Pregnant and worried about hospital bills..x posted in I'm pregnant!

[April411]

I originally posted this in the pregnancy forum but I haven't gotten any responses so I thoutht this forum might be better.

I'm due in about 2.5 months and I am freaking out about what I'm going to have to pay. When I was pregnant with my first dc, I was a broke college student so I automatically qualified for Medi-Cal (medicaid in Ca.).

This time around I am working full time making about 3k per month and have insurance through my employer. However, the issue is that its cr*ppy insurance. ($2,000 deductible, 60% coinsurance) When I called Aetna to find out what I would have to pay I was quoted about $10,000 out of pocket if I used an in-network hospital and possibly more if there are complications.

I was on Medi-Cal about the first 6 months of this pregnancy but when they found out I had insurance they cut it. I tried applying for AIM (Acess for Infants and Mothers) which is a program for mid-income women with no insurance or high deductible insurance but they told me that I make TOO LITTLE for their program and I should go apply for Medi-Cal. I'm extremely frustrated right now. I plan on calling in sick on monday and going down to the Medi-Cal office since I can't seem to get ahold of my caseworker by phone but I'm really scared that this pregnancy is going to put me in severe debt. Are there any of you who have been in this situation? How much did you end up paying?

[greenluv]

Is there a reason you are unable to work with a birth center or midwife??

[April411]

Originally Posted by greenluv

Is there a reason you are unable to work with a birth center or midwife??

There really aren't any birth centers close to where I live and I'm already 7 month pregnant...I don't exactly have a lot of time to find a midwife. I'm also not as brave as some of you ladies on these boards. At this point in my life I just feel more comfortable with a hospital birth.

[4Blessings]

With insurance I ended up paying about $2K for my last birth. I worked with the hospital and made monthly payments. The hospital seemed very happy to make payment arrangements and work with me when I need to adjust the payments to a lower monthly amount too.

[1growingsprout]

I hate to say it but sometimes you are stuck with the health insurance your employer provides you. I think we are condtioned to believe dr's only cost a $10 co-pay etc and thats really not the case. Now quoting you 10k may not totally be accurate either. What I would do is call the hospital you plan on using and speaking to the billing department. They will be able to give you a better estimate of the costs. Yes you are looking at 60% of 'usual and customary' fees so everything will still be billed to insurance and then you should get adjusted bills etc. My family had insurance like this once, while it wasnt my favorite plan it was do-able. This type of plan really made me aware of the price of medical care.
However if you have medical insurace through your employer why do you feel that you should recieve state benefits? Just because you dont have an ideal insurance plan? Thats really not fair either.

[JTA Mom]

Originally Posted by April411

I originally posted this in the pregnancy forum but I haven't gotten any responses so I thoutht this forum might be better.

I'm due in about 2.5 months and I am freaking out about what I'm going to have to pay. When I was pregnant with my first dc, I was a broke college student so I automatically qualified for Medi-Cal (medicaid in Ca.).

This time around I am working full time making about 3k per month and have insurance through my employer. However, the issue is that its cr*ppy insurance. ($2,000 deductible, 60% coinsurance) When I called Aetna to find out what I would have to pay I was quoted about $10,000 out of pocket if I used an in-network hospital and possibly more if there are complications.

I was on Medi-Cal about the first 6 months of this pregnancy but when they found out I had insurance they cut it. I tried applying for AIM (Acess for Infants and Mothers) which is a program for mid-income women with no insurance or high deductible insurance but they told me that I make TOO LITTLE for their program and I should go apply for Medi-Cal. I'm extremely frustrated right now. I plan on calling in sick on monday and going down to the Medi-Cal office since I can't seem to get ahold of my caseworker by phone but I'm really scared that this pregnancy is going to put me in severe debt. Are there any of you who have been in this situation? How much did you end up paying?

If you make too little to be on AIM, then someone at Medi-Cal messed up. I think you might need to pay a portion of your expenses and/or a monthly rate though. But nothing like what you were quoted.

Call up a few in-network hospitals and talk to them about what it truly costs.

1GrowingSprout, I don't think saying 'suck it up' is in any way helpful. She lives in Cali on 3k a month--the fact that that is too LITTLE of an income to qualify for a state program where she pays part of the cost should make it clear that she can't afford the payment for herself.

