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Old 08-12-2014, 07:18 PM
 
68 posts, read 231,692 times
Reputation: 29

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My wife and I are expecting our very first child in late October, and I want to enjoy those great moments when I am at the hospital with her and not be worrying about how much the doctors and insurance are swindling from us. I just wanted to perform some due diligence to find out exactly what things need to be done and how much I will be paying down to the dollar. With insurance companies confusing consumers with multiple contradictions on their plans, I want to be sure I'm not paying through the roof for things.

I spoke to the finance director at the hospital in which we will be delivering, and all he could give me was a total estimate without any breakdown of what costs what. If anyone has any helpful information within this realm, it would be greatly appreciated!
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Old 08-12-2014, 08:03 PM
 
621 posts, read 827,230 times
Reputation: 616
The main charge categories will be:

- providers (docs, nurses, etc.)
- facilities (the bigger the hospital, the bigger the charge)
- supplies and equipment usage

A more ludicrous venture would be hard to embark upon @down to the dollar. Are you able to specify what will happen between now and delivery? You can't predict the future, which is why you have insurance policies. Instead of spinning the crystal ball, read your policy for deductibles, co-ins, out of pocket, etc. But this is a tad too late though unless you plan on finding out the cost structures and changing your service providers.
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Old 08-12-2014, 08:28 PM
 
1,915 posts, read 3,347,180 times
Reputation: 3032
Not sure if you know that North Carolina has some of the best laws on health care disclosure in the country. That's the positive!

I think the finance director may have just given you the basic cost since the outcome has not been determined. Factors like having a C section, length of stay and unexpected high cost NICU scenarios would make it impossible to predict your entire bill until delivery.

I would direct questions to your carrier since the policy will dictate what they cover, copayments, deductibles and other expenses. It' frustrating that hospital bills are unlike all other consumer purchases. I also would ask if there is any way to get a discount (yes, they have them....but usually based on income).

Congratulations!
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Old 08-12-2014, 08:42 PM
 
Location: FL-Gulf Coast
291 posts, read 671,277 times
Reputation: 418
You should be able to get an estimate of your out of pocket from the hospital. Some lessons we learned...

1st-Keep taking your own meds. They say they need to know what meds you are on and that's fine but refuse when they try to bring them. They literally charge stupid prices, like $30 to $40 a pill.

2nd-When you get the bill ask for an itemized copy and go over it. Check for errors and have them correct it.

3rd-Make sure all providers are in-network. Our hospital tried to charge us because they used an out-of-network provider for the epidural. In fact they tried to charge us like an extra $8k. We asked for proof that we were notified of the cost difference. They couldn't provide it, so we told them we would only being paying the legit charges and they relented.
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Old 08-12-2014, 09:56 PM
 
Location: Raleigh NC
9,384 posts, read 7,185,984 times
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if you think the doctors are swindling you, arrange for a birth at home from a midwife/dula.
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Old 08-12-2014, 10:44 PM
 
Location: Chapel Hill, NC
84 posts, read 127,919 times
Reputation: 117
Has your OB/midwife not gone over costs with you? At our first appointment their insurance/billing coordinator sat down with us and gave us a written cost sheet with the total for all routine OB visits including the physician's delivery charge. They also communicated with our insurance to tell us exactly how much deductible we still had to meet, our burden vs insurance's burden, etc. There are other hospital fees not included in here, but I haven't yet investigated those. But, all the prenatal charges and the delivery charges related to the doctors are in writing up front, and I can easily find out what exactly my responsibility is for the rest by calling BCBS.

I suspect many of the hospital charges may very dramatically depending on the type of birth you prefer and the type of birth your wife will need. For example, drugs to induce, pain meds, episiotomy, continuous vs intermittent monitoring, length of labor etc. All of this things could effect the cost and aren't things that are possible to predict in advance.

My advice would be to first start with your OB office to see what specific info they have. Then, call your insurance company to find out l&d and hospital stay coverage. Then try to see if the hospital has a specific list of costs.
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Old 08-13-2014, 05:54 AM
 
2,350 posts, read 2,398,384 times
Reputation: 1982
Yes if you need a C-section and/or the NICU that is when some un-expected costs may arise. For example, your provider is covered but the anesthesiologist may not be. If it is an emergency C-section then, this may covered differently and will depend on your policy. Call your insurance company and the OB for clarification or what the usual out of pocket expenses are.

One thing I suggest for all medical care is review your EOB's (Explanation of Benefits) when you get them. Make sure they are correct. Billing offices do make mistakes, so ask questions if you need to and challenge claims that you believe should not have been denied.
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Old 08-13-2014, 06:01 AM
 
Location: Raleigh, NC
3,478 posts, read 4,172,686 times
Reputation: 4608
Quote:
Originally Posted by ncnittany View Post
1st-Keep taking your own meds. They say they need to know what meds you are on and that's fine but refuse when they try to bring them. They literally charge stupid prices, like $30 to $40 a pill.
Will hospitals let you do that? I thought there was too much liability if they gave you something that didn't come from their pharmacy.
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Old 08-13-2014, 06:08 AM
 
Location: NC
7,007 posts, read 4,961,957 times
Reputation: 7762
First off, congrats!

After that, I have nothing good to say. Be prepared to be screwed in every way possible. You can check what your insurance says, but a lot of it will be manipulated by how they code expenses.

Just one example:
You have a copay, a deductable, and an out of pocket limit. Seems pretty simple right? Pay $50 for the doctor, 20% during the deductable, and capped at a limit, but....
-Each procedure might be coded differently, and considered an outside provider. Each one gets a copay.
-Procedures that may be covered 100% (bloodwork) are not covered because of some technicality (not the right lab, for example).
-You are inpatient, but Doctor files as an office visit. Ping!


Real case: Took my daughter to a wellness visit at Duke (She has CF). Insurance says a visit with a specialist is $50. Our bill was just over $2200 AFTER INSURANCE.

OK, well now we've met our $2k deductable, so I'm thinking the next visit will be covered, right?

Wrong. Next visit they took blood. Standard procedure, one stick, took 60 seconds. But they ran 6 different tests off that blood, coded each test differently. Even though bloodwork is covered at 100%, they failed to tell us that it doesn't count if you're in the hospital (on a visit that only lasted about 2.5 hours, outpatient and in network). $300 just for the labs, still waiting for the rest of the bill.

Sorry to rant, but it goes on and on and on. All I'm saying is that it's a good idea to budget more than you think for your experience. If I'm wrong, then you have extra money left over to do fun things with as a family.

Don't get me wrong, having a child is THE BEST THING THAT EVER HAPPENED TO ME, but dealing with the corrupt insurance racket just gets my blood boiling. I could write a book on this crap!

Short version: Set aside some money, and don't believe anything you see, other than the bill. And question that too, as stated above.
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Old 08-13-2014, 06:25 AM
 
3,245 posts, read 5,277,667 times
Reputation: 5797
Forget the hospital costs, have you started crunching the numbers of financing the costs of raising a child? The hospital is going to seem like a bargain in comparison (sorry, my oldest is leaving for college tomorrow and I feel like all I've done this past week is spend, spend, spend).

And at least with the hospital, if there's a substantial balance after your insurance pays out you can pay it down over time. It's not like they hold the baby as collateral until you pay the bill.

Can I give you some hard earned advice? It's okay to be vigilant and to keep an eye on expenses but do that second, enjoy the ride first.
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