Anybody understand health insurance?

34saving · #1 (**permalink**) 07-30-2006, 12:53 PM

Okay, here's kind of a weird one . . . Dh and I are having a baby at the end of October. Good news

I've been on leave from my job since October 2003 (when our first child was born), but due to some kind of strange circumstances I'm going back to work for about 2 months before dd2 is born. Right now we're on dh's health insurance, which covers 80% of delivery costs up to an out of pocket family max of $2400 and then it covers 100%. I will be offered health insurance that covers delivery at 100%. So . . .

1) Both insurance plans are from Blue Cross Blue Shield (MN) so the doctors are all the same.
2) Pregnancy obviously is a pre-existing condition, but my interpretation of law/insurance docs is that as long as I've always had insurance pre-existing conditions don't get "counted against you".
3) My open enrollment is Sept. 1 and dh's is Jan. 1 (while I'm still eligible for my insurance).
4) Dd2 will be born with at least a cleft lip and possible a cleft palate. (Assuming she doesn't heal in the womb, but if God wants to perform a miracle here I'd be all in favor of it.) Most "cleft teams" don't operate until the child is at least 3 months old (back on dh's insurance), but I'm sure there will be appointments and other procedures before this. I suppose a cleft is also considered a pre-existing condition, but . . .

So, I'm hoping somebody can answer this question: Should we take my insurance for the delivery and then switch back to dh's? Is that possible? Or, should we swallow the $2000 and stay "safe" with one continuous policy? Any experts out there?

aurielle · #2 (**permalink**) 07-30-2006, 01:21 PM

I'm definitely no expert but I just had a thought; why not keep and use both insurances if you can afford it?

DH and I both have medical ins. and are on each other's insurance through work. My job's is a self-insured plan, DH's is BC. My plan is my primary insurance and the BC is secondary, and DH's is the other way 'round. I had a $6000 medical procedure done in March, I only had to pay my yearly deductible for my primary insurance plus about $110 out of pocket.

Something to check into.

34saving · #3 (**permalink**) 07-30-2006, 01:39 PM

I've considered that, but dh was double insured for a few months after we got married and we found that nobody wanted to cover ANYTHING. They just pointed at each other and sent the bills to us. Luckily it was only something like an office call, but I think it took 4-5 months for it to get paid. I like the primary/secondary idea, but they both act like primary plans so I think that might get too complicated? (For example both plans cover all pre-natal care at 100%.)

aurielle · #4 (**permalink**) 07-30-2006, 02:00 PM

Quote:

Originally Posted by 34saving

I've considered that, but dh was double insured for a few months after we got married and we found that nobody wanted to cover ANYTHING. They just pointed at each other and sent the bills to us. Luckily it was only something like an office call, but I think it took 4-5 months for it to get paid. I like the primary/secondary idea, but they both act like primary plans so I think that might get too complicated? (For example both plans cover all pre-natal care at 100%.)

My goodness, what a mess!

Thats too bad, its working okay for us. The only difficulty I had was I didn't know I had to send in a form to both insurances letting them know about the other coverage. I didn't find that out until I started getting EOB's stating that all the claims were rejected. Took a few months to get that straightened out.

sweeps · #5 (**permalink**) 07-30-2006, 02:05 PM

We were double-covered during my wife's pregnancy and delivery (then she went part-time shortly afterward and we dropped her insurance).

Her insurance was the primary and mine was the secondary and practically the entire thing was paid. You just have to make sure that every single hospital, doctor, specialist, etc. involved knows which one is the primary and which one is the secondary. Also the insurance companies will need to be aware of the situation.

PrincessPerky · #6 (**permalink**) 08-01-2006, 06:30 AM

we switched isurance mid pregnancy..it wasn't to terrible, but switching docs was..never do that baring emergency!

Saving in So Cal · #7 (**permalink**) 08-01-2006, 10:38 PM

I am also not an expert, but I am wondering if you can just double cover your baby. In other words, you each have your own insurance now while you are pregnant and then both add the baby after she is born. Usually, the parent whose birthdate is earliest in the year is the primary insured and the other parent the secondary insured. I believe this is true of HMOs as well. Theoretically, this should eliminate any pre-existing condition issue for the baby and limit your out-of-pocket expenses for the baby to whatever the best insurance plan requires.

