Hospital stay and HDHP FTW

csuave · June 2016

I had a minor incident a couple weeks ago (I'm fine it wasn't anything big---dizziness mostly) and took an ambulance from work to the hospital where I stayed one night.

As an overall healthy person this was the first time I really put the HDHP to the test.

The bills are in and total charged was about $13,700.
Insurance rate was $3,300 (does this mean people without insurance pay $13,700?....wow)
Family deductible $2,600 and then 80% coverage kicks in
I'll be paying $2,742 "out of pocket" (actually out of HSA since we have the money in there)

I looked at the numbers and the more expensive, $1,500 deductible plan would have me pay $2,128 out of pocket, or $614 less. But when you consider per paycheck payments are $1,430 lower annually on HDHP we come out ahead on HDHP even paying a little more "out of pocket." And then when you take into account that my work puts $1,000 into our HSA account each year HDHP is clearly the better plan here even with the big hospital bills coming in.

cbee817 · June 2016

Did your insurance company allow $13,700? A hospital can bill $13,700 but an insurance company can just allow a % of that depending on the fee schedule/payment contracts with the hospital. A person without insurance would not be billed that much either- at least not in the state I am in.

csuave · June 2016

cbee817 said:

Did your insurance company allow $13,700? A hospital can bill $13,700 but an insurance company can just allow a % of that depending on the fee schedule/payment contracts with the hospital. A person without insurance would not be billed that much either- at least not in the state I am in.

No. Insurance negotiated rate was $3,300.

cbee817 · June 2016

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

csuave · June 2016

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

It is crazy. I had no idea what to expect with these bills. Very eye opening.

jtmh2012 · June 2016

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

jtmh2012 · June 2016

csuave said:

I looked at the numbers and the more expensive, $1,500 deductible plan would have me pay $2,128 out of pocket, or $614 less. But when you consider per paycheck payments are $1,430 lower annually on HDHP we come out ahead on HDHP even paying a little more "out of pocket." And then when you take into account that my work puts $1,000 into our HSA account each year HDHP is clearly the better plan here even with the big hospital bills coming in.

If you haven't paid yet, call and ask for a "cash" discount. We did that when our son was born and it saved us about $1,000.....

csuave · June 2016

jtmh2012 said:

csuave said:

I looked at the numbers and the more expensive, $1,500 deductible plan would have me pay $2,128 out of pocket, or $614 less. But when you consider per paycheck payments are $1,430 lower annually on HDHP we come out ahead on HDHP even paying a little more "out of pocket." And then when you take into account that my work puts $1,000 into our HSA account each year HDHP is clearly the better plan here even with the big hospital bills coming in.

If you haven't paid yet, call and ask for a "cash" discount. We did that when our son was born and it saved us about $1,000.....

Thanks. I'll look into that. I looked at the claims online but haven't gotten actual bills yet.

cbee817 · June 2016

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

brij2006 · June 2016

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Most be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

So jealous.
We live in a LCOL area, but it's almost like the hospitals know we don't have any other option, so they price gouge with everything.

DD's birth was unmedicated and she was perfectly healthy. I also labored at home as long as possible and showed up 45 minutes before she was born. Total cost was $17k. It sucks when you have a pretty high deductible and maxOOP. I seriously think we would have paid less if we didn't have insurance and received a cash discount for her entire labor and delivery.

We live in the heart of Mennonite country. I have joked with H about having a home birth next time with the Mennonite midwife that lives 2 miles from our house. I'm only sort of kidding. I would seriously look into it if H were on board.

short+sassy · June 2016

brij2006 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Most be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

So jealous.
We live in a LCOL area, but it's almost like the hospitals know we don't have any other option, so they price gouge with everything.
DD's birth was unmedicated and she was perfectly healthy. I also labored at home as long as possible and showed up 45 minutes before she was born. Total cost was $17k. It sucks when you have a pretty high deductible and maxOOP. I seriously think we would have paid less if we didn't have insurance and received a cash discount for her entire labor and delivery.

We live in the heart of Mennonite country. I have joked with H about having a home birth next time with the Mennonite midwife that lives 2 miles from our house. I'm only sort of kidding. I would seriously look into it if H were on board.

Home births scare the hell of out of me and here's why. Sorry, sorry, sorry for the scary pregnancy tale to those of you expecting. My mother had a totally normal and healthy pregnancy with me. However, when I was born, a blood vessel ruptured but it was not immediately detected because she was bleeding internally.

About 30 minutes after she had been wheeled into her room, she mentioned to a nurse she was feeling a little tired. The nurse took her blood pressure and my mom watched as the nurse's face turned white. She not only hit the emergency button, but went running into halls yelling for a doctor.

Fortunately, they were able to stabilize my mother in time, but it was a very close call. If she had given birth at home, she would have died.

Don't get me wrong, I'm sure the vast majority of home births are just fine, but crazy things happen and its a lot better to be in a hospital already if they do.

@csuave, I'm glad to hear everything is fine, but what a bummer to go through that!

jtmh2012 · June 2016

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I'm in Richmond, Virginia if that matters?

