Insurance

First a short backstory. I'm from Europe and while we do pay higher taxes in general we don't pay health insurance or pay for our health care out of pocket. It's paid for by the state (via our taxes).

In 2007 we moved to the US and we've been paying somewhere about $300 a month for insurance for a family of 4.

Since I got pg we started looking into what our out of pocket expense would be for the delivery and prenatal care. Here's what we have to pay (in a nutshell).

* I paid $130 at the first doc's appointment. That covers every aspect of the prenatal care. I don't have to pay for any more docs visits nor do I pay anything for u/ss.

* When I deliver we have to pay $800 a day for each of us for each day spent in the hospital. So since we're having twins that means we'll be paying $2400 a day. However there is a $3000 cap on that and they will never charge us more for the delivery (and subsequent hospital stay if needed) than those $3000 even though we'd end up staying much longer (or god forbid needed NICU for the babies).

Since I come from a socialist (!!! as you Americans would call it) country of socialist medicine where I'm not used to paying out of pocket I know next to nothing if this means we have a good insurance or a crappy one.

Would you please share your insurance-story with me?

Thanks.

 

Actually, to me that sounds pretty good. I have a PPO, and it costs $450 for 3 people. I get no coverage until I meet a $5000 deductible (per year). My daughters do get well-check coverage (with co-pay), but no ER coverage until they each meet a $5000 deductible.

We are shopping around for something better. DH is self-employed, so cannot get insurance through work.

 

Firstly, welcome! Secondly, I do think our health care system is extremely confusing, and I work in the industry.

Premiums, co-pays, co-insurance, deductibles, out-of-pocket maximums, physician v. facility fee structures and network agreements, and coverage all vary enormously by insurance provider and by plan within provider.

Your monthly premium ($300), prenatal co-pay/co-insurance ($130), daily hospital facility fees, and out of pocket maximum ($3k) seem very reasonable based on my experience. My only advice is to confirm whether the $3k out of pocket maximum is for the hospital only, or if it is your annual out of pocket maximum for all health care expenses. If it's the former, then keep in mind that the hospital facility fee is typically separate from the fees you will incur by your doctor(s) (e.g., OB, anesthesiologist) during your hospital stay and I'd recommend clarifying those fee estimates with your insurance provider. Your OB (and those in his/her practice) is likely contracted with the insurer at reduced rates. The anesthesiologist is typically the one on duty at the hospital at the time you deliver and may or may not be contracted with your insurer. Again, this would only be an issue if the $3k is a hospital/facility maximum and not an annual out of pocket maximum.

My specific insurance situation is that I pay a $385 a month premium for myself and my husband on what is essentially a $1000/month plan - my company (headquartered in Europe) pays the difference between the premium and the cost of the plan. I do not have a deductible. I do have a $10 co-pay for all in-network physician visits and my in-network prenatal care (OB/perinatalogist) and hospital care is paid for at 100%. I do have to pay a little for some of the lab work from time to time. This is considered a remarkably good health insurance situation and it is the best I've had since I began working 15 years ago. Perfect time for me to have twins!

 

I'm receiving an error when I attempt to edit my post. So, I've edited it here. I attempted to clarify a few of the in-network v. out-of-network nuances if you have a PPO. In any event, I hope I haven't added to the confusion.

 

I have an HMO and pay about $400 per month for our family of 4 - my employer pays the rest...we only pay co-pays for doctors, ER and prescriptions and have no deductible or co-insurance requirement...from some of the plans I've seen I don't think that what you have is unreasonable!

 

I think your expenses will be higher than you expect.
How much for the epidural or other drug costs? What if you have a c-section? The attending surgeon is paid separately from your OB. Then the OR costs are above what they charge you for the daily rate.
If the babies need the NICU, what do you pay? <---- Medicare will generally cover costs for the NICU for premature babies. Check the regulations in your state.
If you are hospitalized prior to delivery, say for preterm labor, what are your costs?
And if you need to see a peri?

In general, you seem to have decent coverage. But there are so many hidden "gotchas" that I know I aid more out of pocket than I ever anticipated.

 

I'll start out by saying that we have excellent insurance. We pay $1000/year for our family and have a $10 copay for office visits. For my prenatal care there were no copays. I saw the doctor every 1-2 weeks, had cerclage surgery with a 4 day stay at 16 weeks, a 4 week hospital bedrest stay, c-section, and my girls were in the NICU 5 and 6 weeks. We did not pay even $.01 of any of that. It was all covered.

My company provides the family's insurance at no charge, but the copays are $20 and there's a deductible of $750 I think. It works out better for us to take DH's insurance at $1000/year over my insurance at no cost/year.

 

I am also from one of those "socialist" countries (at least to American standards). We had a company policy in the States and sometimes I had co-pays, deductables, etc. but the cap was $2000 for the entire year. Which was basically nothing considering we didn't pay premiums or anything and our 2006 health care / insurance cost were $2000 and not a penny more. I think once you have a reasonable cap ... and your premium doesn't sound bad at all either, I think you're good. Even in Europe we paid euro 200 a month for a family of 5 (kids free but euro 100 a month, or slightly less for us).

 

You have pretty comparable insurance to most that is provided by an employer or private industry. My own insurance is changing from an HMO type with co-pay to one that will cost me $5500 in deductibles next year. I think it sounds pretty normal!

If you find it difficult to pay that all up front, work out a payment plan with the hospital - they are usually VERY willing to do so... good luck!

 

Thanks everybody. All replies have been very helpful. I'm going to look better into the $3000 cap and see if it's the hospital cap or the annual cap. I'm not quite sure about that one. I was told that possible nicu stay etc was covered within the $3000 cap but I?m not sure about the above mentioned issue of specialists at the hospital having contracts with my insurer.

Regarding a payment plan, that's not a problem for us.

Thanks again, everyone.