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re: When to expect a bill from the insurance company for baby delivery?

Posted on 3/26/19 at 7:52 pm to
Posted by LSUFanHouston
NOLA
Member since Jul 2009
37333 posts
Posted on 3/26/19 at 7:52 pm to
quote:

If the bill is coming directly from the hospital, would they just issue one for the max $2500 if the actual total is more than that? Or will they issue whatever the actual number is, then I have to work it out with insurance?


First off, The hospital is going to send a bill to the insurance company for like $374,000 or some other stupid amount.

The insurance company is going to open the bill, laugh, look up their contract with the hospital, and find out that their contract says the agreed-upon amount is something like $9,200.

The insurance company will then see what your deductible and co-insurance is, and determine, how much of that $9,200 you will owe. They subtract that from the $9,200 and send hospital a check for that amount.

The hospital will then send you a bill for whatever part of the $9,200 you owe.

In theory, that's the deal. In practice, it can be more complex due to errors at various points.

Also, your out of pocket max doesn't necessairly mean you will pay $2,500. You may pay less depending on what portion, if any, your deductible is, and what your co-pays and co-insurance rates are.

The process then continues with anyone else who sends you a bill.
Posted by Bestbank Tiger
Premium Member
Member since Jan 2005
71800 posts
Posted on 3/26/19 at 9:33 pm to
quote:

The hospital will then send you a bill for whatever part of the $9,200 you owe.

In theory, that's the deal. In practice, it can be more complex due to errors at various points.



And one way insurance gets you on labor/delivery is most pregnancies span two plan years, so your wife pays her deductible twice, and the baby has its own deductible.
Posted by speckledawg
Somewhere Salty
Member since Nov 2016
3953 posts
Posted on 3/27/19 at 12:36 pm to
quote:

First off, The hospital is going to send a bill to the insurance company for like $374,000 or some other stupid amount.


Yep. Getting these bills myself now. Luckily, this is the second time around, so I prepared myself for the BS that is medical billing. It's almost laughable to open one and see that the hospital billed for $30k and insurance says "nah, how about $800".

OP, as others stated, you will get several different bills most likely. Hospital charges for mom & baby separately, OBGYN charges, anesthesiologist (even got a separate nurse anesthetist one this time), hospital pediatrician, etc. Just be sure to keep track of everything you get and make sure it's all correct (deductible, co-ins amount, etc).
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