My wife is having our first baby, I have a question about insurance/hospital costs?

Question

I have Bluecross of California, this is our insurance info:

$300 deductible
25% co-insurance
$2,500 out of pocket maximum (stop loss)

So if my wife has a hypothetical delivery with a cost of $12,000 then we would pay as follows, right?

$3,000 because we pay 25% of the $12,000 bill
-$500 because our out of pocket maximum is $2,500 and the bill was $3,000
+ $300 deductible (or is the deductible included in the out of pocket max?)
= $2,800 is the maximum we would pay for the delivery

Are my calculations correct? I want to make sure I set aside enough money from our savings account for the baby’s birth. I am unsure how insurance works. Thanks!!

Answer 1

I had BC/BS of Minnesota when I had my daughter. First of all, the deductible is upfront. So assuming the delivery is $12,000, now you have $11,700 to deal with. Then you pay 25% of the $11,700 up to a max of $2200 (since you have already paid $300). So the max you should owe for your wife is $2500 no matter what.

BUT, and here's a big BUT...

Don't forget that you are having another person. You need to get your baby added to the policy ASAP (call now and see what their procedure is). Many times they want to know up front that this is happening - then all you have to do is make the phone call that son/daughter is here. Anyway, they ARE covered as long as you make those phone calls, but any hospital stay or pediatrician that sees the baby in the hospital will likely want to be covered as the doctor of the baby...not your wife. So set aside extra for that.

In my case, my daughter had serious complications and was whisked off to a nearby hospital who had a NICU unit. I was charged for a neurologist, a pediatrician, ambulance ride, and many, many lab tests. So needless to say, I paid the full family "out of pocket" not just the out of pocket for one person. Usually insurance plans have both.

Answer 2

You're not exactly correct. The $12K isn't a far off guessimation.

The $300 deductible is absolute - as long as it applies to hospitalization ONLY. There might be separate additonal ones for doctors. Co-insurance and out of pocket dollar amounts are calculated based on the contracted rate. That is the pre-agreed amount between the insurance and the provider. Providers can, in theory, bill whatever amount they want, they are only going to get paid the agreed rate. (In other words, the hospital might bill $12,000, but they might only get paid a grand total of $9500 because that's the contract.) So, you might be paying a little less than the $2800 or a bit more - depending on your exact coverage and whether or not everyone is in network.

The other thing you have to factor in - not only is the hospital going to bill, but so is the OB-GYN, the anesthesiologist (unless she goes without any kind of pain meds), any labs that are done on her and the baby, and whichever pediatrician examines the baby after birth and discharges him or her. This is assuming there's absolutely no complications.

Your best bet is to contact member services at your insurance company and ask them for specifics tailored to your plan.

Answer 3

The most you can pay in a calender year is $ 2,500. If your correct $300 you will pay as a deductible. For the rest of the year their will be a 2,200 out of pocket left. The way I see it, you will only be paying some $300 for the baby delivery. If you want to save money deliver the baby at home and you be the mid-wife. Scratch that, your wife may not go for that; just call the 800 number on the back of your card so there are no surprises. My wife works for United HC and we have a similar plan.

Answer 4

You can sign up on www.mylifepath.com and see your benefits outlined. I'd recommend sending them an email to be sure you're calculating correctly.

Your copays are what you pay after you have met your deductible. Once you have met the out-of-pocket maximum, most services are covered at 100%.

If it's not too late, sign up for flex-spending at work. Your money goes in pre-tax and you can pull it out any time during the year.

In other words, if you put in $2500 anually, and your wife is due in March, you can still get reimbursed for the $2500 even though you haven't contributed that much yet. You wind up saving at least 20%.

Answer 5

1) give up the idea of the bizarre spelling on your first choice. It will inevitably be pronounced as MEE-kay-lah which is rather illiterate. The traditional (and best) spelling is Michaela. Those who are spelling/pronunciation-impaired use the popular spelling of Makayla (it's icky but at least it's pronounceable). The rest of your names need to get rid of the ridiculous, useless, confusing hyphens. Bureaucracy is the least of your worries when naming a child but schools, hospitals, and government agencies have computers that don't do well with hyphenates. They'll cause sooooooo much grief down the line. Also, hyphenates are backwoodsy-rednecky especially when you use a nn instead of a formal name (Sue instead of Susan, Susanne, etc). Your daughter will have to overcome the "Deliverance" attachment to a name like that. All that said, why not consider Megan Susanna Rosemarie Susanna Ruby May (meh--very lowbrow) Ruby Marietta is much prettier. Good luck. Please remember to think of the cute baby as a grown woman. If the name is cute for a baby but makes an adult female look childish or goofy, get rid of it!

Answer 6

Your best bet is to call the customer service number that should be on your BLue Cross ID card, and speak to a representative. My experience is they are very easy to talk to and will answer all your questions. And I agree with others who have said that you should find out the actual cost of a normal delivery, not use a hypothetical figure. Call the hospital where your wife will deliver the baby, and ask for the billing department. They should tell you the current charge for a routine delivery, for the room, etc. It isn't possible for us to interpret your insurance agreement, because we haven't seen it, and each one is a little different.

Answer 7

The deductible should be included in the out of pocket maximum, so what you would be responsible for would be $2,500. You should check your insurance details to confirm.

Answer 8

Each policy is different in regards to having a baby. You best and most accurate answer will come from your HR person where you work or call your insurance company directly with your plan # and have them tell you the specifics.

No matter what they tell you, save 2x as much in case there are unforseen complications or charges.

Answer 9

Deductibles may or may not apply to your out of pocket max. Check your plan.

the 25% is 25% of UCR (Usual, customary and reasonable) fees not actual fees charged.

Where did you get your hypothetical 12k from?

Answer 10

Good grief I hope it don't cost 12K to have a baby! Did you call the hospital and ask them how much a standard delivery costs?
Don't guess get an estimate.. remember you have to pay the doctor too and sometimes its different terms for maternity did you check with Blue Cross about that?