Having a baby in the US

[londongal 17]

Hey everyone

I'm due in July and hoping to get to America end of March so my partner and I need to start planning for all the costs of having a baby there. (Something us UK citizens have never really had to think about - Oh I do love the NHS!)

Has anyone experienced having a child in America yet... what sorts of costs will we be looking at? My partner has healthcare through his job but I need him to send me the paperwork to see what kind of deductibles we will be facing. Are there any other hidden costs? Will I even be covered? We will be married by April so does that mean I'll be covered under his health plan? He said he has recently upgraded his package to the family one ...

Is there anything else I need to think about... This is very unfamiliar territory having had the benefits of the NHS all my life... as most of you can relate to!

Thanks

[Penguin_ie 5,993]

****** Moving from UK regional forum to Moving Here forum as not country specific ******

You should be covered once married, as it is a "life chaniging event". You may even be covered as soon as you enter the USA, as some insurances consider immigration a "life changing event", allowing adding of individuals to a health care plan, but have him check with his insurance.

As well as the deductible, there may be co-pays (certain costs you need to pay every time you see a doctor). Also, many insurances contract with a specific number of doctors/ hospitals, so before you make your first appointment in the USA, ask the doctor's office whether they take your specific insurance.

Lastly, some things may not be covered by insurance. For example a doula to help you and your then-husband at the birth, certain vaccinations like the BCG which is unusual in the USA, more than 24 hours hospital stay unless an absolute medical necessity etc. I have no birth-related experience with this, as we self-paid for the birth of our US-born child, but when she broke her arm at age 5, and really wanted a pink cast, the tech warned us that there would be an extra charge for that over plain white that the insurance would not cover.

[sia82 10]

i'd check the insurance, they probably are all different. i had to wait for my SSN to be covered by my husband's health plan (3 months after marriage)

[kzielu 1,149]

It all depends on your husbands plan - if it's high deductible one, expect couple of thousand dollars at minimum.

[londongal 17]

Right so I've had a look at his plan

This is what it says:

The price on left is "in network" and the right is "out of network"

I'm hoping the sums are the maximum you will ever have to pay out in a calendar year? Although I'm unsure about what in network and out of network mean

Individual Deductible Calendar Year $1,500 $2,250 Family Deductible Aggregate Dollars Calendar Year $4,500 $6,500

[yuna628 9,671]

In network are providers (doctors) that participate with your insurance plan. Out of network are those that don't.

For example, my sister needed an extensive surgery that required a skilled neurologist. He participated, his hospital participated, and several other related individuals in the room during the time of the surgery participated... however he required an assistant to help him complete the operation. This assistant did not participate. My sister received a bill for the services rendered, without ever knowing who the doctor was, why they were required, and was never disclosed that others in the room may not participate with the insurance.

She argued with the insurance company over the bill to little use. The surgeon was kind enough to pay the bill on my sister's behalf, since he was the one that required the additional surgery assistant in the first place.

You will find out of network costs cropping up more and more in hospital visits( including costs for doctors that might be present in the delivery room), especially in the ER. While the hospital might participate, the doctors or PA's might be classed as a type of 'contractor' or independent doctor who doesn't participate with the insurance you have, leaving the patient with a bill they were never disclosed about.

[Umka36 781]

Think of the medical deductible is what you have to pay first before your insurance kicks in. There is typically a maximum medical out of pocket expense as well, which is the most you would have to pay in a calendar year. Below is an example of the coverage I chose at my work place (we always use in-network).

Medical deductible

What is a medical deductible?

$350/person
$1,050/family

Medical out-of-pocket limit

What is a medical out-of-pocket limit?

$2,000/person
$4,000/family
Your deductible, copays, and coinsurance for all covered services apply.

I recommend also checking out if your husbands insurance has a separate clause for child births. For instance, I didn't have to pay anything for my wife's prenatal care/appointments/ultrasound/genetic testing.

During the actual birth, I only had to pay for the hospital inpatient care at $200/day or maximum of $1,000 (we use a birth center) because my wife had already maxed out her annual deductible.

YMMV, but I recommend looking more into your husband's health insurance policy.

Edited December 15, 2015 by Umka36

[Nich-Nick 3,354]

You pick a doctor that accepts your particular insurance plan. Then you are In Network.

Deductible means you pay the first $1500 of your medical bills before insurance starts paying. Can't really for sure tell what you mean by left and right and what the other numbers are saying because it looks like a copy/paste that didn't line up. I think the family deductible in-network is $4500?? That means, for example, if one person's bills reach $4500, the whole family has met the deductible. Each person does not have separately on their own reach $1500 for insurance to pay once the family combined reaches $4500, even if there was six family members.

Then there is a copay to look at once you get past your deductible. That will be a percentage your insurance will pay...maybe 80% is typical. You pay 20%.

Example.

Doctor bills $10,000 to,deliver your baby.

-$1500 you pay first to reach deductible

-----------

$8500 left on bill to copay with insurance

$6800 insurance pays 80%

$1700 you pay 20%

So you have paid $1500 + $1700.

