Federal Employees Open Season--Which Coverage Best for Pregnancy?

[Anonymous]

Looking to compare pregnancy coverage by insurance companies serving Federal employees. What is your copay each visit? What special benefits do you get? How much does it cost to have a baby? Other facts of note?

I have MD IPA. I pay $30 for each dr. visit. We also a Healthy Pregnancy book we get for free and 24-hour access to a nurse line as well as to LaLeche League for breastfeeding advice. I was also told I would be getting a "goody bag." I have not given birth yet, so don't know about those costs.

[Anonymous]

I went through 2 pregnancies with CareFirst BC/BS basic as a fed. All maternal visits and ultrasounds and lab work are free, my amnio with the 1st and CVS with the 2nd were free, and the hospital labor and delivery were $100 each. I went to doctors and hospital within the network (GWU MFA and GWU).

[Anonymous]

I am currently pregnant with the federal individual BC/BS Basic plan, and have been very pleased / surprised by how good the coverage has been.

In some respects, I am still waiting for the shoe to drop, e.g., get some huge bill at some point. I have not paid an office co-pay since my first appointment, all my ultrasounds (and I've had at least 7 due to complications) have been covered completely, same for procedures and hospital stay due to complications. Plus, no deductible!!

I am upgrading to the family bc/bs basic option this open season to cover my husband and baby when he gets here. So long as your providers are in network, the coverage is great and much better deal than the other plans, including the BC/BS standard. I haven't had trouble finding providers at all in this area...most large DC area hospitals and physicians all take the federal plans.

[Anonymous]

I just gave birth with BCBS Basic. Everything was covered, and no co-pays for prenatal visits.

[Anonymous]

how different is BCBS standard vs. basic? Seems like basic is generally a co-pay while standard you pay 15% of the amount. Standard costs almost twice as much so it's hard to tell which one to go with. Any thoughts?

[Anonymous]

With basic, you have to use BCBS providers. There is no coverage for out of network providers. With standard, you can go out of network, but you pay more cost-sharing. I just delivered a baby and was extremely happy with BCBS Basic. Every provider we were referred to was in the network, expect for our lactation consultant (who doesn't contract with insurance companies). I think BCBS has the best provider network in the DC area and unless you are really picky, you should have no problem finding a good doctor in their network. We considered upgrading to the Standard option this year, but decided to stick with the Basic option because we have been so happy with the BCBS network.

[Anonymous]

Anonymous wrote:how different is BCBS standard vs. basic? Seems like basic is generally a co-pay while standard you pay 15% of the amount. Standard costs almost twice as much so it's hard to tell which one to go with. Any thoughts?

My husband and I discussed this same issue in depth very recently. After doing a lot of research online in forums, etc., it seems that the standard plan isn't worth the extra costs unless you need more extensive prescription coverage and/or have a doctor that doesn't take BC/BS. Everything we read distiguishes the two based on (1) prescriptions, e.g., if you have more than one family member taking daily medications over long periods of time, then the savings for the standard plan are better (e.g., you can get 90-day supplies of meds at lower cost vs. 30-day supply under standard). (2) Another major difference is that the basic plan only lets you see in-network providers (but for certain emergencies). Because we don't have any household members taking long term medications, and all of our doctors (and pretty much all hospitals) in this area and nationwide take BCBS we don't think finding providers will be a problem. (3) We liked that there was no deductible for the basic vs. $600 for the standard family...which we didn't think would balance out given our situation. (4) I would rather deal with absolutes, e.g., flat copay, fees, etc., rather than having to navigate the percentages waters after every doctors visit.

If you plan on using doctors that don't take insurance at all, then go with the standard. But otherwise, we didn't think the cost to upgrade was worth it, especially in the DC area where the vast majority of docs accept BCBS.

I have been very pleased with the individual basic plan, which is what i have now. It's so nice to walk in and out of the doctor's office without having to write a check each time. Not to mention all labwork, tests, bloodword, ultrasounds, etc. have been covered 100%, and some went into the $1000s range (e.g., cystic fibrosis screens, quad screen, amnio, etc.). Every time I receive a benefits statement in the mail (which is a lot when yu're preggo), it amazes me that i am not getting charged for more.

[Anonymous]

Anonymous wrote: have been very pleased with the individual basic plan, which is what i have now. It's so nice to walk in and out of the doctor's office without having to write a check each time. Not to mention all labwork, tests, bloodword, ultrasounds, etc. have been covered 100%, and some went into the $1000s range (e.g., cystic fibrosis screens, quad screen, amnio, etc.). Every time I receive a benefits statement in the mail (which is a lot when yu're preggo), it amazes me that i am not getting charged for more.

