Self proclaimed health insurance experts step in
- Thread starter Mike K
- Start date
Do you have a self sponsored policy? (i.e. not through a employee sponsored group policy)
either way, I'd recommend speaking with an insurance broker, they can help steer you in the right direction. Just make sure to double check their recommendations, since they usually get a nice referral commission from he insurance companies.
either way, I'd recommend speaking with an insurance broker, they can help steer you in the right direction. Just make sure to double check their recommendations, since they usually get a nice referral commission from he insurance companies.
Congrats on the kiddo on the way.
One thing we learned with our kids (and I am not sure how Cedars does their billing), but we received separate bills for the Hospital stay/supplies, one bill for the OB, and a separate bill for the anesthesiologist. So, just because your PPO does not cover the hospital itself, you may want to check to see if the doctor's bills associated with delivery are covered. It's possible your PPO would cover the OB (or their practice) alongside covering the anesthesiologist (if you are using drugs). So just throwing it out but the cost of changing the plan may be greater than looking at the individual costs? For the flipside, and not knowing your risk aversion I will at least point out - if there are delivery problems or you are there for an extended stay, well this may not be the path to take.
To your question - - the answer really depends who your health plan is through: an employer, self insured, healthcare.gov? I have always understood that mid-plan year changes to insurance plans will require a scenario such as:
* Life event, e.g. birth, death, change in marital status
* Change in employment for the (better or worse)
There are a rare others scenario's where you can change plans mid-year and outside of the Open Enrollment period, but I believe these are rare.
However if you are self insured I understand you do have a few additional options.
One note of caution if you are using an employer, state or federal plan. Even if you are able to move your wife moves to a new policy, you may still be required to pay for her for the balance of the plan year. I would absolutely validate the policy for dropping coverage alongside your search for new options.
One thing we learned with our kids (and I am not sure how Cedars does their billing), but we received separate bills for the Hospital stay/supplies, one bill for the OB, and a separate bill for the anesthesiologist. So, just because your PPO does not cover the hospital itself, you may want to check to see if the doctor's bills associated with delivery are covered. It's possible your PPO would cover the OB (or their practice) alongside covering the anesthesiologist (if you are using drugs). So just throwing it out but the cost of changing the plan may be greater than looking at the individual costs? For the flipside, and not knowing your risk aversion I will at least point out - if there are delivery problems or you are there for an extended stay, well this may not be the path to take.
To your question - - the answer really depends who your health plan is through: an employer, self insured, healthcare.gov? I have always understood that mid-plan year changes to insurance plans will require a scenario such as:
* Life event, e.g. birth, death, change in marital status
* Change in employment for the (better or worse)
There are a rare others scenario's where you can change plans mid-year and outside of the Open Enrollment period, but I believe these are rare.
However if you are self insured I understand you do have a few additional options.
One note of caution if you are using an employer, state or federal plan. Even if you are able to move your wife moves to a new policy, you may still be required to pay for her for the balance of the plan year. I would absolutely validate the policy for dropping coverage alongside your search for new options.
Our PPO covers everyone but the hospital and the new plan I'm looking at covers everyone including the hospital. Cedars is only contracted with two insurance companies. Everyone else dumped them because they wouldn't accept lower reimbursements for services and they're one of the most expensive hospitals in the country.
You've got me thinking though... My wife can is giving birth in 2 months and it's open enrollment right now so I can put her on the platinum plan with no co-insurance and a low deductible and then the birth of the baby is considered a "life event" which would allow us to change plans as soon as the baby is born, essentially letting me put her on a cheaper plan after that huge expense.
I'm gonna game my Obamacare like a thug.
No, I just buy it and my company reimburses me. I'm going to call an agent though. They were supposed to simplify all this with the affordable care act and it seems more confusing than ever.
You've got me thinking though... My wife can is giving birth in 2 months and it's open enrollment right now so I can put her on the platinum plan with no co-insurance and a low deductible and then the birth of the baby is considered a "life event" which would allow us to change plans as soon as the baby is born, essentially letting me put her on a cheaper plan after that huge expense.
I'm gonna game my Obamacare like a thug.
No, I just buy it and my company reimburses me. I'm going to call an agent though. They were supposed to simplify all this with the affordable care act and it seems more confusing than ever.
Wait, the government got involved in something and it got more confusing ?!?!? Say it isn't so.... LOL
I agree with talking to your insurance broker though, I always talk to mine anytime I have any questions... He gets paid to know the answers.
Congrats on the baby BTW !!!!
