Thursday, July 14, 2011

Million Dollar Baby

Our baby girl may not actually cost us a million dollars, but what is the difference between a million and some other amount when you don't have it!

If you missed the post about the baby we had, she was born three weeks ago tomorrow. She is perfect in every way. Thank heavens! Yesterday was not perfect, however. My parents (live in childcare providers/entertainers for the last 3 weeks) left the Midwest for their home in the Southwest and I received the first of many bills that are coming my way. Double whammy!

As some background, the hospital we are "employees" of merged with another larger hospital last year and introduced a new health plan - only one option: take it or leave it. I would have thought with a bigger pool of covered employees, all forced into the same plan, there would be some improvements over the last plan. Wrong. They disguised an awful plan with beautiful brochures and advertisements. They should have saved that money and put more into their plan!

This isn't the first baby we've had mind you. We now have four, all by c-section. The first was born during a year off of medical school between 3rd and 4th year and we had insurance from the University my husband was doing research at. That birth was FREE, covered 100%, no deductible, no co-pay, nada! Our next two were born during residency under the hospitals previous insurance plan and each cost us about $2,500 out of pocket. I thought that was bad... turns out that was nothing compared to the bad news we just got.

Tuesday we received an information sheet from Blue Cross Blue Shield. You know the one that says This is Not A Bill - but is a foreshadowing of what is going to come. It showed what was billed and what they covered with an "amount you may owe provider". I showed it to my husband and about passed out. He responded optimistically with "that may not be the actual amount we owe". I said "we'll see". And we did... yesterday. Our first bill from the OB/GYN for obstetric care only showed the amount we owed, after insurance did their part, was $2,682.59. Do we really have insurance? That is more than we paid total for our other births. And that doesn't include the other bills that are coming: the anesthesiologist, the pediatrician, the hospital stay, etc.

When we found out we were expecting we immediately started saving for this particular expense. I wanted to have the money for the baby saved before she was born so we wouldn't have that particular stress to deal with. I thought we were being responsible, and we were. So the day we walked into the hospital I had $2,500 saved to cover what I thought (hoped) would be our expenses. After seeing this first bill it is obvious we won't have near enough.

I immediately sent the doctor/husband a text with a picture of the bill. He called when he could and I was still crying. I asked him, when he had a moment, to make a visit to the HR department and find out exactly how bad this is going to be. It's going to be bad. Let me explain how this plan works.

After our annual deductible for our family of $3,200 is met, we pay 10% (and that is the discounted rate for using this hospital instead of another) until we hit the magic number of $4,000 out of pocket expenses for the year. After which, all further expenses are covered at 100% for the year. That means our contribution to this is a maximum of $7,200 each year that we require services. And then they do something rather clever, or sneaky, depending on how you look at it. They give each family a Deductible Reimbursement Account and contribute $1,200 to it automatically. Why not just reduce our deductible? Then you can subject yourself to health screenings and get another $600 upon completion. Currently, my husband has been screened and is having phone counseling sessions to get this money. We just found out I can be screened as well and hopefully get another $600 for our DRA. So the math now changes to $7,200 minus the $1,200 they automatically give, minus the $600 for each of us, assuming we pass the screenings and undergo necessary counseling/coaching sessions, bringing our out of pocket totals to $4,800! I am pretty certain we'll meet that number, or at least close to it. With just one bill we are already more than half way there. Oh, and our annual premiums are another $4,000.

I am MAD! After complaining to HR about the situation they retorted that he should talk to housekeeping. Sarcasm, that's helpful. Meaning that they make less than he does and have the same coverage. I'd like to slap them. Housekeeping staff may have the same insurance but they can't compare the two! They suggested he could ask the doctors for professional discounts. That's a great idea, but why should I ask the doctors to reduce their fee? It isn't their fault the insurance the hospital provides is awful. And someday my husband will actually be the beneficiary of his own billing. The doctor isn't to blame.

I will have no problem whatsoever asking the hospital to reduce their portion of the bill for us, and this is why: They have taken our father/husband from us for the past 5 years. He works upwards of 80 hours a week without adequate compensation for his time. The don't allow him to moonlight as a way to increase his earnings so we can pay for our out of pocket health care expenses. Is that the same for housekeeping? I don't think so! They get overtime, shift differentials, and can have another job if they want. Last I checked we didn't have that same luxury. It is insulting!

I was already pregnant when they switched insurance plans, there wasn't much I could do. And maybe that is my real issue. I believe maternity care should be treated differently than other medical procedures. Maybe that is influenced by my pro-life stance. A pregnancy isn't a disease. Or maybe by my belief that a baby who provides joy to a family shouldn't come with a price-tag that requires financing. And I don't believe that the number of babies that would be born by members of this plan would be so great that covering those expenses in their entirety would bankrupt the insurance company or the hospital. I'm tired of giving all my money and my husband to the hospital. What is left for us?

I told my husband something needs to be done! What? I don't know. I'd like to give the hospital administration, and the program director a piece of my mind - and maybe I will. If nothing else I feel like this program should be obligated to disclose their horrible insurance plan to residents contemplating this program before the match. Or they should compensate their residents proportionately with the annual out of pocket maximums. It's not enough that we live in a state with one of the highest tax rates (both personal and property) that eat away at our income, now this. I can't wait to get out of here! 11 months and 15 days.

So today my husband is removing two brain tumors. All the while he is worrying about his wife and how we are going to come up with the extra money to pay for this beautiful baby. Doesn't seem fair for the patient, the doctor, or his family. Yes, he is a doctor and we have the worst medical insurance I have ever heard of - what is wrong with this picture?


  1. Insurance is such a frustrating and stressful issue. I'm so sorry you and your family are having to deal with this now.

  2. I couldn't stop myself from smiling when I read your passage. Especially the part where they send you beautiful brochure for the new insurance coverage.
    My husband is 3rd year resident and his hospital was recently taken over by much larger chain of hospital. They provided us with similar brochure with beautiful pictures of happy smiling families and cute babies in it and at the end in teeny tiny letter they put in the hike in insurance premium which we have to pay ( take it or leave it kind).
    Its good to read your stories and know some one out there knows what I am going through and have made it to other end.


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