Aetna in-network fees for delivery and hospital?

[Anonymous]

Has anyone delivered recently with Aetna and can provide me with (approximate) in-network negotiated amounts for prenatal care and delivery/hospital? I am trying to comparison shop. I currently have Aetna, and will be responsible for 15% of prenatal/delivery fee as well as 15% of the hospital charge. We have a chance to switch insurances due to DH's new job, his plan has higher premiums but all prenatal care and hospital is covered 100%. So I am trying to estimate whether the higher premium is worth it for more coverage. I will most likely be having a c/s. My only point of comparison is my prior delivery, but I had a different insurance at the time and everything was covered 100%, so I am hazy on the details.

Any info would be very helpful. TIA!

[Anonymous]

hi, i'm aetna and delivered at gtwon, so in network... but i didn't switch to aetna until the birth, so i don't know about pre-natal care, but i think i paid about $450 for the (vaginal) delivery.

Gtown actually gives out a handout that explains how much your insurance is going to cover and what you will owe - they'd estimated $800 total for prenatal and birth and postnatal with my prior insurance. Maybe try calling Gtown and having them send you the billing handout for Aetna patients? pretend you're considering it, but want to see costs... the woman in charge of billing was jacqueline jackson - (not sure on the ;last name)

[Anonymous]

I have an Aetna plan that was 80/20.

The billed cost for my prenatal care with midwives was $700 (I was responsible for 20% of that). Ultrasounds were between $100-200 each. Then I developed serious complications and things got a little complicated and expensive. I was in the hospital for two weeks (bedrest, delivery, recovery) and had a complicated c-section with hysterectomy. I think the c-section was $30,000. I want to say it all cost around $80,000, but I was getting bills for my baby who was in the NICU so that might not be exactly right. So I paid my maximum out of pocket for the year which was $5,500. At first my husband and I were really pissed at ourselves for not getting me on his much more generous insurance, but because my premium costs were so low, I think it actually would have been a wash. So for the worst case, you may want to check and see how much you would be responsible for under each plan.

Online at the Aetna site they have that estimate cost of care calculator, which could give you a sense of the cost of a normal delivery.

[Anonymous]

If you are going to stick with Aetna, sign up for the Healthy Moms or Babies program....some name like that. Its not an extensive program. The application is on the Aetna site and they just have a nurse call you and asks some questions. They offer discounts on certain things like breast pumps and other items. I mainly signed up for the 5% difference. When you enroll in the program, they cover 90% of labor and delivery as opposed to 85%. My prenatal care is still billed at 85%, but every little thing helps. Good luck!

[Anonymous]

Not to hijack a thread here, but this is just SO awful that we have to "shop" around for the best price for childbirth. Imagine the plight of lower middle income working women and how bad that $5k hospital bill hits. Especially if she is in an hourly job and has to take unpaid leave to deliver. Not trying to get super political here, but I think our system is SO flawed.

[Anonymous]

I'm the PP with the 5k bill and I my household probably qualifies as lower-middle and 5k for me plus 5k for my baby did hurt, but honestly I was just thankful that I had insurance and that we only had to pay 11k on what was probably 500k total (at Aetna's negotiated prices). There was nothing like seeing a single 100K bill (my daughters NICU room and board only) to make me feel for people who are uninsured.

I am super healthy, had never had a surgery before, had never been an inpatient in a hospital, really only used doctors for preventative care, and suddenly in two weeks I required more medical care than I ever had in my life. My daughter has had more medical care at 6 months that my husband and I in our entire lives. I definitely learned a lesson about preparing for the almost worst (I can't call it the worst because baby and I are both doing well now).

[Anonymous]

It really is a shame. I often look at the explanation of benefits for my visits...specifically my perinatal visits and the costs amaze me. I am so thankful to have a decent insurance plan....and I am a believer in revamping the nations healthcare system....its a sham!

[Anonymous]

This is the OP - thanks all. The information has been very helpful. Looks like the higher premiums will be worth the extra coverage.

Thanks again - love this board!