My husband jokes that pregnant women are the reason why health care costs are so high... Now we all understand why!

But I agree that the Basic Plan is good for the DC area, unless you plan to see some rare specialists/holistic doctor, or use lactation consultants that don't take insurance. There are certain recommended obs and peds in DC who don't take insurance...but more recommended obs and peds who do.

[Anonymous]

I would also recommend Blue Cross/Blue Shield basic. So far,
everything has been covered 100% for my maternity care
(I am at 21 weeks). I've tried other plans before I got
pregnant - Aetna, and some other HMOs - and it always seemed like
I would find a doctor I liked, and then the doctor would drop the insurance.
With BC/BS, I have so far been impressed with the choice
of doctos in their preferred provider network. For the DC
area and for maternity care, I think it's a pretty safe bet.

[Anonymous]

I would go with BC/BS standard. Basically, I would play it safe until your child is a little older and you have a better sense of your family's medical needs.

I have not researched this as much as some of the PPs, but we had an experience w/a pregnancy that put me on bedrest at 20 weeks and on expensive tocolytics and nurse service that were totally covered. Then we had a premature newborn and we were glad not to have to worry about whether any specialists were in or out of network. We were also able to get the very expensive medication that our child needed, again without any concern for costs.

Yes, I know you can switch plans when the baby is born, but you probably don't want to deal with the paperwork at that time. I'm glad we paid extra for more coverage. (Also, our ped, whom we love and would not leave, does not take BC/BS, so standard is the best option for us).

ps -- I hope this doesn't come across like I'm trying to scare you. I'm not. Our child is fine now and doing great. Good luck with your pregnancy and best wishes for an easy delivery and healthy child.

[Anonymous]

Two questions...

1. Aetna Open Access HMO Basic: It says that we are responsible for 10% of the cost of hospital stays. Would this include the cost of delivery? They told me it only meant the cost of room and board, but since that is listed seperately I am disinclined to believe them.

2. Carefirst: The rep at our benefits fair told me we couldn't get labwork done in our doctor's office, is this true? My PCP has a small lab to draw blood and they send it out, so would I not be able to use that service anymore? Having to go elsewhere for labs would be a dealbreaker for us.

[Anonymous]

Anonymous wrote:Two questions...

1. Aetna Open Access HMO Basic: It says that we are responsible for 10% of the cost of hospital stays. Would this include the cost of delivery? They told me it only meant the cost of room and board, but since that is listed seperately I am disinclined to believe them.

2. Carefirst: The rep at our benefits fair told me we couldn't get labwork done in our doctor's office, is this true? My PCP has a small lab to draw blood and they send it out, so would I not be able to use that service anymore? Having to go elsewhere for labs would be a dealbreaker for us.

Question #2: I think it depends on the type of labwork that can be done in-house.

I know I'm covered when the doc. office does a standard "non technical" glucous and protein check (urine sample collected during monthly prenatal visit), but when checking for UTI, blood work for pregnancy, paps, etc. that all gets sent out.

You also have to watch out for how your doc. office bills, labels, and codes different things. That makes a huge difference.

[Anonymous]

We just went through all this and decided on BCBS Standard plan. For us, our pediatrician does not accept insurance and I take daily medication, which always amazes me at how much it cost. If it wasn't for these factors, we would have gone with the basic plan. Comparing it to all the other plans (quite a lot after being in the private sector), we believe that BCBS is the best value for the premium charged. Good luck!

[Anonymous]

Is there any kind of dental benefit with BCBS Basic?

[Anonymous]

I've had BCBS Standard for five years now and two pregnancies now, and have been mostly happy except for my recent delivery. With my son, I had an emergency c-section; thankfully BCBS paid for everything. Fast forward three years, I had a c-section again with my daughter and she also had to stay her first night in the NICU (at Fairfax Hospital). BCBS is refusing to pay $4,000 for the NICU costs because the NICU "provider" is not preferred. Like I had a choice, I tell them, as she couldn't breathe and had to be rushed immediately to the NICU for emergency treatment. Sorry, they say, they're out of network.

So that's been a real bone of contention and I'm appealing. So BCBS is good if you have an easy pregnancy, easy/complicated delivery, but you're in big trouble if your newborn/baby is in any sort of stress and needs life-saving specialty assistance. BCBS is so screwed up with their priorities.