But it never quite works out that simply. There may be addition charges by the hospital for your room, the delivery room, the nursery for baby. An anesthologist my have a separate bill. The pediatrician who looks over your baby after the birth will bill. Your insurance may have a fee that you pay $200 up front for any hospital admission. It gets complicated.

That brings up your out-of pocket maximum you can look up. Once you have paid out of your own money a certain dollar amount in a calendar year, then insurance starts covering at 100% because you have paid the most you can be changed for that year. Also gets weird and complicated to keep up with. A question to ask insurance--"Does my $1500 deductible I pay count toward meeting my out-do-pocket amount?"

Edited December 15, 2015 by Nich-Nick

[NikLR 13,227]

Because it will be a family plan, the deductible is $4500 before the insurance picks up the bill. If her husband has an HSA or similar that can pay for that however. We have a high deductible plan that pays into an HSA (health savings account.) We don't go see the doctor unless we're really sick or hurt, and preventative care is covered 100% in network. But I cannot have children so this works well for us. People that do have children or plan on it, should look at different options.

There are plans that are good to have when you plan on having children, and there are plans that are better for it you're an adult who rarely sees a doctor, and plans that are good for people who go in for every sniffle.

[NikLR 13,227]

Thankfully they no longer are allowed to do the "preexisting condition" thing, of which they claimed pregnancy was one. So you can't be denied insurance anymore because you're pregnant.

[B-2-Z 37]

Hi, I just wanted to tell you to check your messages. We have very similar insurance so I'm sending you some estimates I got recently from my insurance

[ambyuk 8]

Have you thought about a midwife/birth centre? They can be significantly cheaper. And in the UK you get midwifery based care anyway... I'm moving in a few weeks and am currently almost 29 weeks. I've already hired a midwife team there and will have a home birth (though they do birth centre births too) and it'll be $3k. If we get insurance by then, brilliant, but if not I know I won't be too out of pocket!

[londongal 17]

Thank you all for your responses. I've got his log-in details now to his healthcare package website and have sent some emails to them just to confirm what exactly we would have to pay with regards to maternity care. I've also as recommended by Nich-Nick asked about if the deductibles will count towards the out of pocket expenses. I will most definitely consider a birth centre if that works out cheaper as that's what my current midwife in the UK has recommended for me.

[Marco&Bettina 502]

Thank you all for your responses. I've got his log-in details now to his healthcare package website and have sent some emails to them just to confirm what exactly we would have to pay with regards to maternity care. I've also as recommended by Nich-Nick asked about if the deductibles will count towards the out of pocket expenses. I will most definitely consider a birth centre if that works out cheaper as that's what my current midwife in the UK has recommended for me.

Another thing to keep in mind, & this helped us tremendously as my wife just delivered our daughter Oct 11, whatever you owe in the end can go on a payment plan. The clinic we went to for prenatals recommended we pay like $60 every time we went, which was once a month, to pay towards the birth. We did, so by the time the birth happened, we'd paid in a decent chunk of money. The prenatals become more frequent the closer you get to the birth, but we didn't have to increase what we paid in. Then shortly before the birth, we found out how much everything was likely to cost & it was well over $10k to my insurance. With what we paid & what the insurance paid, we are out of pocket an additional approximately $700, which we are going on a payment plan for. I will actually be setting that up next week to pay like $75/month till done.

The moral of my entire post is don't stress about the money. Stress is bad on your pregnancy & you already have enough stress with the move. So just try to take it easy. The hospital cannot legally refuse care. Insurance generally covers most of a pregnancy. Whatever they don't, you can go on a payment plan for where you will get to dictate how much you pay towards it. Just be reasonable & they'll agree to whatever you propose. Hospitals deal with more pregnancies than any other medical "condition" & laws in America are set up to favor the patient, so everything will be OK.

Edit: We needed to be married & my company required my new wife to have a SSN before she could be added to my insurance.

Edited December 16, 2015 by Marco&Bettina

[londongal 17]

Another thing to keep in mind, & this helped us tremendously as my wife just delivered our daughter Oct 11, whatever you owe in the end can go on a payment plan. The clinic we went to for prenatals recommended we pay like $60 every time we went, which was once a month, to pay towards the birth. We did, so by the time the birth happened, we'd paid in a decent chunk of money. The prenatals become more frequent the closer you get to the birth, but we didn't have to increase what we paid in. Then shortly before the birth, we found out how much everything was likely to cost & it was well over $10k to my insurance. With what we paid & what the insurance paid, we are out of pocket an additional approximately $750, which we are going on a payment plan for. I will actually be setting that up next week to pay like $75/month till done.

The moral of my entire post is don't stress about the money. Stress is bad on your pregnancy & you already have enough stress with the move. So just try to take it easy. The hospital cannot legally refuse care. Insurance generally covers most of a pregnancy. Whatever they don't, you can go on a payment plan for where you will get to dictate how much you pay towards it. Just be reasonable & they'll agree to whatever you propose. Hospitals deal with more pregnancies than any other medical "condition" & laws in America are set up to favor the patient, so everything will be OK.

Thanks for the kind words... you're more than right, I just need to take it easy and I'm sure things will work out just fine.