Federal Employees Health Insurance - which has the best maternity coverage?

[Anonymous]

I have the Aetna open access plan and recently delivered at GW in mid October. I just received a hospital bill for $871, even though I paid my premium for a C-section, which was $390. So yes, looks like we still have to pay 10% premiums for hospital stays. I had the Aetna for possible IVF coverage, which I didn't need. I may be switching back to BCBS for baby number 2.

[Anonymous]

Anonymous wrote:I don't think it includes actual brest pumps since if you go to the next page it states Not included: Breast pumps

It does include breast pumps. I called the CVS Caremark number and was informed they would pay for it as long as you had a note from the doctor. Goes into effect in January 2013. Also, here's an article that states BCBS will pay for breast pumps in 2013.

http://www.fepblue.org/news/benefitsandservices/2013-benefits-rates.jsp

"Benefits are available for one pump per year for women who are nursing and/or pregnant."

[Anonymous]

Anonymous wrote:NP here and I really appreciate all the insight into BCBS standard vs. basic. We currently have standard, but I am seriously thinking we should switch to basic. DC1 was born under standard and, if I recall correctly, the only out of pocket expense was a payment towards our deductible when DC needed to be aspirated right after birth. (Baby considered own patient at that point, not part of maternity/delivery.)

It's my understanding that with Basic, you MUST use an in-network provider to be covered. I don't see that as a problem day to day, but how does that work with delivery. If I deliver at Fair Oaks Hospital, which is in-network/preferred, can I assume all the doctors practicing at the hospital (anesthesiologist, neonatal team, etc) are all in-network as well? I couldn't be surprised by a bill for a delivery/post-delivery check up because the on-call doctor isn't preferred, right??

I have BCBS basic and wondered the same thing but everything for my delivery (and epidural) at Inova Fairfax was covered except the co-pay. Not sure if I just got lucky or if the hospital somehow monitors this and only assigns doctors to your case who are providers? The BCBS basic network is huge, so my guess is that most doctors do work with them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP here and I really appreciate all the insight into BCBS standard vs. basic. We currently have standard, but I am seriously thinking we should switch to basic. DC1 was born under standard and, if I recall correctly, the only out of pocket expense was a payment towards our deductible when DC needed to be aspirated right after birth. (Baby considered own patient at that point, not part of maternity/delivery.)

It's my understanding that with Basic, you MUST use an in-network provider to be covered. I don't see that as a problem day to day, but how does that work with delivery. If I deliver at Fair Oaks Hospital, which is in-network/preferred, can I assume all the doctors practicing at the hospital (anesthesiologist, neonatal team, etc) are all in-network as well? I couldn't be surprised by a bill for a delivery/post-delivery check up because the on-call doctor isn't preferred, right??

I have BCBS basic and wondered the same thing but everything for my delivery (and epidural) at Inova Fairfax was covered except the co-pay. Not sure if I just got lucky or if the hospital somehow monitors this and only assigns doctors to your case who are providers? The BCBS basic network is huge, so my guess is that most doctors do work with them.

My understanding is that BCBS covers hospitals as one provider. For example, I am seeing Wisdom for my prenatal care and delivery. None of the midwives are listed on the BCBS website as providers. When I called BCBS to ask if the midwives were considered "in network," I was told that all providers operating out of a covered hospital (i.e., GW) were covered. I am 31 weeks and have paid $0 so far for my prenatal care.

***

As for the PP asking about dental coverage... it is actually more annoying than anything that BCBS now covers minimal dental. With the Basic, you pay a $25 copay for a semiannual cleaning, exam, and x-rays. With the Standard, you pay a percentage (I think it's 15%) of the total cost of the appointment, which ends up being substantially more than $25. Other basic services (fillings, etc.) are covered at the same rate... but nothing extra is covered. If you know/think you might need extra dental work (root canal, crown, orthodontia, etc.) you need to buy separate dental insurance. Getting the secondary (dental) insurance to pay is a huge pain because they want to first see that BCBS rejected the claim.