As for stating the 'true' cost of medicine, hospitals are known to charge exorbitant rates for uninsured/underinsured people. Insurance companies pay LESS. How is that fair? If an insurance company can pay less, well then, so should people paying cash. Unless, of course, profit is a motive. But that's not part of this discussion.

Ami

[mamadelbosque]

I'd definetly go back and talk to the medicaid/medical folks. You probably don't qualify if your *not* pregnant, but if you *Are* pregnant, the cutoff limit is much higher than for standard medicaid (at least, here in OH). And just because you have other insurance does *NOT* mean you *don't* qualifiy for medicaid (at least, once again, here in OH) - it then becomes the 'supplemental' part of your insurance, so the hospital bills your insurance first, and the medicaid picks up the rest.

[scrapadoozer]

Originally Posted by mamadelbosque

I'd definetly go back and talk to the medicaid/medical folks. You probably don't qualify if your *not* pregnant, but if you *Are* pregnant, the cutoff limit is much higher than for standard medicaid (at least, here in OH). And just because you have other insurance does *NOT* mean you *don't* qualifiy for medicaid (at least, once again, here in OH) - it then becomes the 'supplemental' part of your insurance, so the hospital bills your insurance first, and the medicaid picks up the rest.

That's how it works here in Maine as well. My friend had insurance through her husband's job and still qualified for state health insurance.

[zacharysmom]

it was that way in GA when i had my son they did double coverage with work insurance and medicaid

[Noelle C.]

I hate this about California. The cut-off for Medi-Cal for pregnancy is really pretty low, yet for certain other programs, the minimum is high. It's entirely possible to fall right into the cracks. When we were faced with this possibility, we/I fell right into the crack.

Emily, the cut-off here for pregnancy Medi-Cal is indeed higher than when not pregnant, but still very low considering the cost of living. In some areas, if you can make rent, even if you can afford nothing else, that means you have more than enough money, according to the state. It's so messed up.

[Captain_Crunch]

Make sure they are counting you as 2 people, in utah it specifically states that if you are pregnant to count yourself as 2 people when figuring which income bracket you'd fall in.

I suggest filing an appeal or reapplying. I was already double insured when I had my DS but because they were through my parents neither insurance would cover my son. I was initially denied because with double insurance I had ZERO medical costs for the pregnancy but when I appealed and brought letters from the insurance companies stating they would not cover anything for the baby I was approved. So reapply or appeal and send in documentation ( a written estimate from the doctor and hospital) to show that the copays are too high and there is no way you can pay those.

[RoadWorkAhead]

Originally Posted by 1growingsprout

I hate to say it but sometimes you are stuck with the health insurance your employer provides you. I think we are condtioned to believe dr's only cost a $10 co-pay etc and thats really not the case. Now quoting you 10k may not totally be accurate either. What I would do is call the hospital you plan on using and speaking to the billing department. They will be able to give you a better estimate of the costs. Yes you are looking at 60% of 'usual and customary' fees so everything will still be billed to insurance and then you should get adjusted bills etc. My family had insurance like this once, while it wasnt my favorite plan it was do-able. This type of plan really made me aware of the price of medical care.
However if you have medical insurace through your employer why do you feel that you should recieve state benefits? Just because you dont have an ideal insurance plan? Thats really not fair either.

Because she's lower income. 10k in debt could sink some one for years in her income bracket. That benefits society in no way over paying medical bills. Should we also not get medical benefits for our DD? She has private insurance now that covers about 4-5k of her yearly expenses. I mean, under your comments, its completely acceptable then that we pick up the additional 30-35k tab each year even though that is our yearly income? Doesn't make any sense

[Noelle C.]

I agree with RoadWorkAhead. There's something known as being under-insured. Having insurance, but it doesn't cover enough. No one's saying 100% should be covered, but when what's left is enough to financially destroy a person, then there's a problem. SInking someone so they can't get ahead works against everyone.

Captain Crunch, in California, a baby doesn't count as a +1 until born. A pregnant woman applying for WIC qualifies not so much as 2 people, but as a pregnanct woman who herself needs extra nutrition because of a medical condition. For Medi-Cal, same deal. You count as 1, not 2. Remember this is a state paying debts with IOUs. Boy how I'd love to write out an IOU and give that to the apartment manager, saying we'll pay rent when money's esier to come by.

