I though I'd write a little post on what I know about Health Insurance, and maybe it will help someone save some money somehow...someday...somewhere....maybe...but probably not....because health insurance is a honey-badger...It dont give a $%&! (If you haven't seen the honey-badger video on you-tube then you are missing out on some laughs...*foul language warning though*)
While working at a Doctors office I learned about insurance....I hate Health Insurance, it seems like they always have an excuse not to pay or delay paying...It is a necessary evil though and I am lucky to have it.
Its just so confusing!! The terminology "allowables, out of pocket, deductables" and the always awesome "based on medical necessity"...which gets them out of paying a lot of charges and in turn YOU get to pay them!
Now, each health insurance plan is different and benefits are different...so I'm attempting a sort of "blanket" post. Good luck to me.
Your health insurance company has a panel of Doctors or possibly just one Doctor they pay to review your medical bills to see if the procedure and/or charge you accrued was really necessary for you.....Yes, this person who doesn't know you, who wasn't there... can say if you really needed something or not...just by looking at your paperwork! These Doctors are usually known to be sell-outs in their profession by saying another Doctors decision wasn't really necessary. And to no surprise they are usually pretty skimpy and try to save the insurance company as much money as possible.
So if you see a lot of "based on medical necessity" wording in your health care benefits description then you could be facing a lot of charges when that hospital bill comes! "Based on medical necessity" is almost always deemed NOT medically necessary, FYI. That motrin you took a day after birthing a human...not medically necessary...that will be $30 please... that was what my hospital charged PER pill, how do I know???...because I asked and then politely declined....and a family member smuggled some in our room later.
I asked one of the nurses to please take off orders of any "extra's" for me, like motrin, nipple cream...and whatever else that was just a fringe benefit....just know that if they offer you something they WILL charge your insurance for it and if you have crappy insurance it will not be covered and you will be responsible for the charges.
Dont be afraid to ask the nurse about the price of anything...having a baby is expensive! So what if you look like a cheap skate....you don't know these people!
Other terms to know:
Deductible- the amount you have to pay before **a portion of** your health benefits kick in.
example: after a $2,000 deductible your insurance covers 80%, you are still responsible for the other 20% until your "out of pocket" is met.
Out of pocket- the amount of money you still have to shell out (after you've paid the deductible) before your health insurance covers 100% of the charges.
So, if you have a $2,000 "deductible" and a $2,000 "Out of Pocket", you will pay $4,000 and then the insurance will cover the rest....unless you see the dreaded "not medically necessary" on your bill...most likely you will have to pay for all those charges as well.
You will also receive charges on your baby...the baby usually has their own deductible and out of pocket as well. For example, if your baby stays in the nursery instead of with you, you can get charged for that. I'm sure each hospital is different though so ask a nurse.
Also, you can usually take home the nasal aspirator and other goodies that your baby has used, but again...ask a nurse.
Oh and when you go into labor if you go to the hospital too early they will charge you for that as well...one mom said "they'll charge you for that tiny visit of getting checked, haha, I went in for about 45 minutes earlier in day when I went into labor and even with my (great) insurance I had to pay $350!!!!
Hopefully something in this post will help you out! If you have any corrections to this post or some insight for other things to think about to save money please leave a comment! Share your wisdom! ~Kellie
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