Xstatic3333 · June 2016

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I think a lot of it is just the individual insurance plan, too. We're in the pro-ACA, HCOL northeast where many people have awesome insurance. Our plan was great when we were healthy but we're finding with the maternity stuff it's all adding up quickly. We will owe at least $500 for just the hospital admission, plus we may owe 20% up to the OOP max for our midwife (hopefully) or doctor. It's all a little confusing trying to figure out who at our practice is in-network and who isn't. For the most part I think they're in-network but I get hit with this weird surcharge since they aren't in Massachusetts. I'm just stashing money away and expecting the worst. My deductible is only $150, but my OOP max is $5000 and I'm already at $480 with two appointments and an ultrasound.

cbee817 · June 2016

Xstatic3333 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I think a lot of it is just the individual insurance plan, too. We're in the pro-ACA, HCOL northeast where many people have awesome insurance. Our plan was great when we were healthy but we're finding with the maternity stuff it's all adding up quickly. We will owe at least $500 for just the hospital admission, plus we may owe 20% up to the OOP max for our midwife (hopefully) or doctor. It's all a little confusing trying to figure out who at our practice is in-network and who isn't. For the most part I think they're in-network but I get hit with this weird surcharge since they aren't in Massachusetts. I'm just stashing money away and expecting the worst. My deductible is only $150, but my OOP max is $5000 and I'm already at $480 with two appointments and an ultrasound.

We live in NY with a PPO copay plan through my employer. Can't get more pro-ACA unless we lived in MA.

brij2006 · June 2016

short+sassy said:

brij2006 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Most be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

So jealous.
We live in a LCOL area, but it's almost like the hospitals know we don't have any other option, so they price gouge with everything.
DD's birth was unmedicated and she was perfectly healthy. I also labored at home as long as possible and showed up 45 minutes before she was born. Total cost was $17k. It sucks when you have a pretty high deductible and maxOOP. I seriously think we would have paid less if we didn't have insurance and received a cash discount for her entire labor and delivery.

We live in the heart of Mennonite country. I have joked with H about having a home birth next time with the Mennonite midwife that lives 2 miles from our house. I'm only sort of kidding. I would seriously look into it if H were on board.

Home births scare the hell of out of me and here's why. Sorry, sorry, sorry for the scary pregnancy tale to those of you expecting. My mother had a totally normal and healthy pregnancy with me. However, when I was born, a blood vessel ruptured but it was not immediately detected because she was bleeding internally.
About 30 minutes after she had been wheeled into her room, she mentioned to a nurse she was feeling a little tired. The nurse took her blood pressure and my mom watched as the nurse's face turned white. She not only hit the emergency button, but went running into halls yelling for a doctor.
Fortunately, they were able to stabilize my mother in time, but it was a very close call. If she had given birth at home, she would have died.
Don't get me wrong, I'm sure the vast majority of home births are just fine, but crazy things happen and its a lot better to be in a hospital already if they do.
@csuave, I'm glad to hear everything is fine, but what a bummer to go through that!

That is definitely scary.

I know bad things can happen. I would probably only seriously consider it if we lived closer to a hospital. We're still 30 minutes from a minor hospital and an hour from one with better services and abilities. We drove an hour while I was in the most intense part of labor (transition stage) just so we could deliver at the better hospital.

It just still sucks that even though those are our only 2 options, they price gouge because of it. We live in a rural LCOL area where the average household income is just under $40k/year. You would think our pricing for medical services would somewhat reflect that as well.

vlagrl35 · June 2016

jtmh2012 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I'm in Richmond, Virginia if that matters?

We are in midwest and 4 days with a c/section and 4 days for DD was $31k - I have no idea what insurance paid. Its been 5 years. I know that doesn't include the 9 months of OB bills.

Xstatic3333 · June 2016

cbee817 said:

Xstatic3333 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I think a lot of it is just the individual insurance plan, too. We're in the pro-ACA, HCOL northeast where many people have awesome insurance. Our plan was great when we were healthy but we're finding with the maternity stuff it's all adding up quickly. We will owe at least $500 for just the hospital admission, plus we may owe 20% up to the OOP max for our midwife (hopefully) or doctor. It's all a little confusing trying to figure out who at our practice is in-network and who isn't. For the most part I think they're in-network but I get hit with this weird surcharge since they aren't in Massachusetts. I'm just stashing money away and expecting the worst. My deductible is only $150, but my OOP max is $5000 and I'm already at $480 with two appointments and an ultrasound.

We leave in NY with a PPO copay plan through my employer. Can't get more pro-ACA unless we lived in MA.

I should clarify that I still love the ACA. We just have bad luck and a somewhat unusual situation working against us. I realized it didn't sound that way when I read it back. My main point was just that health care plans vary a ton, even within regions. Glad you've got a good one!

cbee817 · June 2016

jtmh2012 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I'm in Richmond, Virginia if that matters?

