <p>If I understood the lady correctly, I just have to hit my individual to receive benefits (and DH has to hit his own to get benefits). The family deductible/OOP makes more sense when the baby comes; the $1400/$8000 will not change even if I have 5 kids so the more people in the family, the better. That's probably why I didn't understand individual vs. family since there are only the 2 of us right now. </p> <p>The only thing is, she doesn't know what services performed will get billed to me or not. She said the doctors use codes to determine whether something is necessary, or it's elective. So I guess I need to make sure at every appointment to confirm... </p>