Another insurance question (sorry long)

formerlyGDaisy09 · November 2015

brij2006 said:

Everyone is pointing out the global billing part. While it is great and wonderful, I will point out that not everything falls under that. My doctor offered it and that's what we went with, knowing everything would be billed in February when baby was born and I would only have to worry about deductible and max OOP for 2014.
However, I had blood work done right after a positive test that was not part of the global, then 2 extra ultrasounds because of a placenta and cervix issue, and then in November she decided to give us a scare and not move for 3 days straight. So to the hospital we went to be hooked up to monitors.
Those items alone, while are considered a routine/precautionary visit, were not part of the global billing. Hence why I met my deductible in 2014, even with taking advantage of global billing.
And for what it's worth, my pregnancy was considered low risk and I received the okay to labor at home as long as possible because of it.

Golbal billing covers routine prenatal care and labor/delivery. anything outside of that, labs, ultrasounds, other testing, or any problem visits are billed seperately. so 8, 12, 16, 20, 24, 28, 30, 32, 34, 36, 37, 38, 39, 40, 41, 42 week appointments plus labor and delivery are charged under global billing. for me that's $30 co-pays for each of those visits (potentially $450) plus all L&D.

I've received seperate bills for 3 sets of labs, 2 ultrasounds, and a problem visit for a UTI. The other thing to consider with TTC is that there might be other care you don't normally use that you will use while pregnant. For example, I don't normally seek chiropractic care, but I had terrible problems with sciatic nerve pain from about 8 weeks on (it took me until 16 weeks to actually seek chiropractic help). at $20/visit with co-pays for the aloted number of visits allowed by my insurance company and then $45 out of pocket after I exceeded my allowed number of visits that isn't an insignificant expense either.

julieanne912 · November 2015

Thanks for all the responses everyone! I am asking H today to inquire a bit further or get a summary grid that gives the basics of his plan so I can look at it myself, since I'm not really trusting what he says after reading here. Unfortunately his company is a small startup so they don't really have an HR expert with this stuff (and also why the plan isn't that great).

But, if his plan really isn't that great, I think I'll go with the HDHP plan and contribute $50ish/check to the HSA.

julieanne912 · November 2015

OK so here's the details of H's plan... I'm not sure where he was getting $10,000 deductibles from, I think he was maybe looking at the max OOP for non-PPO. His plan has a higher premium, and $500 more in deductible, but higher max OOP. His deductible for him as an individual is $1500 with a $3500 max OOP.

His plan is with Cigna and is interesting because it offers a PPO and a non-PPO option. I'd probably be fine with the PPO since Cigna is pretty widespread, even moreso than Kaiser.

Premium for me: $88.67 per check

Deductible: $3,000 family

Max OOP: $7,000 family

Co-pays for primary care: $20

Co-pays for specialists: $40

100% paid preventative care

Same prescription plan as my options (CVS Caremark)

20% coinsurance

Does not cover infertility treatments

They also sent over a grid of estimated costs for having a baby, and it puts it at $3,780 in the patient pays column. I've asked my HR people if they have a similar grid for the Aetna plans.

So, still thinking my HDHP with the HSA is a better option but I'll wait to see the grids so I can really compare them all.

Another insurance question (sorry long)

Re: Another insurance question (sorry long)

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