[jindc]

I have a question about self vs self plus family.
I just changed to MD IPA because we have to do IVF. I signed up for self because it is still cheaper to sign up for two self plans (husband is also a fed).

If we are fortunate enough to have IVF work (sigh), will the newborn NOT be covered if I only have self? I thought there was a 30 day window - they have to be added to your insurance within 30 days of birth. Is this not the case?

I gather I can still change if needed since it's still open season if you all say it's not worth doing self only.

[Anonymous]

jindc wrote:I have a question about self vs self plus family.
I just changed to MD IPA because we have to do IVF. I signed up for self because it is still cheaper to sign up for two self plans (husband is also a fed).

If we are fortunate enough to have IVF work (sigh), will the newborn NOT be covered if I only have self? I thought there was a 30 day window - they have to be added to your insurance within 30 days of birth. Is this not the case?

I gather I can still change if needed since it's still open season if you all say it's not worth doing self only.

Having a baby is considered a "life-changing event" for which you can change your plan outside of open season. You usually do have 30 days to add your baby/change your plan, but check with your plan for the exact timeline. You will need your baby's SSN to add them. (I am due in early February and my husband and I each have a BCBS Basic self plan... we plan to switch to the BCBS Basic family plan and add the baby once she is born... I already have the paperwork filled out.)

[Anonymous]

Anonymous wrote:PP - that is a high copay for an MRI and what I'm worried about with the Standard plan.

Comparing the two BCBS programs it does look like the basic may be a better option as long as you are OK using the in network drs. My reading of it is that with Standard you can be charged a % for certain procedures like PP. However, basic has a set copay. I also read a recent review that stated paying more doesn't always get you more and they compared the two BCBS programs stating the basic was the cheaper but better program IF you are ok with the in network drs.

I'm 13:43. I believe I was billed just under 1K for the fetal MRI because I have a 1K deductible. I'm Fed on the 2G5 plan. It doesn't sound like others have this deductible? Also, since it's open season, I looked for info on the Basic plan but it is not listed as one of my options and there is no info about Basic in my packet. Anyone else notice it is missing?

[Anonymous]

PP - it is listed on the OPM website. Have you searched there? If you are federal and in this area I would think it would be an option.

Those with standard - do you have to pay a % for some procedures vs. a copay?

[Anonymous]

*bump*

[Anonymous]

Anyone with additional info on pregnancy and delivery with Aetna open access?

[Anonymous]

Anonymous wrote:PP - it is listed on the OPM website. Have you searched there? If you are federal and in this area I would think it would be an option.

Those with standard - do you have to pay a % for some procedures vs. a copay?

OK, I went to OPM and I see that I need to include Nationwide plans in my search. Thanks for you help!

[Anonymous]

I delivered with Aetna but changed to the high option so I would have to pay 10% of the hospital bill (only difference between basic and high option). I was charged 150 for each hospital admission (I was admitted several times before delivery). However, high option is almost double the cost of basic so this time around I'm switching to BCBS. I just have to decide between the basic and standard...

[Anonymous]

Hi, thanks for all of the posts in this thread. I appreciate it very much.

It looks like I will be switching to BCBS Basic for Self and family coverage.

One question about newborn circumcision, anyone knows how much is this going to cost? BCBS states "Surgical benefits, not maternity benefits, apply to circumcision."

If I decide to go with the BCBS Basic, does this mean that I will have to pay an additional $150? and possibly another $150 as listed in the Surgical Benefit section if they have a co-surgeon?

[Anonymous]

I'm 12 weeks and currently have GEHA. So far I have paid nothing for visits and ultrasounds. It's pretty stressful trying to decide whether i should switch to BCBS...since most people have recommended it. but we're happy with the low premiums of GEHA...I'm just worried about surprise bills for delivery and hospital stay

[Anonymous]

Anonymous wrote:Anyone with additional info on pregnancy and delivery with Aetna open access?

i am curious about this too. Please post!