Determine Uncovered Costs Before Baby Comes
What can be more frightening than having a baby is finding out afterward which expenses weren’t covered by insurance.
One consumer notes that her insurer rejected $900 in charges from the hospital, another $750 from her obstetrician and $550 of the anesthesiologist’s bill. Added to the deductible and 20% co-payment she needed to satisfy as part of her health plan, this woman’s out-of-pocket costs exceeded $3,500.
Dozens of phone calls, re-submissions and heated negotiations later, the total was reduced. However, industry experts maintain that this woman could have saved herself some time and money by planning.
When major medical expenses are foreseeable--as they generally are with a pregnancy--consumers can reduce their chances of suffering expensive surprises by talking money with both their doctors and their insurers long before they enter the hospital.
This article is the first in an intermittent series about managing health-care expenses. It will deal solely with obstetric charges, but many of the steps consumers can take to manage these costs are the same for virtually all medical procedures that you know about in advance. Future articles in this series will talk about managing the costs of emergency operations and voluntary procedures, such as plastic surgery, and making health-care choices at work.
So how does one manage maternity costs? It isn’t easy.
“Most of the time you can knock your head against the wall trying to find out in advance what is covered by insurance,” said Arthur A. Levin, director of the Center for Medical Consumers. “Retrospectively, of course, you find out the hard way.”
To ensure that most costs are covered by insurance, consumers must be exceptionally persistent--often aggressive. And they should always refuse to accept vague responses for answers. Individuals should also be aware that there are dozens of little extras that may or may not be covered by an individual health plan. And these little extras can add up to hundreds of dollars.
Where to start:
Financial planning for a pregnancy should start with the first doctor’s visit. At that time, many doctors will tell the prospective parents what to expect in terms of doctor’s fees for the delivery. They often will also specify some of the extra costs that could be incurred if there are complications.
Where doctor’s fees are often predictable, it is much harder to figure out in advance how much you’ll spend at the hospital. The problem, incidentally, does not usually arise because the hospital is less forthcoming. Instead, it is because few prospective patients think to ask. And when they do ask, their questions often center on major expenses--such as room costs. Many people forget about the less obvious charges, such as those for pads and syringes and other accessories.
Details from one patient’s hospital bill can clarify the point. The charges for room care added to $1,425; IVs and additional equipment cost $1,145, and the anesthesiologist’s bill came to more than $1,000.
There are also little extras that are often optional--not to mention not covered by insurance. One woman, for example, said her hospital charged $42.50 for a “dad’s pack”--hospital garb for the father during labor and delivery. Her insurer rejected the charge. The parent might have rejected the pack too had he known he would be paying so richly for paper pants and a shower cap.
A good strategy to get a handle on hospital charges is to request a copy of a recent bill for the same surgery. Many hospitals will provide this although they will generally erase the actual patient’s name and address. If your hospital refuses, you might be able to get such a bill from a friend or relative who has been through the process already.
Once you know what things are likely to cost, call your insurer and ask them to verify that the charges are in line with what that insurer considers to be “reasonable and customary” for this type of operation in your area.
Usually, insurers will not detail exactly how much they will pay for each type of medical procedure, but they will say whether your prospective charges fall within their guidelines.
If they do, you have some assurance that your insurer will pay to the maximum allowed under your policy. But make sure you take down the full name of the person you talked to just in case the situation changes between the time you called and the time your claim is filed.
If the insurer says certain items will not be covered, return to the doctor or hospital and ask whether these items are necessary. If so, you might want to try to negotiate a lower price.
“These fees are not written in stone,” Levin said. “It is not inappropriate to say, ‘Hey, given my insurance, I can’t afford that. Can you accept a lower fee?’ Where is it written that 20 minutes of surgery is worth $3,000?”
