Which insurance is best for a birth?

[Longhorn]

We have to decide today to either go with a HMO or a PPO. Our birth in the future will probably be the most expensive thing we encounter and I want to make the reight choice. The HMO is with UHC and PPO is with Pacificare. We have UHC and it says it covered midwives which is what I want....but I Dont know anything about HMOs

[alegna]

Usually I'd say a PPO, but I've had good luck with UHC (though always a PPO)

I would think that you could get an exception for a licensed midwife since they say they cover midwives but of course have none in network.

-Angela

[meggles]

Yeah, PPO all the way. We have an HMO and they didn't cover anything.

[patchynurse]

You should look at your deductible and determine which is lowest. I switched to an HMO a few months ago because I knew I was early pregnant and the deductible for the HMO was 2,000.00 less than the PPO deductible.

[alegna]

Originally Posted by patchynurse

You should look at your deductible and determine which is lowest. I switched to an HMO a few months ago because I knew I was early pregnant and the deductible for the HMO was 2,000.00 less than the PPO deductible.

I would never decide based only on the deductible. It's important to me to have providers I trust. I will not birth in a hospital short of an emergency. So if I *couldn't* get an exception and force an HMO to cover my midwife, that would mean paying the whole bill myself.

-Angela

[Longhorn]

Originally Posted by alegna

I would never decide based only on the deductible. It's important to me to have providers I trust. I will not birth in a hospital short of an emergency. So if I *couldn't* get an exception and force an HMO to cover my midwife, that would mean paying the whole bill myself.

-Angela

Ya, thats exactly what I was thinking...I think I have a better shot at getting a homebirth covered with a PPO....

[alegna]

Originally Posted by Longhorn

Ya, thats exactly what I was thinking...I think I have a better shot at getting a homebirth covered with a PPO....

In general I would agree- BUT I would check that PPO first. You're ahead of the ball with a UHC policy that says in black and white that they cover midwives.

-Angela

[loraxc]

My homebirth is being covered 100% by an HMO. Depending on the laws in your state, this may be a possibility.

If I'd stayed with my PPO, I would have had 60% coverage. Big difference.

What does your MW recommend? Start there.

[alegna]

Originally Posted by loraxc

My homebirth is being covered 100% by an HMO. Depending on the laws in your state, this may be a possibility.

If I'd stayed with my PPO, I would have had 60% coverage. Big difference.

What does your MW recommend? Start there.

You're in FL I bet Great, but there are no such laws here in TX.

-Angela

[Longhorn]

Ya, we stuck with our PPO. Its with UHC and we feel like we have our foot in the door because there is a specific section that says it covers Mid-Wives. Which is SO important for us because we want a HB. I feel lucky that is even in our policy...It says it covers 80% in network and 50% out, but of course there will be no licensed midwives in Austin at which point I am going to file a gap extension to get it covered in network.

[filiadeluna]

It really depends on the company & the benefits. I have Cigna HMO, and our hospital copay is only $100. I really don't *want* to give birth in a hospital, but for insurance reasons (including "special" maternity insurance plans), I have to if I want to get a pay-out to cover my lost income during maternity leave. I'm going to make the best of it and try to go to a hospital that has midwives, is crunchy-friendly, etc.

My husband's job offers a PPO, and honestly *that* particular PPO is a rip-off. It's not worth it to me.

[wannabe]

The best hospital here is an HMO, so you can't really generalise.

But I'd say choose if you want home or hospital, if hospital, find out which is hospital and midwife is best and go with what will get you them, there

Originally Posted by patchynurse
You should look at your deductible and determine which is lowest. I switched to an HMO a few months ago because I knew I was early pregnant and the deductible for the HMO was 2,000.00 less than the PPO deductible.

I wouldn't do this. I could have paid $3000 less and had a nice c-section scar to show for it.

[Vancouver Mommy]

Question from Canada. I'm just curious about birth costs in the US. I had a midwife and a homebirth (followed by a post-partum hemmorage and a blood transfusion) and it was fully covered by my provincial medical insurance. My family pays a little less than $100 per month for coverage. Actually we pay nothing as my husband's employer pays for both out basic and extended medical. I just can't imagine having cost be a variable in my birth choices.

[alegna]

Originally Posted by Vancouver Mommy

Question from Canada. I'm just curious about birth costs in the US. I had a midwife and a homebirth (followed by a post-partum hemmorage and a blood transfusion) and it was fully covered by my provincial medical insurance. My family pays a little less than $100 per month for coverage. Actually we pay nothing as my husband's employer pays for both out basic and extended medical. I just can't imagine having cost be a variable in my birth choices.

What is your question?

-Angela

[Vancouver Mommy]

I guess it varies depending on the type of birth and the type of coverage a person has, but I'm really curious about how much it costs to have a baby. For example, when the doc/mw tells you that you may need a c-section, do they say something like "and that will be an extra "X" thousand dollars"?

