My wife and I are first-time parents, and although we love our little string bean, we have been greeted by a complicated mess of insurance coverage and billing issues. Allow me to summarize:
- General note – my wife and I are on separate insurance through our jobs; her insurance is cheaper (100% company paid) though it has a higher deductible. She has $3,200 individual / $6,400 family HDHP coverage. My wife hit her deductible during childbirth. As a result, her plan should kick in for subsequent, required, non-preventive care. We are fortunate in that her plan pays 100% after deductible.
- We have gotten three bills for various services for my wife subsequent to her hitting her deductible, all of which should have been covered under the plan.
- We were balance-billed for newborn audiology screening because the provider was out of network (this is wrong on multiple levels since our hospital has a policy preventing their providers from balance billing patients who are seen on an in-patient or emergency basis); this was quickly adjusted to be considered in-network, but then we were billed for even more because it was incorrectly processed. Standard audiology screening is preventive care, covered by all compliant insurance plans at 100%.
- We received bills for multiple other preventive services, all of which are, per our benefits package, covered at 100% irrespective of deductible.
In total, the erroneous bills have come to ~$2,000. We were fully prepared for the $3,200 and for subsequent visits when our baby is ill; we were not prepared to be billed due to our insurance company failing to abide by its own policies!
We have gotten bills from no fewer than ten different providers; if we weren’t educated on our plan coverage, we could easily have just paid these bills without a second thought, and if we had ignored them without contacting the providers and insurance company, our credit would have been hit pretty hard.
The story is still playing out – insurance is adjusting the claims it processed wrong – but the moral of the story is to get educated on your benefits before having a baby, and read every single bill and EOB you get to make sure you are not paying too much.