MM hit today.

MommyLiberty5013 · March 2016

I'm 16 weeks pregnant and woke up with an extreme headache with neck pain and weakness in both hands and arms. Called my OB. He asked me to go to the ER. After an EKG, blood work, meds to reduce pain, an MRI without contrast, the docs concluded I likely had a migraine that presented in an odd way. I'm very thankful that's all it was. I have had some odd things happen to me in the past. But now I'm laying in bed, still with dull pain, thinking about the bills. Radiology consult, neurological consult, tests, ugh. Plus just the ER cost. It makes me sad. Cheer me up, please??!!

blondie42107 · March 2016

The bill might suck but it's really good that you went to the ER! You just never know. I haven't been super active on here because we've been so busy. Do you know baby's gender? I sat next to a coworker Friday who is due in May. I really miss being pregnant!!

bmo88 · March 2016

While the bills will definitely suck, do you have health insurance that will cover it? Also, will it count toward your out of pocket max and deductible? Depending on your insurance, you will have a child this year and you probably would have it your OPP max anyway. So you will just be building toward it sooner and not hitting it in a different medical year, so that could be a silver lining....

But, at least you are healthy and baby is too! So that is always something to be happy about!

kmurphy2131 · March 2016

At least you and baby are both okay :-)

I feel your frustration though. My H had a GI virus two weeks ago and missed two days of work (unpaid, 20 hours of lost wages) & now I have a nasty virus that has cost us $25 copay, plus $30 of stuff at CVS, and with me not cooking (5 days now) H has been eating out more. It's so annoying to lose money on this kind of stuff.

vlagrl29 · March 2016

bmo88 said:

While the bills will definitely suck, do you have health insurance that will cover it? Also, will it count toward your out of pocket max and deductible? Depending on your insurance, you will have a child this year and you probably would have it your OPP max anyway. So you will just be building toward it sooner and not hitting it in a different medical year, so that could be a silver lining....

But, at least you are healthy and baby is too! So that is always something to be happy about!

That's what I was thinking - your max OOP will be met anyways so try not to worry about it. At least you and the baby are ok. Worry about bills later.

formerlyGDaisy09 · March 2016

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

vlagrl29 · March 2016

formerlyGDaisy09 said:

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

really? The c section alone for me for 4 days stay was $20k. You must have a high deductible.

formerlyGDaisy09 · March 2016

vlagrl29 said:

formerlyGDaisy09 said:

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

really? The c section alone for me for 4 days stay was $20k. You must have a high deductible.

We got to the hospital Wednesday night at 11pm (had I known I had another 10 hours to go I would have pushed myself to hang at home another hour, but I honestly had myself convinced that it was 10 days before my due date and we'd likely be going into the hospital for some IV fluids, contractions would stop, and they'd send me home). We were discharged Friday around 3pm, so 2 nights in the hospital. I had an unmedicated, uncomplicated, vaginal birth, and baby was perfect (we count our blessings everyday). After insurance the total out of pocket cost for us, including hospital and physician practice charges for myself and baby, was just shy of $1,300 ($200 for baby the rest was me). Not saying that not reaching the OOP max is unlikely during pregnancy, nor should anyone build their birth-pan around the cost, I was on the brink of begging for drugs just before it was time to push.

There was probably another $500 of charges throughout pregnancy for blood-work and ultrasounds (I had 2; one around 9 weeks because my cycles were not close enough to 28 days to use my LMP for a due date, and the regular A/S at 19 weeks). Our Family OOP max was $5000 last year; individual $2,500, so I was still several hundred dollars away from my individual max.

bmo88 · March 2016

formerlyGDaisy09: Do you have a high OOP max? Our is $4,000, and when I estimate on our online simulator, I am expecting to pay at least $3,500 for an entire pregnancy. So while it's not the full OOP max, it's really close.

formerlyGDaisy09 · March 2016

bmo88 said:

formerlyGDaisy09: Do you have a high OOP max? Our is $4,000, and when I estimate on our online simulator, I am expecting to pay at least $3,500 for an entire pregnancy. So while it's not the full OOP max, it's really close.

see above.

