Couple of Questions

LuckyAngel07 · November 2013

Question 1: I feel like I've got pnd/mucus in the back of my throat. I'm worried I'm coming down with a cold (damnit!). Can I take anything right away, or am I stuck without relief for the next 9 months?

Question 2: Our company's open enrollment starts today. I want to finally start putting money into the health savings account they offer, and I'm just curious approx. how much I might expect to spend next year on doc's appts, hospital stay (I already know my insurance says this is $150/day), etc that I can submit for reimbursement from my account. I know it's hard to ballpark this with insurance variability, but any input would be appreciated!

sparklingdiamond · November 2013

Do you have a high deductible on your plan?

LuckyAngel07 · November 2013

sparklingdiamond said: Do you have a high deductible on your plan?

I have a regular PPO plan, though they do also offer a high deductible plan. I just missed the meeting time for the info session on the HDHP, and since we really have nothing put aside for medical expenses right now, I'd be nervous switching to that and paying OOP for all my appts.

kanels11 · November 2013

I am not much help with the insurance part of it all but as far as the cold goes...When I got my BFP, I had bronchitis. They put me on an antibiotic that was safe for pregnancy but as far as relief before that kicked in, I basically used halls cough drops to help with the cough and sore throat.

Not sure if those are symptoms you are having but if so...they helped me. Also, Maybe start increasing your vitamin C intake? I would think that would be safe for pregnancy.

Good Luck! I really hope it doesn't turn into something completely miserable for you.

Uptowngirl2009 · November 2013

Ugh I am sick right now too. I got a list of safe medications but I really didn't want to take anything. On it for decongestants was Sudafed 30 mg or Tylenol Sinus. As far as cough, plain robitussin. I tried some of that Simply Saline spray last night and it seemed to help with congestion. I hope whatever you have goes away soon!

LuckyAngel07 · November 2013

Thanks, @kanels11! I'm trying to figure out if I can take something like Emergen-C or Zycam to head off the cold before it really goes full-fledged.

brij2006 · November 2013

My Dr said Tylenol Cold & Sinus was okay and so was Sudafed. But each Dr is different.

As far as the insurance information. Take a look at your plan. You will have one amount for the deductible (if you're on your plan by yourself then look at the individual one), and one amount for Maximum out of pocket expense. Add both of those up, and that's likely the maximum you will have to pay. My insurance also has me paying $30 co-pays for each Dr's visit on top of my $1,000 deductible and $3,500 max OOP expense. So we had budgeted for $5k in medical expenses.

Each company is different, but mine said I had my individual deductible and OOP amount for a normal birth and stay right after the birth. If baby or I needed to stay longer than 48hrs after vaginal or 36hrs after c-section, or baby was put in the NICU at all, then I would bump up to my family deductible of $2k and my max OOP of $5k. So we knew there was a possibility of paying $7k instead of $5k.

You can also call into your insurance and let them know you are pregnant and ask them to explain your coverages. I did this at around 5 weeks, and they then let me know that a breast pump was 50% covered under my plan and so were some other things I didn't know about. So it doesn't hurt to call.

If you have any questions, feel free to PM me.

LuckyAngel07 · November 2013

Here's some info on my plan's coverages:

sparklingdiamond · November 2013

So your out of pocket is $3000, which should be the maximum you would have to pay. If you go to a participating provider, you don't have a deductible, so make sure yours is in network. I know on mine it says I have a 20% coinsurance after deductible, so I would pay 20% after paying the deductible until I meet my out of pocket limit.

LuckyAngel07 · November 2013

@sparklingdiamond, right. No deductible if I'm in network. I know my OB is already in network, so the hospital I would deliver at should also be, correct?

Further info on pregnancy specifically:

Prenatal and postnatal care: $15 copay (30% after deductible if it were out-of-network), Your cost is for your first OB visit only (does this mean I don't have any copays for all my OB visits except the intake appt??)

Delivery and all inpatient services: $150/day; max of 5 copayments/admission (30% after deductible if it were out-of-network), prenotification requested

sparklingdiamond · November 2013

Well most OBs bill globally, so they submit one bill for all your visits at the end of the pregnancy. So like mine will bill like $3000 total and then I would pay my deductible towards that and then a percentage. It looks like you would pay a $15 co-pay and the rest should be covered if you have no coinsurance you have to pay for it.

