Numbers are approximate.
My wife had a scheduled routine c-section. We went through all the proper channels and have good health insurance. The hospital had us make a down payment a week before the c-section of about $2800. We knew it was going to cost about this much, and we had the money so we paid it. C-section went well. Our baby is healthy, everything’s great.
A few weeks later we get three bills: $1300 from the hospital, $1700 from the insurance company for the baby, $2300 from the insurance company for my wife. None of which mentioned my down payment. I called my health insurance and the hospital to get answers.
My wife has her own insurance, and we added the baby to hers. Apparently, if the baby and the mother leave the hospital at the same time, all the hospital charges go towards the mother’s individual deductible and out-of-pocket maximum ($1500/$3500), not the family out-of-pocket maximum($3000/$7000). We have paid about $1500 for my wife’s medical expense in this calendar year. Meaning that the down payment I paid the hospital would easily cover the out-of-pocket maximum of $3500. I should be getting a refund. So why am I getting more bills?
In the end, my insurance admitted their mistake and are currently going through all of it. I expect more time and phone calls to get it all straight, but I expect to actually get money back from that down payment. If I just paid the bills at face values, that’s $5300 plus a refund that would have been lost.
Lesson: Don’t just trust the insurance and hospital billing at face value. Understand you insurance. Have someone explain it to you. This stuff is complicated even for the people working in the field. This was a routine scheduled c-section and they still royally fucked it up at my expense. Don’t let it happen to you.