TL/DR: $2,500 individual max, $5,000 family. $1,100 L&D charges for me, $200 for baby; maybe $500 in other pregnancy related charges earlier in the year.

formerlyGDaisy09 · March 2016

We could get into a whole healthcare discussion related to this here; but hospital charges vary widely across the country. a lot of what you pay may have absolutely nothing to do with your health or insurance, but might depend on the health, age, and insurance mix of the community that you live in.

julieanne912 · March 2016

formerlyGDaisy09 said:

We could get into a whole healthcare discussion related to this here; but hospital charges vary widely across the country. a lot of what you pay may have absolutely nothing to do with your health or insurance, but might depend on the health, age, and insurance mix of the community that you live in.

Yup, it can even vary by hospital. My insurance website has a feature where you can put in the "procedure" you want done (in this case, a vaginal delivery with no complications is what I picked), and it'll tell you what your potential costs could be after your insurance kicks in. I've got 4 hospitals within a reasonable driving range of my house. The estimated costs to me, out of pocket, varied from $4000 to $7000. What was interesting to me though, was the "before insurance" costs varied WILDLY... like $16,000 to $60,000. That was what blew my mind....and the $60,000 hospital was the middle of the road pricing when it came to my costs.

formerlyGDaisy09 · March 2016

julieanne912 said:

formerlyGDaisy09 said:

We could get into a whole healthcare discussion related to this here; but hospital charges vary widely across the country. a lot of what you pay may have absolutely nothing to do with your health or insurance, but might depend on the health, age, and insurance mix of the community that you live in.

Yup, it can even vary by hospital. My insurance website has a feature where you can put in the "procedure" you want done (in this case, a vaginal delivery with no complications is what I picked), and it'll tell you what your potential costs could be after your insurance kicks in. I've got 4 hospitals within a reasonable driving range of my house. The estimated costs to me, out of pocket, varied from $4000 to $7000. What was interesting to me though, was the "before insurance" costs varied WILDLY... like $16,000 to $60,000. That was what blew my mind....and the $60,000 hospital was the middle of the road pricing when it came to my costs.

yes. we have 2 hospitals within 3 miles of our home. the estimated cost a the hospital I delivered at was $1,500 the other was $2,800. The lower cost hospital is also the one that is higher rated for maternity care and is a designated Baby-friendly hospital...so in that case cost didn't even equate to higher quality.

julieanne912 · March 2016

formerlyGDaisy09 said:

julieanne912 said:

formerlyGDaisy09 said:

We could get into a whole healthcare discussion related to this here; but hospital charges vary widely across the country. a lot of what you pay may have absolutely nothing to do with your health or insurance, but might depend on the health, age, and insurance mix of the community that you live in.

Yup, it can even vary by hospital. My insurance website has a feature where you can put in the "procedure" you want done (in this case, a vaginal delivery with no complications is what I picked), and it'll tell you what your potential costs could be after your insurance kicks in. I've got 4 hospitals within a reasonable driving range of my house. The estimated costs to me, out of pocket, varied from $4000 to $7000. What was interesting to me though, was the "before insurance" costs varied WILDLY... like $16,000 to $60,000. That was what blew my mind....and the $60,000 hospital was the middle of the road pricing when it came to my costs.

yes. we have 2 hospitals within 3 miles of our home. the estimated cost a the hospital I delivered at was $1,500 the other was $2,800. The lower cost hospital is also the one that is higher rated for maternity care and is a designated Baby-friendly hospital...so in that case cost didn't even equate to higher quality.

Yup, the $7,000 one for me was the oldest hospital with the least nice facilities. My manager had both her kids there and said she wouldn't recommend it.

formerlyGDaisy09 · March 2016

julieanne912 said:

formerlyGDaisy09 said:

julieanne912 said:

formerlyGDaisy09 said:

We could get into a whole healthcare discussion related to this here; but hospital charges vary widely across the country. a lot of what you pay may have absolutely nothing to do with your health or insurance, but might depend on the health, age, and insurance mix of the community that you live in.

Yup, it can even vary by hospital. My insurance website has a feature where you can put in the "procedure" you want done (in this case, a vaginal delivery with no complications is what I picked), and it'll tell you what your potential costs could be after your insurance kicks in. I've got 4 hospitals within a reasonable driving range of my house. The estimated costs to me, out of pocket, varied from $4000 to $7000. What was interesting to me though, was the "before insurance" costs varied WILDLY... like $16,000 to $60,000. That was what blew my mind....and the $60,000 hospital was the middle of the road pricing when it came to my costs.

yes. we have 2 hospitals within 3 miles of our home. the estimated cost a the hospital I delivered at was $1,500 the other was $2,800. The lower cost hospital is also the one that is higher rated for maternity care and is a designated Baby-friendly hospital...so in that case cost didn't even equate to higher quality.