My wife has a HMO plan. Pays a little less than $300 ($270 iirc)/month. Co-pay is $25 for general practice, $45 for specialist (which accounts for OB/GYN). All she had to do was pay $45 the one time and it covered every visit for her pregnancy. She was supposed to go to St. Joseph Hospital in Elgin, but they no longer have a labor and delivery room. So she had our baby at the new Sherman Hospital. We received several statements already for various things (labor and deliver, anesthesia, blood work and shots for the baby, ect). Everything is covered 100%. Now that the baby is a month old, we now have to get insurance for the baby, which only adds about $100/month if I'm not mistaken.
One thing with my wife's plan was that we didn't know you can change providers/Networks. She has BCBS with the provider/network being Health Select. Was a pita to figure this shit out on our own. Now we got the feeling on how it works, it's not so bad. If my wife wanted to start going back to Centegra, then she just has to call up and tell them she wants to be on the Centegra network.
Btw-buying the plan was directly through the blue cross website.
One thing with my wife's plan was that we didn't know you can change providers/Networks. She has BCBS with the provider/network being Health Select. Was a pita to figure this shit out on our own. Now we got the feeling on how it works, it's not so bad. If my wife wanted to start going back to Centegra, then she just has to call up and tell them she wants to be on the Centegra network.
Btw-buying the plan was directly through the blue cross website.
I am a Federally Facilitated Licensed Insurance Agent in the States of IL, IN, and WI. Yes you can sign your wife on a "platinum plan" now until February 15th during open enrollment. The actual child birth will be on your wife's policy. When your baby is born, that is called a "life event" and you have 60 days from the day your baby was born to switch your wife and child back to your policy.
Just make sure that when you do enroll your wife on the "Platinum plan" that she has her OB/GYN in that network also.
Let me know, if you have any general questions that I can answer. Since you are in California, they have their own State Exchange. My suggestion is that you go straight to the carrier that you are choosing and not to the exchange for her enrollment. This way you won't be apart of the statistics for your State and subsidy qualifications. Let's all do our part have have the "Marketplace" a federally facilitated high risk pool for low income individuals! That is what I foresee on how this will all play out at least.
I was on my wife's employer insurance until this year. Premiums on ACA were lower for similar coverage w BCBS so I now have my own coverage while she stays w her employer paid insurance. Should be no reason why your wife could not enroll in an individual plan. However, I suspect there's no subsidy in her case.
BTW, I did use Healthcare.gov to research and purchase.
BTW, I did use Healthcare.gov to research and purchase.
I would LOVE to have an HMO because the cost of delivery goes from being 20% co-insurance to $250 a day for Cedars. Amazing. The problem with that is her OB/GYN doesn't take any HMO insurance so she would have to switch doctors and I wouldn't ask her to do that. Her doctor is a sweetheart. Plus the HMO plans are all like 15% cheaper than the PPO but alas.
Yeah I've just been going to Anthem directly. I wish they offered a no co-insurance plan. I would totally buy that for a couple months then switch it out to what we have now after the baby is born.
I hear ya about switching. Unfortunately for my wife she was somewhat forced to but also we were ignorant about how her insurance worked. She signed up for her plan and her original ob/GYN was listed for the HMO plan. So she went to her appointment. Well the insurance told them (centegra) that they didn't deal with them. So my wife called BCBS and asked and they said the same thing although centegra says they take her HMO plan. The website says the same thing. Well later on, she calls up the network provider (health select) and it's THEM that doesn't take centegra. We would have to change our network provider to do so.
Sad thing is, my wife only found out about the network provider and what doctor to go to after she tried making an appointment with St. Alexis (which was also listed as a provider on the BCBS website). The lady told my wife to call the network provider up and ask them (and not BCBS) as to which doctors take her plan. It was a huge headache at first until we figured it out. We even had problems with dealing with my wife's bloodwork. But eventually everything got straightened out.
How I see it, it's worth the headache for 100% coverage and for a cheap premium payment. Less than $300/month, $25 general practice co-pay, $45 specialty co-pay, $1300/year max out of pocket, and 100% coverage. We haven't paid a single cent for my wife's delivery of our child.
Also, not sure if your wife breastfee or wants to, but insurance companies do offer pumps. There's a website I can send you that basically deals with all the paperwork. You just fill in the form (name, address, insurance policy, ect) and they send in the claim and send you the pump right away.
I didn't even know about that. Just hope I don't receive a bill from any out of network. Not sure how Sherman Hospital is ran, although there is a bit of flexibility since the original hospital should have been st Joseph but since they no longer do deliveries, Sherman works with many plans to incorporate people who normally wouldn't be there. So far so good. We've received 3 or 4 statements so far for my wife and baby and all were covered.
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