[alegna]

Originally Posted by Vancouver Mommy

I guess it varies depending on the type of birth and the type of coverage a person has, but I'm really curious about how much it costs to have a baby. For example, when the doc/mw tells you that you may need a c-section, do they say something like "and that will be an extra "X" thousand dollars"?

Nope- you get the bill later....

-Angela

[hubris]

How much a birth actually costs can vary a lot. I'm looking through back records - for my first pregnancy (in 2002) the amount the OB office billed the insurance company was something like this:

office visits ranged from $100-$150 each
ultrasound ranged $350-500
labs varied, anywhere from $15 to $100+
the OB who attended the birth billed $4200 for her services
hospital costs for the baby billed at $770
hospital services for me (1 night in room, some ibuprofen) ~$3500

(By the way, that doesn't include any pain medication or anaesthesiologist's bill, I'm not sure how much those services would cost.)

All told, that whole pregnancy/birth/post-partum was probably billed at over $10,000. Mind you, this is how much was billed, not how much the insurance company actually paid (they negotiate prices with the hospitals/care providers) and not how much I paid (I paid $30 copays for my reproductive endocrinology appointments and a one-time copay of $30 for my first OB visit).

The total cost to me, out of my checkbook, was less than $200. BUT that doesn't mean that my insurance was "good". My choice of providers/ birth locations was limited. We had that insurance policy because DH was a resident at that hospital and that's what was provided to him as a benefit. So it was a cheap policy (we weren't paying any extra for it), it provided an inexpensive birth, but it didn't give me flexibility for caregivers/birthplace.

For my 2nd and 3rd pregnancies, we have had different insurance that provides far more flexibility in coverage for birth attendants, and therefore, birth locations. The total amount billed to my insurance company was less for DS2's pregnancy/birth/PP, but I actually paid more out of pocket (copay for every visit). Our insurance is through DH's practice, so technically, we're paying for it (comes out of his check). During our childbearing / child rearing years it seems worth it to me to pay for this particular plan because it's outweighed by the costs of the medical needs we have had.



I think you have to ask yourself...
- how much are you actually paying for the insurance?
- how much will that company cover when it comes to birth costs?
- will the choices you wish to make be covered by that insurance plan? Will you feel forced by finances to accept a caregiver or birth location that doesn't meet your needs?

[california_mom]

As for the costs, it also depends on the time of year you're giving birth. I know when we looked into PPOs, because my due date is in January, we would have had to pay the entire deductible upfront, plus a percentage of the remainder of the bill, not to exceed $6k (I think). If we assume a $10k bill, then we would pay $2k out of pocket for the deductible plus 20% of the remaining $8k (=$3600 total). If I were to give birth in December, assuming the deductible was already covered by previous appts earlier in the year, then I would only pay a percentage of the bill (20% of the $10k or $2,000).

Whereas our HMO was a $50 copay. Period.

[Ironica]

I had my first birth under my crappy student coverage PPO with UCLA. Now, the hospital was also run by UCLA, the midwives and everyone employed by UCLA... and it was a billing NIGHTMARE. They required me to pay a "deposit" because, apparently, they have trouble getting paid sometimes. I asked them a billion times what it was for before I got a straight answer, then I demanded a bill and receipt that reflected exactly what it was for. I had to watch every freakin' piece of paper they sent me to make sure they didn't charge me over the "copay maximum", and I got THREE pieces of paper for every transaction. On our final billings, there were a couple where the numbers literally didn't add up! Some of this was that that particular insurance was mismanaged, but some of it was just the way a PPO works; I paid 10% of the costs, until I'd paid $3000, which meant a whole lot of keeping track of things on my own.

I have UHC's Choice something HMO this time around, and it's been much simpler so far. If the one you're being offered is the one where you don't have a PCP, and you self-refer to specialists, totally do it. This is also the first insurance I've ever had besides Kaiser that pays for anything but catastrophic mental health services. They do cover my nurse-midwife practice, though it was a little awkward to work that out, since the practice bills under the name of the OB who "supervises" (during my son's entire gestation, birth, and PP stay, I never saw this doctor once... I never saw an OB at all until we went into the OR for a c-section, and even then the midwife was still with me).

I had PacifiCare HMO before this, and I liked it, and was upset when DH's employer switched to UHC. Now I'm soooo glad they did. ;-)

[lizzylou]

I like my HMO because I only have to pay one copay the whole pregnancy ($25 at the first visit). I think I will also have to pay the hospital copay - $100. Not a bad deal.

Had a PPO plan once, and would have had to pay for each prenatal appointment, plus had a deductible.

It all varies greatly depending on the company, the state, the individual coverage...