Carefirst and $5000 max during pregnancy?

[Anonymous]

My policy has a $5k pregnancy maximum. Has anyone managed to get through a pregnancy on this? I'm trying to figure out how the whole thing works, how much I will end up paying out of pocket, and how it might affect a c-section (my first two pgs. were c-sections but I had different insurance).

[Anonymous]

Are you sure this isn't an out-of-pocket maximum? If it's not and they will really only pay $5K (which sounds strange btw), I would at least find out if that amount applies to the billed amount or the (usually lower) rate negotiated by the insurance company, that would make a big difference. Also, find out if that applies only to you or the baby too (pediatrician at the hospital, newborn procedures, NICU etc).

For cost comparison - here is what my charges were for a c-section, all my providers were in-network (and I have Carefirst too). Had the baby last year.

OB, including prenatal care - billed $4,600, insurance negotiated rate $2,600
Hospital (5 night stay including 1 night during labor) - $17,300 ($5,700)
Anesthesia - $1,500 ($1,000)
Pediatrician - $225 ($100)

My daughter ended up in NICU for 3 nights, the charge for that was somewhere around $14K.

This of course doesn't include any prenatal testing, ultrasound, etc. That was probably another several thousand.

Good luck!

[Anonymous]

I had Carefirst PPO and didn't pay a dime, not for the regular visits pre-birth and nothing after the birth. I stayed with a doctor and hospital that was within network.

[Anonymous]

This is the 4:28 poster. Just to clarify - although I don't think this is relevant to OP's question - I also have the Carefirst PPO plan and paid nothing for all the prenatal/postnatal care (for me or the baby).

[Anonymous]

OP here. DH is self-employed, and we have the Carefirst PPO plan that is offered to self-employed people. It doesn't cover maternity benefits at ALL but you can buy a rider that gives you $5000 of coverage - max.

When I got the plan, I didn't think that I might be having another baby. (I'm not actually pregnant yet, but I'm trying.) So it's an awful plan in this way, but being self-employed doesn't give you a lot of options.

Thanks to the poster who broke down her costs. I'm hoping someone else might have this plan and know more than me - and I'll call my ob's office too.

Thanks again.

[Anonymous]

sorry to hear that your individual coverage has such bad maternity benefits. You could also try to switch plans, but if you have had a c-section, that can be enough for a plan to reject you for coverage if that coverage would include full maternity benefits (there was a recent New York Times article on this). If your income is under 300% of poverty (about $60K for a family of four) you can qualify for Mediaid while you are pregnant in DC. You can also ask your OB if they will honor the rate your insurer negotiated after you have reached the $5K max. But I have found that often after you reach that max, you have to pay the full rate.

[Anonymous]

Anonymous wrote:sorry to hear that your individual coverage has such bad maternity benefits. You could also try to switch plans, but if you have had a c-section, that can be enough for a plan to reject you for coverage if that coverage would include full maternity benefits (there was a recent New York Times article on this). If your income is under 300% of poverty (about $60K for a family of four) you can qualify for Mediaid while you are pregnant in DC. You can also ask your OB if they will honor the rate your insurer negotiated after you have reached the $5K max. But I have found that often after you reach that max, you have to pay the full rate.

Thanks. I have to keep the insurance for now at least - relatively, it's good insurance if you're not planning on getting pregnant. I don't meet those other criteria, so I'll call my OB office and see how they handle this sort of thing. I have a feeling I'll be paying a lot of money out of pocket. We'll see....

Thanks for the tip on asking my OB if he'll honor an insurance rate - ha, I bet not, but I'll try!

[Anonymous]

it's much cheaper to have a baby at a birth center. it costs about $4500. and often times the midwives are trained in vbacs.

[Anonymous]

OP- I had a Carefirst PPO plan that sounds very similar to yours before DH and I got married (now I'm on his Carefirst plan, which covers everything). Carefirst offers two of the exact same plans for self-employeed except that one covers maternity benefits and is more expensive, and the other doesn't cover maternity benefits is costs a lot less. I don't see any reason why you wouldn't be able to pay a higher monthly premium to switch to the plan that covers maternity benefits. I highly suggest you call them to ask if you can do this before you become pregnant. You will spend thousands, maybe even tens of thousands, more paying doctor and hospital bills (even for a normal non-complicated pregnancy) than you'd pay in higher premiums for a policy that covered maternity benefits.

When I had this plan, I think the monthly difference was about $300 for maternity vs. no maternity benefits. I'm sure it's gone up, but regardless, the $5,000 max probably wouldn't even cover prenatal care, let alone delivery, so it would be well worth it to pay this extra premium.

[Anonymous]

Anonymous wrote:OP- I had a Carefirst PPO plan that sounds very similar to yours before DH and I got married (now I'm on his Carefirst plan, which covers everything). Carefirst offers two of the exact same plans for self-employeed except that one covers maternity benefits and is more expensive, and the other doesn't cover maternity benefits is costs a lot less. I don't see any reason why you wouldn't be able to pay a higher monthly premium to switch to the plan that covers maternity benefits. I highly suggest you call them to ask if you can do this before you become pregnant. You will spend thousands, maybe even tens of thousands, more paying doctor and hospital bills (even for a normal non-complicated pregnancy) than you'd pay in higher premiums for a policy that covered maternity benefits.

When I had this plan, I think the monthly difference was about $300 for maternity vs. no maternity benefits. I'm sure it's gone up, but regardless, the $5,000 max probably wouldn't even cover prenatal care, let alone delivery, so it would be well worth it to pay this extra premium.

THANK YOU!