Out of pocket medical expense estimate?

[Anonymous]

My husband and I are expecting next summer & are trying to figure out how much (ballpark) our out of pocket expenses will be so we can take full advantage of my flex benefits program. I have Cigna insurance and will be using Sibley Hospital. Any ideas would be appreciated!

[Anonymous]

Tough one, since it totally depends on your pregnancy.

Assume you'll have a private room for at least 2 nights. Call Sibley, but I think it's $250/night. OF course, if you have a c-section it'll be for 4 nights.

If you have a c-section, you may also have other out-of-pocket expenses, like having a neonatologist in the room at delivery. My insurance covered 100% maternal benefits, but considered that an uncovered baby expense. Cost ~$500.

Do you think you'll want to hire a lactation consultant? Are those classes covered (either pre- or post-partum)?

Also, check the listing of what is covered in the flex program. Diaper creme, baby tylenol, bandaids, etc are all covered. So if you end up with extra money in the account at the end of the year, stock up on the basics. They don't go bad and you know you'll use them.

Are you having a boy? If so, would you circumcize? At the hospital or with a mohel? Look into those rates as well and find out if they are covered by insurance or not.

I would say you'll want at least $1000, but that could go up to $2000 very easily with a c-section.

Good luck and congrats!

[Anonymous]

I think you can flexspend a breastpump (not sure about rental but it would make sense).

[Anonymous]

I had a c-section at Sibley 2 years ago, and to my knowledge, did not have a neonatologist in the delivery room. I certainly did not get billed for it.

Also you can most likely submit expenses like breast pump rental, lactation services, etc. directly to your insurance company for reimbursement. I got receipts for all of it and submitted the claims myself, did not get 100% back, but definitely got money back. The remainder that isn't reimbursed you can submit for Flex Reimb.

$2000 sounds awfully high to me for out-of-pocket expenses... You should check with your insurance first and see what they cover based on what type of plan you have (HMO vs PPO). My out-of-pocket expenses for c-section delivery at Sibley were $150 hospital copay, 4 nights of private room fees, and the lacation services/breast pump rental. Don't think this was more than $1000 total.

Don't forget to budget in your copays for many visits to the pediatrician. You will go at minimum the week you get home from the hospital, again at 1 month, 2 months, 4 months, 6 months. Plus other visits for "new mom freakouts" as I like to call them... I had at least 3-4 of those in the first 6 months when you're not sure if something is wrong so you go to the ped.

[Anonymous]

If you want a doula, I think some people have been able to be reimbursed, but as I recall it's a gray area.

As best I can recall, for a vag. delivery we paid maybe $200 out of pocket at Sibley a few years ago?

[Anonymous]

You've received great suggestions about maternal care and L&D.

However, DON'T forget about things like the pediatrician's office visits (newborn wellness visits for the first 12 mo.) and also if Junior has a rash, suspected allergy, or anything else that requires an "extra" doc. office visit. Just something to factor in terms of co-pays, prescriptions, calling the advice hotline (some ped. offices charge for this!).

Finally, don't forget about you and DH. I had a few extra trips to the doc. for mastitis and some post partem follow ups.

DH was rear ended and had to go to the doc. several times (eventually reimbursed by the other guy, but still....).

So, although it is smart to think about the L&D/hospital portion, don't forget to look at the larger picture.

One last thought...is dental covered in anyway? If so, keep that in mind. Thirty years of perfect teeth and then had to pay for my first cavity (dentist said that is very common in pregnant/nursing moms).

Also, if you need an anasthesiologisy for any reason (c/s) make sure that person is in network (if possible) else that bill can be pretty hefty.

[Anonymous]

A birth is a "qualifying event" not only for health insurance, but for FSA as well. So that means that you'll have 30 days after you give birth to sign up/update your FSA coverage (and this is IRS rules, not plan dependent). Most of your bills will have come in by then - and if not, you can request your provider(s) to expedite that. I know that both my OB and my hospital submitted their claims to insurance within like 2 weeks of my giving birth.

You should call your insurance and ask specifically what they will and will not cover. One thing to note is that sometimes even if the hospital itself is "in-network", some of the providers might not be (apparently anesthesiologists are notorious for this). I gave birth at GUH and didn't have an issue with this during L&D, but their prenatal diagnostic center for example is an out-of-network provider even though the hospital itself is in-network (I had to go elsewhere to get my ultrasounds).

I also had a c-section, and to the best of my knowledge there wasn't a neonatologist present - at least, the insurance didn't get billed for this.

With my FSA plan, breastpumps are not eligible expenses (either rental or purchase).

Good luck!

[Anonymous]

Thanks everyone - this is extraordinarily helpful!