Yup, the $7,000 one for me was the oldest hospital with the least nice facilities. My manager had both her kids there and said she wouldn't recommend it.

...and even given all that OB/GYN practices, generally, are money loosers for hospitals.

vlagrl29 · March 2016

formerlyGDaisy09 said:

vlagrl29 said:

formerlyGDaisy09 said:

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

really? The c section alone for me for 4 days stay was $20k. You must have a high deductible.

We got to the hospital Wednesday night at 11pm (had I known I had another 10 hours to go I would have pushed myself to hang at home another hour, but I honestly had myself convinced that it was 10 days before my due date and we'd likely be going into the hospital for some IV fluids, contractions would stop, and they'd send me home). We were discharged Friday around 3pm, so 2 nights in the hospital. I had an unmedicated, uncomplicated, vaginal birth, and baby was perfect (we count our blessings everyday). After insurance the total out of pocket cost for us, including hospital and physician practice charges for myself and baby, was just shy of $1,300 ($200 for baby the rest was me). Not saying that not reaching the OOP max is unlikely during pregnancy, nor should anyone build their birth-pan around the cost, I was on the brink of begging for drugs just before it was time to push.
There was probably another $500 of charges throughout pregnancy for blood-work and ultrasounds (I had 2; one around 9 weeks because my cycles were not close enough to 28 days to use my LMP for a due date, and the regular A/S at 19 weeks). Our Family OOP max was $5000 last year; individual $2,500, so I was still several hundred dollars away from my individual max.

that makes sense. the most we will spend next time is $1,000 - that's our family max OOP.

MommyLiberty5013 · March 2016

Yes, we have good HI. But to keep our premiums lower, we opted for higher deductible. We've never met it, even with each of the kiddos (3 so far). Maybe we will this year.

I don't chose my delivery hospitals based on cost, I choose them solely on the level of care their NICU offers. Thankfully, we have never needed the NICU. But my mom worked for 30+ years as a nurse in labor and delivery and the post-partum, and she always encouraged me to deliver at hospitals with higher level care available for newborns (you just never know what will happen).

vlagrl29 · March 2016

MommyLiberty5013 said:

Yes, we have good HI. But to keep our premiums lower, we opted for higher deductible. We've never met it, even with each of the kiddos (3 so far). Maybe we will this year.
I don't chose my delivery hospitals based on cost, I choose them solely on the level of care their NICU offers. Thankfully, we have never needed the NICU. But my mom worked for 30+ years as a nurse in labor and delivery and the post-partum, and she always encouraged me to deliver at hospitals with higher level care available for newborns (you just never know what will happen).

Yes I've based my hospital for our #2 (not pregnant yet) based on vbac policies. Those hospitals have to have a really good NICU as well.

AprilZ81 · March 2016

I'm super jealous of those with low deductibles/OOP Max. I'm on my own policy and my deductible is $1,500 and my OOP max is $5,500. Normally that isn't an issue because I'm generally a low user of health care services. This year, due to our infertility treatments I'm almost at our deductible already.

A vaginal birth is going to cost us about $3,000 (depending on exactly when the deductible kicks in and assuming I get pregnant in the next three weeks), a c-section about $4,000.

If I don't get pregnant in the next 3 weeks the baby would be due in 2017 and we would be starting all over again on our deductible. Super fun times!

vlagrl29 · March 2016

AprilZ81 said:

I'm super jealous of those with low deductibles/OOP Max. I'm on my own policy and my deductible is $1,500 and my OOP max is $5,500. Normally that isn't an issue because I'm generally a low user of health care services. This year, due to our infertility treatments I'm almost at our deductible already.

A vaginal birth is going to cost us about $3,000 (depending on exactly when the deductible kicks in and assuming I get pregnant in the next three weeks), a c-section about $4,000.

If I don't get pregnant in the next 3 weeks the baby would be due in 2017 and we would be starting all over again on our deductible. Super fun times!

Just know that all the OBs I've talked to do global billing which means they don't submit the claims for the prenatal care until baby is born so if you are pregnant this year but don't deliver til next year you don't have to worry about fulfilling 2 years of deductibles. With dd my max oop on a cobra plan was $3500 but we ended up putting dd on dhs plan once born so she had her own ded at 4k. It's like heaven with this new low ded we have. Less money stress.