Since you will both be insured through Blue Cross Blue Shield, they may have some sort of coverage rule against this (although it sounds like one of you has a PPO and other has an HMO, so that adds a twist). It can't hurt to ask. The insurance company should have a rep who can talk you about these issues. (Don't rely on what your HR person tells you. They tend to be very helpful, but not a reliable source of accurate information.) Get whatever you can in writing and don't believe the first thing you're told. Keep asking to talk to the next person up the ladder until you are convinced you have the straight scoop.

Also, after open enrollment, an employee usually can't add a dependent to his/her insurance unless there has been a "change in circumstances." The birth of a baby definitely counts as such a change. In my part of the country, the loss of your own insurance would also count. However, this type of issue is policy specific. You'll want to read your coverage brochures thoroughly on this point.

PrincessPerky · #8 (**permalink**) 08-03-2006, 06:03 AM

i just want to ditto that, when they tell you something try to figure out how you could get out of paying if you were them, and don't mind being dirty callus and idiotic, spliutting hairs is the way to go.

when I had my second kid (the 4,000 baby) I was told lots of things were 'covered' if the insurance pays any porton it is called 'covered' but that leaves me with the bill for the rest.

Never believe them.

34saving · #9 (**permalink**) 08-03-2006, 10:46 AM

Double coverage isn't really a possibility. Both policies would be with the same company (if they deny something under one policy they'll deny it under the other) and it would cost us about $500 a month extra to be double covered. Both policies have out of pocket yearly maximums around $2000 so if all heck breaks loose that's what we'll be paying. Around here if "participating providers" give you an uncovered service (without your informed consent/signature) they swallow the cost. Dd1's delivery was billed at $15,000. Insurance paid $5000. I paid nothing. So . . .the question remains of whether we stick with one (less coverage) policy or switch back and forth . . .Thanks for the input so far!

sweeps · #10 (**permalink**) 08-03-2006, 11:00 AM

I went back and re-read your original post and understand the dilemma now. Well, it's definitely a tough call, but if it were me, I would stick with your husband's insurance the entire way. Based on my experience, switching insurance policies always causes problems. Switching twice would be an even bigger mess.

rooskers · #11 (**permalink**) 10-10-2006, 09:30 PM

Right now we're on dh's health insurance, which covers 80% of delivery costs up to an out of pocket family max of $2400 and then it covers 100%. I will be offered health insurance that covers delivery at 100%.

My wife and I had a baby back in Feb. Health Insurance is very difficult to understand but what we did find out was that delivery costs are very little of what the hospital will bill you for. For example usually a pediatrician will visit within 24 hours after the baby is born that is not part of the delivery cost. If you have any pain med. or epideral which was the most expensive for ours that is not covered in the delivery cost, sometimes materials and room and board will be billed under something else too and if you go in but they send you home because your contractions were too far apart that visit is billed under something else too. When we itemized our bill almost nothing was covered under the delivery instead it was under some other part of the insurance coverage which was not 100%. So anyway in the end the 100% delivery coverage was BS because most of the things billed fell under a diff. category so really whichever insurance has the smallest out of pocket family max is your best bet because that is what you should plan on paying. The new insurance that offers 100% for delivery might not offer 100% in all the other categories they will bill you so you should check on what there out of pocket max is. Also if you have payed any other medical expenses this year that also counts towards the current $2400 out of pocket max on dh insurance. Hope this helps if you have any ? feel free to ask them I will do the best to answer.

poundwise · #12 (**permalink**) 10-11-2006, 05:49 AM

Quote:

Originally Posted by Sweepsplayer

I went back and re-read your original post and understand the dilemma now. Well, it's definitely a tough call, but if it were me, I would stick with your husband's insurance the entire way. Based on my experience, switching insurance policies always causes problems. Switching twice would be an even bigger mess.

Ditto.