You still want to check and make sure your hospital is in network. Just because your doctor is doesn't mean your hospital is, since they are independent of each other when it comes to contracting.

brij2006 · November 2013

You should be safe with the $3k put aside for your OOP maximum (it will likely meet that).

I would definitely check to make sure the hospital is in your network. Just to be safe.

LuckyAngel07 · November 2013

sparklingdiamond said:
You still want to check and make sure your hospital is in network. Just because your doctor is doesn't mean your hospital is, since they are independent of each other when it comes to contracting.

If the hospital comes up in the search results when I look for a doctor or hospital from my insurance's plan web site, that means they're in network, right? I'm assuming they wouldn't be listing providers who are out of network.

brij2006 · November 2013

LuckyAngel07 said:

sparklingdiamond said:
You still want to check and make sure your hospital is in network. Just because your doctor is doesn't mean your hospital is, since they are independent of each other when it comes to contracting.

If the hospital comes up in the search results when I look for a doctor or hospital from my insurance's plan web site, that means they're in network, right? I'm assuming they wouldn't be listing providers who are out of network.

That's correct. So you should be safe.

LuckyAngel07 · November 2013

brij2006 said:

You should be safe with the $3k put aside for your OOP maximum (it will likely meet that).
I would definitely check to make sure the hospital is in your network. Just to be safe.

The savings account maximum is $2500. And if I don't use it all, I lose it. I'm nervous to put that much into the account and then be SOL if we don't spend anywhere near that much.

I'm going to call and speak to someone in my plan's customer service. Hopefully they can better explain what's covered and what extra costs there might be beyond what I'm seeing.

brij2006 · November 2013

What about not doing an HSA account at all, and just putting that money aside into a separate savings account between now and when baby is born. That way you have more than the $2,500 allowed, put aside. Then if there's anything left over you can use it toward other things that aren't medical related.

amccul20 · November 2013

@LuckyAngel07 I would call your Dr's office about cold meds. let them tell you what they're Ok with you taking. they may also have a list on their website so maybe check there.

the reason I say see what your dr says is because a lot of the girls above mentioned taking sudafed and I was told specifically no sudafed, but I don't know the reasoning.

MadeOfAwesome · November 2013

Lucky, check out this website. You can look up all sorts of different medications and it tells you whether they're safe or not: http://safefetus.com/index.php

LuckyAngel07 · November 2013

MadeOfAwesome said: Lucky, check out this website. You can look up all sorts of different medications and it tells you whether they're safe or not: http://safefetus.com/index.php

I did check there, thanks! They didn't have Zicam specifically, though, which is what I need to know about, since I don't actually have a full-blown cold yet, just the inklings of one. I wanted to try the Zicam to head it off before it gets nasty.

@Brij2006, the whole benefit of the HSA vs just a savings account is that the HSA is completely pretax. I'm essentially not paying tax on up to $2500 (that's pretty substantial!) of money I can put toward medical expenses, rather than getting my pay taxed and then using the "leftover" money for those medical expenses.

I typically spend so little money every year on health-related costs (a couple of dental visits and an annual gyn visit that's 100% covered), that I can't see needing to put away that much. Then again, after talking to them, I might have a better idea of what other costs to anticipate, and can be better prepared to put away the appropriate amount.

I do already have a savings account going, btw. It was supposed to be for our July vacation to somewhere Caribbean with DH's family, but now I consider it our baby fund, which can definitely include medical costs.

brij2006 · November 2013

Wow. I'm being a doof this morning. I completely forgot that the HSA was pretax. I would definitely get it set up and put the maximum in there, then just put aside the remaining amount post tax.

Baby is definitely more fun than a Carribean vacation BTW. :-)

bobcee · November 2013

I don't know that I'd do the max without talking to them to see exactly what's covered first. All my prenatal appts as well as hospital costs for labor and delivery were 100% covered. The only medical bill we had to pay OOP was for Zack's circumcision and then it was only about $120 if I remember correctly.