Erikan73 · March 2016

The best news that you and baby are ok. Maybe start tracking your foods going forward & include any candy & beverages. This way if this happens again in the future you can look at your journal and see if there is any type of trend that maybe triggering it. There is a possibility that something that didn't bother you before maybe now since your hormones are different. Good luck & stay positive, you and your baby are ok, financial issues can always be figured out & taken care over time.

formerlyGDaisy09 · March 2016

vlagrl29 said:

AprilZ81 said:

I'm super jealous of those with low deductibles/OOP Max. I'm on my own policy and my deductible is $1,500 and my OOP max is $5,500. Normally that isn't an issue because I'm generally a low user of health care services. This year, due to our infertility treatments I'm almost at our deductible already.

A vaginal birth is going to cost us about $3,000 (depending on exactly when the deductible kicks in and assuming I get pregnant in the next three weeks), a c-section about $4,000.

If I don't get pregnant in the next 3 weeks the baby would be due in 2017 and we would be starting all over again on our deductible. Super fun times!

Just know that all the OBs I've talked to do global billing which means they don't submit the claims for the prenatal care until baby is born so if you are pregnant this year but don't deliver til next year you don't have to worry about fulfilling 2 years of deductibles. With dd my max oop on a cobra plan was $3500 but we ended up putting dd on dhs plan once born so she had her own ded at 4k. It's like heaven with this new low ded we have. Less money stress.

This. Half the charges I was billed after delivery were for all of my prenatal care. I also absolutely did not pick the hospital I delivered at based on cost, it was just coincidence that the hospital with the higher prenatal care ratings was also cheaper.

Related, the hospital that I delivered at did not have a NICU, but they were very clear from the beginning that if I went into labor before 36 weeks they would send me straight to the other hospital, and after that if anything seemed off baby and I would be transferred to the medical center with the NICU, the hospital has a reputation for exercising an abundance of caution and often makes transfers that were, retrospectively, unnecessary. On the otherhand, the large medical center has a reputation for having a high c-section rate, and most babies are discharged on a combination of formula and breastmilk. although they are a higher level care center we felt that simply delivering there would be putting me at higher risk of c-section and might als be detrimental to establishing good breastfeeding. NICUs are important, but for those thinking about TTC I would definitely also consider C-section rates (all OB/GYN practices should be able to give this to you), and breastfeeding resources when selecting where you plan to deliver. And from a MM standpoint, avoiding unecessary C-section and establishing breastfeeding both make MM sense.

formerlyGDaisy09 · March 2016

formerlyGDaisy09 said:

vlagrl29 said:

AprilZ81 said:

I'm super jealous of those with low deductibles/OOP Max. I'm on my own policy and my deductible is $1,500 and my OOP max is $5,500. Normally that isn't an issue because I'm generally a low user of health care services. This year, due to our infertility treatments I'm almost at our deductible already.

A vaginal birth is going to cost us about $3,000 (depending on exactly when the deductible kicks in and assuming I get pregnant in the next three weeks), a c-section about $4,000.

If I don't get pregnant in the next 3 weeks the baby would be due in 2017 and we would be starting all over again on our deductible. Super fun times!

Just know that all the OBs I've talked to do global billing which means they don't submit the claims for the prenatal care until baby is born so if you are pregnant this year but don't deliver til next year you don't have to worry about fulfilling 2 years of deductibles. With dd my max oop on a cobra plan was $3500 but we ended up putting dd on dhs plan once born so she had her own ded at 4k. It's like heaven with this new low ded we have. Less money stress.

This. Half the charges I was billed after delivery were for all of my prenatal care. I also absolutely did not pick the hospital I delivered at based on cost, it was just coincidence that the hospital with the higher prenatal care ratings was also cheaper.

Related, the hospital that I delivered at did not have a NICU, but they were very clear from the beginning that if I went into labor before 36 weeks they would send me straight to the other hospital, and after that if anything seemed off baby and I would be transferred to the medical center with the NICU, the hospital has a reputation for exercising an abundance of caution and often makes transfers that were, retrospectively, unnecessary. On the otherhand, the large medical center has a reputation for having a high c-section rate, and most babies are discharged on a combination of formula and breastmilk. although they are a higher level care center we felt that simply delivering there would be putting me at higher risk of c-section and might als be detrimental to establishing good breastfeeding. NICUs are important, but for those thinking about TTC I would definitely also consider C-section rates (all OB/GYN practices should be able to give this to you), and breastfeeding resources when selecting where you plan to deliver. And from a MM standpoint, avoiding unecessary C-section and establishing breastfeeding both make MM sense.

