Posts Tagged ‘medical claims’

Maternity/Pregnancy Insurance for Self Employed – Part 2

November 10th, 2010 Vijaianand

It has been more than 3 weeks since I posted anything in the website because I am so deep into CFP exam preparation which is coming up on Nov 19th and 20th. I literally don’t have time for anything and feel the 24hrs is really short period for a day. As some of you know, I have completed my CFP course and next milestone is to pass the exam. I been preparing for this exam since Aug and hope to pass the exam with GOD’s grace. I decided to finish this post which I started last month and take a break for the exam and come back later to update about my exam experience.



In the last related post about Maternity Insuarnce, I shared about our recent pregnancy experience with the cost associated with the process. We also saw some points on different ways to get a maternity coverage. In this post, we will see some important things to consider and finish up with the claim process which is really important to understand.



Important Things to Consider



How Maternity Insurance works?


You better understand how the Maternity insurance works so it will help you to keep up with benefits, bills and claims.



1. Get the Coverage first


As I mentioned in my early post, get the Maternity Insurance coverage first before getting pregnant. If you already have individual insurance, you should know that they don’t usually cover maternity/pregnancy. If they do, please confirm with your insurance provider about the benefits. May be there are few exceptions to some insurance carriers but 99% of the time they don’t cover it. In that case, you need to look for a coverage which can cover your pregnancy or  at minimium share some expenses.



If you already pregnant and hope to get a coverage, sorry to say that you only have less than 1% chance in finding any insurance provider. If you haven’t got pregnant yet and thinking about it, WAIT!! You better get the coverage before you get pregnancy positive.



2. Select A Proper Plan



As per my research last year, there is not much options for Individual maternity coverage. You will have a choose a proper plan which suits your needs out of 2 or 3 out in the market.  For example, Humana used to offer a plan in Texas which covers 50% of delivery cost with max of $5000 of you pregnancy and you have to pay the rest. The plan premium might cost you around $200/month and your coverage will be $5000. For an year with maternity expenses, you will get around $5000 off from you bill for the premium cost of $2400 for the year. It doesn’t cover anything else whether the delivery is complicated or normal. It is just an expense sharing mechanism.



On the other hand, Cigna(Assurant Health) plan which we bought last year is actually a good plan comes with your individual major medical coverage. So there is two parts to the coverage. One part which covers all major medical problems with a seperate deductible and out of pocket limit and the second part is totally for pregnancy and it has the deductible limit. We paid around $269/month for $5000 pregnancy deductible and $2000 major medical deductible with $2000 coinsurance max. It wasn’t bad compared to no coverage. It covers your normal delivery and complicated delivery will be covered under Major medical coverage. You can get the help of independent insurance agent like the one I used to find this insuarnce. My insurance wa Ruth in Houston, her website is instexas.com


 


3. Understanting Coverage Benefits



Like group health insurance,  deductible insurance plan with maternity coverage covers both Major medical and maternity but have different deductible for major medical and maternity. They both works in tandem and you have to fullfil the deductibles seperately. If you going for your normal medical exam or physician visit, Major medical coverage kicks in and you pay the deductible for the visit as per the plan. If you visiting your gyny for Maternity/Pregnancy purpose, your maternity coverage of the policy kicks in and you pay the expenses related to the visit to satisfy your deductible for Maternity Coverage. Usually, lab work, prescription, gyny visit you will end up paying first to satisfy the deductible.


Normally with these type of plan, insurance company have a waiting period of atleast a month before getting pregnant. They just want make sure you are not pregnant at the time of pregnancy. So be careful with the timeline, we were so close and just about a month when my wife got pregnant. It is decided by your gynecologist during your first visit.



4. Choose Gynecologist



Next comes choosing the right gynecologist. If its your first pregnancy and you been asking your friends and family to refer a good gyny, thats a good start. But in order for the Maternity insurance plan to work, you better find a gynecologist who is under their provider network. Seeing an In-network gyne is really important in reducing your expense and getting insurance to cover most of cost as per the network agreements. If you are seeing out of network, it might not be covered 100%, check with your provider. You have to decide whether choosing a gyne who is referred by friends and not in network or gyne who is good but covered in the network. I would consider the second choice and try to get a list of gyne close to you and checking it out.



5. Select right In-Network Hospital


Today most of Hospitals take all major insurance carriers. So this won’t be an issue but similar to the gynecologist selection, you need to find the hospital where you want to have your baby accepts the insurance plan/network. Also find out from them how much will be estimated cost/expense for delivery both normal and complicated. Try to check with them whether they have payment arrangements if paid without insurance. Sometimes these hospitals are ready to work out an deal to avoid insurance carriers and give discount to the consumer directly.