They do have a similar program, the flexible spending account (FSA), though that allows you to put aside $5000 pretax for daycare that we use because it works out better than the child care credit you can claim on taxes for us. Don't recall if you'll be needing child care but just thought I'd throw that out there.

LuckyAngel07 · November 2013

bobcee said:

I don't know that I'd do the max without talking to them to see exactly what's covered first. All my prenatal appts as well as hospital costs for labor and delivery were 100% covered. The only medical bill we had to pay OOP was for Zack's circumcision and then it was only about $120 if I remember correctly. They do have a similar program, the flexible spending account (FSA), though that allows you to put aside $5000 pretax for daycare that we use because it works out better than the child care credit you can claim on taxes for us. Don't recall if you'll be needing child care but just thought I'd throw that out there.

You've got awesome insurance!! I just got off the phone with them explaining coverage, and it breaks down to:

$15 for first OB appt

$30 (the regular specialist copay) for all follow-up prenatal visits

$30 for imaging (u/s)

$150/day for hospital admission/delivery up to 5 days (if I have to stay longer, it's covered 100%).

All labwork is 100% covered

So, worst case scenario we pay $750 for the hospital. I have no idea how many appts we'll have, but at 2 per month (I know some will be less, some more), it's $540 for visits, plus a couple of ultrasounds. That's already over $1300 for the full 9 months, then we'll have all my and babies postnatal visits. So I'm thinking of socking away at least $1500 in the HSA. That still feels a little low, but not by much, and at least that way I won't go over and lose it.

brij2006 · November 2013

@bobcee and @luckyangel07 Can I have either one of your insurance plans please? I even work for an insurance agency, and my health insurance is crap.

bobcee · November 2013

Yeah. I can't complain at all about my insurance. Did you also ask about post natal visits for baby? All of our post natal (well child care) visits are covered and don't require a co-pay, only when we go in for a different reason (ie illness) do we have to pay the co-pay. I didn't see it in your breakdown above which is why I was asking.

bobcee · November 2013

Also by your above breakout you are planning for worst case scenario so it doesn't seem too low to me. Hopefully your hospital stay won't be a long one.

LuckyAngel07 · November 2013

@bobcee, no, I didn't ask about postnatal visits for baby. That's one thing I forgot about! For the time being, I'm expecting it to have the PCP copay of $15/visit, but most preventative visits in our plan are 100% covered, so I could be wrong.

If we are left with a bunch at the end of the year because I overcompensated, I know I can submit my receipts for contact lenses, dental copays, and the cost of DH's glasses (above what's covered) if he waits until next year to get them.

bobcee · November 2013

That's good. Sounds like you've thought it through well then and have a good back up plan for the money if there's extra so it doesn't go to waste!

mseale · November 2013

Hi lurker here.

You should check on your HSA. The benefit of an HSA (Health Savings Account) over FSA (flex spending account) is that you keep whatever you don't use. It continues to roll over, and you can invest money into mutual funds to help it grow larger for when you need it. FSA is a use it or lose it account.

DangerMuffin23 · November 2013

I have the same symptoms, but I'm 98% sure mine are allergy related. I got some nasal saline spray with no drugs and it's helped tremendously. GL!

bobcee · November 2013

I think OP was talking about an HSA. I mentioned the FSA for daycare/childcare costs which the HSA will not cover. And with the max being $5000 to put into that and daycare costs well exceeding that, we have never run into an issue with having extra money at the end of the year unfortunately. I however did not realize that the HSA allowed you to keep/rollover what you didn't use.

LuckyAngel07 · November 2013

@mseale, you're absolutely right. I was mashing up my terms. I'm referring to flex spending accounts, this one being for health costs. I have one for transportation expenses, too, since I take the train to work.

@bobcee, I haven't even looked into dependent care stuff yet. I'm not nearly far enough along to ask HR the details about that one, and no one else in the session today had dependents to necessitate talking about it. We're also probably going to talk to my dad and see if he wouldn't mind helping take care of baby when I go back to work. He's SAH. So hopefully we won't even need to worry about it.

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