We're in NY- one of the most heavily regulated states for health insurance. We're required to be non-profit, we have MLR that are run constantly, along with quarterly rate approvals by the state DFS. There are no Aetna/Humana/United around here.

vlagrl35 · June 2016

Xstatic3333 said:

cbee817 said:

jtmh2012 said:

cbee817 said:

Sorry I missed that- that's pretty nuts.. hospital bills $13,700 and insurance only allows $3,300. I mean that right there shows some serious issues with hospital charges. I had 2 babies and the hospital billed less than that for each delivery.

When we had our little one, the initial billed amount by the hospital was $35k. That's for a normal, uncomplicated delivery. Insurance knocked it down to $16k and paid most of it.

Must be the part of the US you are in- that's more like our c-section deliveries. Quick, no meds delivery- hospital billed (for me and DD#2 - DD#1 was with DH's insurance but is was at the same hospital and the only extra thing I had was pitocin) $7,240, Insurance paid $7,100 and maternity IP visit is CIF (for both of our medical plans).

I think a lot of it is just the individual insurance plan, too. We're in the pro-ACA, HCOL northeast where many people have awesome insurance. Our plan was great when we were healthy but we're finding with the maternity stuff it's all adding up quickly. We will owe at least $500 for just the hospital admission, plus we may owe 20% up to the OOP max for our midwife (hopefully) or doctor. It's all a little confusing trying to figure out who at our practice is in-network and who isn't. For the most part I think they're in-network but I get hit with this weird surcharge since they aren't in Massachusetts. I'm just stashing money away and expecting the worst. My deductible is only $150, but my OOP max is $5000 and I'm already at $480 with two appointments and an ultrasound.

technically you shouldn't be paying more than $5000 - but I know that can vary with out of network. I know DD's newborn hearing test was out of network so we paid it separately with cash to get a 40% discount.

smerka · June 2016

I don't remember what we wound up paying, but the bill from the hospital for one of my kids was $40,000 and the OB was $5,500. But those are the list prices. My insurance paid less and our portion was even lower. So much depends on the plan your employer picks.

julieanne912 · June 2016

Meanwhile, out here in CO, according to my insurance's "price comparison" tool on their website, giving birth ranges from 18k to 59k before insurance, for a normal vaginal birth with no complications.

Insurance knocks it down to anywhere from 4500ish to 9000ish out of pocket for me with my HDHP plan.

jtmh2012 · June 2016

julieanne912 said:

Meanwhile, out here in CO, according to my insurance's "price comparison" tool on their website, giving birth ranges from 18k to 59k before insurance, for a normal vaginal birth with no complications.

Insurance knocks it down to anywhere from 4500ish to 9000ish out of pocket for me with my HDHP plan.

After we were sure all the bills were in, I added up my actual payments and I think we came out about $4500 or so as well with our HDHP.

The only thing that sucked in our case is that our OB required a payment plan (or paid in full) for our portion of the charges over the course of the pregnancy. Well, the hospital beat them to the billing and mailed us a bill for the portion the insurance said we owed. Made a call to the OB and they issued a check in short order and without grief, but it was still annoying.

short+sassy · June 2016

jtmh2012 said:

julieanne912 said:

Meanwhile, out here in CO, according to my insurance's "price comparison" tool on their website, giving birth ranges from 18k to 59k before insurance, for a normal vaginal birth with no complications.

Insurance knocks it down to anywhere from 4500ish to 9000ish out of pocket for me with my HDHP plan.

After we were sure all the bills were in, I added up my actual payments and I think we came out about $4500 or so as well with our HDHP.
The only thing that sucked in our case is that our OB required a payment plan (or paid in full) for our portion of the charges over the course of the pregnancy. Well, the hospital beat them to the billing and mailed us a bill for the portion the insurance said we owed. Made a call to the OB and they issued a check in short order and without grief, but it was still annoying.

Not at all pregnancy or medical related, but I had the same thing happen when I bought a car out of state. I live in Louisiana, but bought a previous car off E-bay (of all things). It was a Houston dealership selling the car, so I flew there and drove back.

The dealership insisted I HAD to pay Louisiana state sales tax to them, but not the parish (county) tax, because there is some kind of reciprocal agreement between the two states. I argued pretty hard against it because it was really only adding extra hassle and extra steps when, either way, the taxes have to be paid before I can register the car anyway...and they weren't even collecting the full taxes. But no.

Here is how stupid this was!!!! If I was just paying the taxes myself, I could have gone at any time to register my car and get a permanent plate. However, NOW, I needed to wait for the state to receive the check from dealership.

And the best part. They royally screwed up and never sent the check to Louisiana (rolling eyes)! I found this out when I called for them to send me another paper dealer plate because mine was about to expire and the state still hadn't received their check. They overnighted me a check for the taxes. And made it payable to me, lol. So much for that reciprocal agreement.

jtmh2012 · June 2016

short+sassy said:

And the best part. They royally screwed up and never sent the check to Louisiana (rolling eyes)! I found this out when I called for them to send me another paper dealer plate because mine was about to expire and the state still hadn't received their check. They overnighted me a check for the taxes. And made it payable to me, lol. So much for that reciprocal agreement.

That would infuriate me.

Hospital stay and HDHP FTW

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