[Captain_Crunch]

For Pregnancy-only medi-cal a pregnant woman is considered 2 people

http://www.healthconsumer.org/cs027POP.pdf
"In determining a pregnant woman’s eligibility, Medi-Cal counts the pregnant woman as a family of two.

Example: A pregnant woman with two children applies for Medi-Cal. She
has an income of $2,900 a month. The welfare department mistakenly
classifies her family size as 3, finding her ineligible with income above 200%
FPL for a family of 3 ($2,862 a month). In fact, pregnant women count as
two. The family size is 4. She qualifies since her income is below 200% FPL
for a family of 4 ($3,442 a month)."

Again, the op should appeal or reapply.

[p1gg1e]

Can you talk to the hospital before your birth and ask about costs?

So say you go pain med free and leave before 24 hours ( unless there is a reason to stay).

Can you cut some costs from your budget and save as much as possible before the baby comes? Anything you can sell to pad that account?

[leavemealone]

At two of the hospitals where I live (not in CA), there is a prenatal care 'clinic' that provides care to women. For a vaginal birth, the cost is $2400; for a c-section, the cost is $2,900. I believe that covers everything including room charges and even an epidural if you want it. Look into hospitals in your area to see if they have something like that.

Otherwise, you may be able to work out a payment plan with them afterward. Depending on your income, you may even qualify for a reduction in your bill even if you make too much for other assistance.

[Satori]

There are a ton of birth centers around the long beach area if you'd like to check them out. It would cost you less then $4k and thats if you had to pay for care from day 1. As long as you have been getting OB care you should not have any problem switching to midwife care in a birth center.

[AnnaNova]

i have only a couple suggestions for you...
1. i dont know about the place where you live, but here there are different programs with the HOSPITAL that you can apply for if you cannot pay your bill. Go and talk to them, they should be happy to help because there are so many people these days that simply ignore their medical bills because they cant pay them, and then the hospital carries that expense.
here, there is a program called the indigent fund that helps people pay when they cant afford it, there is also hospital fund and a few others.
2. i second the idea of talking to the hospital rather than the ins company. they might give you a better idea. a natural delivery with no interventions, if thats what you are planning will not cost you that much. maybe you were given the cost of a 'standard' delivery with epidural/pitocin/what not. we pay about 20% on our ins and we ended up paying about 300 dollars for the delivery itself. so for you that would be 900, a lot, but at least not 10 000.
3. you can negotiate your bill after the delivery too. if you are honest and clear about your situation, the hospital might cooperate and disregard some charges. they'd rather get something than nothing at all.
4. if you pay everything right away you can be elegible for a prompt pay discount, depending on where you deliver it can be up to 30%. the only thing is that you have to ASK about all that, this information is not exactly posted on a flyer in the waiting area or something like that.
5. im not sure how exactly it works, but maybe you can apply for medicaid as a SECONDARY ins to what you have, in that case it helps to cover the costs after your primary pays. i see some patients with that type of coverage where i work
good luck and congrats on the little one!

[April411]

5. im not sure how exactly it works, but maybe you can apply for medicaid as a SECONDARY ins to what you have, in that case it helps to cover the costs after your primary pays. i see some patients with that type of coverage where i work
good luck and congrats on the little one!

Well...good news. I went down to the Medi-Cal office today and they told me that I do qualify for secondary coverage. My mistake was doing everything by mail (to avoid missing work) instead of going down to the local office. The caseworker I had from the main office basically didn't care and was impossible to get ahold of.

I was assigned another worker today. She told me that I am eligible and that basically they will bill Aetna first and then anything that they don't cover, Medi-Cal will pay for. I just have to fax in some additional info (which I will do tomorrow). This is definately a load off my shoulders.

Thank you for all your responses!

[RoadWorkAhead]

Originally Posted by April411

Well...good news. I went down to the Medi-Cal office today and they told me that I do qualify for secondary coverage. My mistake was doing everything by mail (to avoid missing work) instead of going down to the local office. The caseworker I had from the main office basically didn't care and was impossible to get ahold of.

I was assigned another worker today. She told me that I am eligible and that basically they will bill Aetna first and then anything that they don't cover, Medi-Cal will pay for. I just have to fax in some additional info (which I will do tomorrow). This is definately a load off my shoulders.

Thank you for all your responses!

SO glad to hear it.