Life Updates
We have crossed the halfway mark on pregnancy which feels great! Kind of…ok, I’m exhausted all the time and now wearing what I call “Steve Urkel pants” to fit over the bump, but otherwise great! We also got to see baby Weitzman again on the ultrasound and watch the little arms and legs wiggle around.
A few weeks ago we started a registry at Babies R Us, but have to scratch that now since it looks like they are really going under. Womp, womp. Bye, bye Geoffrey! Andrew is crushed by this turn of events and is determined to buy a Geoffrey stuffed animal to give to our son as a last vestige of a better time. Think he’s being a little dramatic? I didn’t say it.
Over to Buy Buy Baby and Target for us, I guess. And one note on registries, even if someone isn’t throwing you a shower, be it bridal or baby, most stores offer discounts on anything you buy off the registry after the event. I’ve seen anywhere from 10% to 15% which can be a nice way to save on things you need to buy for either a new home together or a baby.
Now to the real talk of this week. I wanted to share with you our adventures with health insurance and having a baby. So, apologies in advance that this post will be very baby focused because the bump is growing and bills keep rolling in. And frustrations keep increasing too.
Health Insurance Basics
I don’t know much about how health insurance works or the political debates surrounding it. It even seems daunting to try to understand, which is probably part of the issue with healthcare in general. But, I know that I do need to understand at least how my health insurance works. Every bill that comes in or call with the insurance carrier leaves me more confused and less like I have a grasp of how it works.
To start this adventure, let’s have a vocab lesson on health insurance terms. Thank goodness my husband works in the insurance industry and can explain these terms to me (although he doesn’t deal with healthcare). Side note: we get our health insurance through his work, so it is with one of the major health insurance companies. Not everything may apply to how your insurance works, this is just what our situation is.
Important Vocabulary (aka if the SAT tested things you will actually need to know in life)
Deductible – The minimum amount you have to pay out of pocket before the insurance company has to pay out anything
In-Network vs Out-of-Network – If your plan is a “network” plan, then you need to be aware of what doctors are considered in-network meaning that they accept your insurance and claims are paid at the highest level. If a doctor is not in your network, then the insurance company may not pay for any of the claim or may pay a reduced amount of it. Basically, know what type of plan you have and if a doctor needs to be in-network, ask before you make an appointment with the office.
Co-Pay – The amount that your plan may require you to pay for a service
Out of Pocket Maximum – The annual maximum amount you have to pay with your plan. Once you hit that number, the insurance company is responsible for the remaining costs of covered benefits.
Explanation of Benefits (EOB) – a statement sent from the insurer to your listing the services billed and what they cover verses what you may be responsible for. Note that this does not mean that is what you are actually going to pay. Sometimes, the insurance company and doctor’s office go back and forth on the charges and you may have to pay less than that. You won’t really know until the doctor’s bill shows up in the mail. This can cause some panic situations when the EOB shows a really big number but it’s not what you end up having to pay.
Doctors vs Insurance
It seems that insurance companies and doctors don’t have the same mindset about how healthcare works. For a doctor, they see something like genetic screening tests as a way to get ahead of any potential future issues with the baby. However, insurance carriers are like, nah, we won’t pay for that because it’s “experimental”.
As a patient, I find this disconnect troubling. You hear all this talk about “preventative care,” which makes sense, why not try to prevent problems that will be costly beforehand instead of paying for them later. Yet when push comes to shove, other than that annual physical we get for free as “preventative care”, the message seems to be don’t even bother unless you are willing to pay full costs out of pocket.
Can I really get the best and most advanced care available if insurance is years behind what doctors are deeming valuable? What insurance companies seem unable to understand is that if patients knew there was going to be an issue, we could prepare better for it. And maybe it would cost them less in the long run to care for the person with that disease. In short, interests seem misaligned when it comes to healthcare.
What’s Covered for Baby
Now that we’ve got that all out of the way, let’s look specifically about the costs of having a baby. I talked about budgeting already in general for a baby, but healthcare costs are one of the biggest expenses we are going to have for the baby this year.
At the beginning of this adventure I called the insurance company to let them know and see what resources were available. They sent me some documents and went over some things on the phone. I felt like I had a good understanding of what was covered…which sounded like all the regular prenatal appointments and testing. That makes sense, all these appointments to check on the baby’s health are necessary.
Fast forward to after the first appointment and a bill shows up in the mail. Andrew asks why we got it since we thought that the blood test it was for was part of prenatal coverage and was either covered or we would be billed at the end for everything.
Time for Call Number 2
In total we probably spent over an hour on the phone between two separate calls trying to understand how the plan works, what is covered, what is not covered and when we would be billed. Now, we are two educated individuals, we should have been able to easily figure this out. Think again.
On the second call we even asked if they had a list of what was covered. Well, that list doesn’t exist but they were happy to provide us with a list of what isn’t covered. This takes me back to the root of the issue. Insurance companies are about what they don’t have to pay for not about what care is needed for the patient.
Watch any movie or ask a parent about the pregnancy process, and without a doubt the moms will say that they were constantly poked and prodded for numerous blood tests, weighed and measured, and had at least one ultrasound, possibly more. Yet despite being told that all prenatal care is covered and that all of these blood tests and ultrasounds are essential prenatal care (according to you know, the medical professionals) the insurance plan makes us pay something for each and every test.
Lessons Learned
What we seem to have gathered from these calls is that there is no copay for the office visits for prenatal care, but we pay something for each lab visit and more for ultrasounds. One other fun fact we learned was that delivery is not 100% covered meaning we will pay something for those costs. I get that they don’t pay everything, but the end game here of having a baby is delivering it, right? Not really an optional part of the process? So why isn’t more of that covered?
I understand that some of the genetic screening is still considered “experimental” and therefore not covered, but I’ve yet to meet a doctor that doesn’t recommend it or push it.
We also got billed for the gel they use for the ultrasound. Ultrasounds aren’t really an optional procedure anymore either and the gel is kind of a necessity. Try making a PB&J without the J. Feels like money grabbing if you ask me. I hope I don’t need a tissue at the office!
And don’t even get me started on their website. All of these challenges have me referring to our insurance company as “expletive Company Name”…you can use your imagination on that one. And I’m sure I’m not the only one who has felt this way about health insurance.
Even some big non-insurance companies announced recently that they are trying to solve the problem that is health care. I would be thrilled if there were a better answer out there. It is something everyone has to deal with but so complicated that most adults don’t really understand how their health insurance works. A little free market competition could go a long way…
If you want to read more about all kinds of costs surrounding starting a family, here are some articles to start with:
[CNBC] Baby On The Way? 5 Key Financial Tips For New Parents
[Dreaming of Baby] Financial Tips for Millennial Parents To Be
[Investopedia] Financial Planning Tips for New Parents
[Vox] You Want to Have a Family. Here’s What it Will Cost You