...all that to say that there is an increasing level of research that shows that simply being at a facility that offers a higher level of care puts you at higher risk for using that level of care, mostly out of an abundance of caution on the part of doctors; because they have the resources available they are more likely to use them, plus they are less likely to be sued for malpractice if they do too much than if they do too little, but also in the current fee-for-service model if you have a NICU (and all the equiptment and staff to go with it) you pay for it by keeping it full.

brij2006 · March 2016

vlagrl29 said:

formerlyGDaisy09 said:

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

really? The c section alone for me for 4 days stay was $20k. You must have a high deductible.

So lucky!
I had an unmedicated vaginal delivery and zero complications with DD, yet still met my max OOP of $3,000. Plus my pregnancy ran into 2 calendar years, so we had 2 max OOP's to account for.

formerlyGDaisy09 · March 2016

brij2006 said:

vlagrl29 said:

formerlyGDaisy09 said:

Worry about the bills later. If its a lot of money, many many hospitals are more than willing to work out interest free payment plans. It does get you close to your OOP max for the year, so hopefully if there are more complications further down the road more things will be covered.

I will however add that it's possible you won't meet your OOP max, we didn't even come close to our OOP max last year and my entire pregnancy fell into that insurance year. I'm sure you've prepared for that potential, but its possible that the rest of your pregnancy, L&D, and pediatric care might be inexpensive. all well-child checks should be covered at 100% (ACA rules) and all your preventative care should also be covered at 100%.

really? The c section alone for me for 4 days stay was $20k. You must have a high deductible.

So lucky!
I had an unmedicated vaginal delivery and zero complications with DD, yet still met my max OOP of $3,000. Plus my pregnancy ran into 2 calendar years, so we had 2 max OOP's to account for.

Again a lot of this has to do with geography, I'm lucky to live in an area that has an older population so a higher percentage of people are on medicare so hospitals get reimbursed for most services they provide and don't have to overcharge me as much to account for charity care and bad-debt.

vlagrl29 · March 2016

formerlyGDaisy09 said:

vlagrl29 said:

AprilZ81 said:

I'm super jealous of those with low deductibles/OOP Max. I'm on my own policy and my deductible is $1,500 and my OOP max is $5,500. Normally that isn't an issue because I'm generally a low user of health care services. This year, due to our infertility treatments I'm almost at our deductible already.

A vaginal birth is going to cost us about $3,000 (depending on exactly when the deductible kicks in and assuming I get pregnant in the next three weeks), a c-section about $4,000.

If I don't get pregnant in the next 3 weeks the baby would be due in 2017 and we would be starting all over again on our deductible. Super fun times!

Just know that all the OBs I've talked to do global billing which means they don't submit the claims for the prenatal care until baby is born so if you are pregnant this year but don't deliver til next year you don't have to worry about fulfilling 2 years of deductibles. With dd my max oop on a cobra plan was $3500 but we ended up putting dd on dhs plan once born so she had her own ded at 4k. It's like heaven with this new low ded we have. Less money stress.

This. Half the charges I was billed after delivery were for all of my prenatal care. I also absolutely did not pick the hospital I delivered at based on cost, it was just coincidence that the hospital with the higher prenatal care ratings was also cheaper.

Related, the hospital that I delivered at did not have a NICU, but they were very clear from the beginning that if I went into labor before 36 weeks they would send me straight to the other hospital, and after that if anything seemed off baby and I would be transferred to the medical center with the NICU, the hospital has a reputation for exercising an abundance of caution and often makes transfers that were, retrospectively, unnecessary. On the otherhand, the large medical center has a reputation for having a high c-section rate, and most babies are discharged on a combination of formula and breastmilk. although they are a higher level care center we felt that simply delivering there would be putting me at higher risk of c-section and might als be detrimental to establishing good breastfeeding. NICUs are important, but for those thinking about TTC I would definitely also consider C-section rates (all OB/GYN practices should be able to give this to you), and breastfeeding resources when selecting where you plan to deliver. And from a MM standpoint, avoiding unecessary C-section and establishing breastfeeding both make MM sense.

Agreed! I've researched OBs and am down to 2 hospitals I would want to deliver at - I'm favoring 1 more than the other but once we start TTC we will get tours of the hospitals and then decide. I will be bringing 2 birth plans with me next time - best case and worst case lol- with the next one being our last baby I want things a bit different.

MM hit today.

Re: MM hit today.

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