Assumption is dangerious and risky. So it is important to select the right plan, choosing the right gyne and the hospital which is covered by the maternity insurance carrier. Otherwise it will too late once you become pregnant and you will be wasting your money and end up losing your savings. These are five important items which needs to be considered and understood properly while taking your individual maternity/pregnancy insurance coverage.



I thought of completing the Maternity Insurance series by posting everything in this post but it’s already too long. So I decided to cover the rest of topics about Claims and Appeals process in the next post after exam.  I will see you guys after Nov 20th, wish me some luck.



Image source: business.rediff.com

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Maternity/Pregnancy Insurance for Self Employed

October 22nd, 2010 Vijaianand

Are you self employed and have Individual health insurance coverage?


Are you planning to start a family by getting pregnant and having baby?


If you answered yes to both of the above questions, you can almost forget about having a baby without losing all your savings. Yes, I say that with lots of frustration and sigh after going through the hassle ourselves during our pregnancy period this year for our second baby.  It is hard to find a reasonable insurance coverage with maternity these days. You might be lucky to find some in certain states or cities but 75% of the time you will never see an insurance company covering maternity or pregnancy. That’s one of the biggest exclusion item.

I have spent number of hours googling and asking my friends and collegues around to finally got hold of one and only company which covered pregnancy in Texas(Assurant Health) with a reasonable deductible and major medical coverage for hefty price tag. But getting the insurance wasn’t hard part, getting them pay for the claims is the hardest of all. After you paid premiums every month for a year or so, you will shock to hear that they won’t cover certain claims.  

Like any industry, there are lot of loop holes associated with the medical codes system where insurance companies easily find ways to get you pay as much as possible before they pay their share. I am just talking about for normal delivery and you can imagine how difficult and hard it would be for C section or delivery with complication. In this post and next posts, I plan to share the real experience of going through the hassle of finding a insurance carrier, how to get the coverage abiding with their restrictions and how it all turned out during the delivery time.

How much it cost?

First and foremost, lets share the maternity bill for my wife’s delivery which is normal delivery and no complications to get some perspective. These are aproximate figures closer to the billing charges. I got bills from almost 5-10 different providers. I thought I will only get bills from Hospital and Doctors but I was surprised by providers which are billed seperately and not included in the Hospital charges  like pathologist, anesthesiologist , lab work, and so forth.

Hospital charges  – $13500,  $3000 (Baby)
Doctor’s Charges – $3500
Anesthesiologist – $$3800 (epideral medicine)
Pathologist –  $200
Pediatrician – $1000

Total    –  $25000  (before insurance insurace discount)

With the insurance discount, it all came down to $15,000 or so. The charges are only for the delivery period. There are bills during the pregnancy period for lab work, scans and different pregnancy tests. Our mail box was always filled a bill or two every day.

According to the some reports, the pregnancy cost have gone so much and it ranges anywhere from $15000 – $25000 for normal delivery and cost more around $35000 or up for other types depending on the complications. That’s the main reason, I wanted to have maternity insurance. You should have one too. Baby delivery is so  unpredictable and anything can happen for the mother and the baby and you better have coverage to cover otherwise don’t be shocked to see the Himalayan bill at a later point. To avoid heart attack and save your life savings, you should have a pregnancy/maternity insurance. I highly recommend it if you can find one in your state or city.

How to get Pregnancy/Maternity Coverage?


1. Easiest and cheapest solution, get a job in  a company which offers group health insurance. I only paid $500 for my first kid when I was working for big company with good insurance 5 years ago, now I paid more than $5000.  Even if your spouse can get a part time job in an organization and get health coverage, that would save your money if she/he doesn’t earn a lot. That would be best choice.

2. If self employed or own a company with employees, sponsor for group insuarnce for all and get maternity coverage. There are many insurance carriers like Aetna, BCBS, United Healthcare which offers good coverage for small business companies.

3. If you weren’t able to get any group coverage, then your last resort is to find a individual insurance with maternity coverage.  You might be able to find coverage from companies like Cigna, Assurant Health(bought by Cigna now) and few others.

4. If you can’t get insurance coverage, atleast talk to your gynogolist and hospital where you planning to have a baby and workout a deal. Many providers/hospital are willing to work out a payment plan and give discounts which might work better. Because they are better off getting money from you than from insurance companies which only pays discounted/adjusted charges.

With the recent Health care Act changes gone effect on Sept 23, 2010, Kids can be covered under parents plan upto 26 years. If your parents have good health coverage and you are below that age range, you might have a chance to get covera but please check the insurance carrier.

In the next post, we will see some important things to consider while getting the Maternity/Pregnancy insurance coverage and after delivery.

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