A colleague with a corporate health plan told me that his family hospital bills – with a corporate health plan – for the birth of his baby was more than $3,000. The health plan only covered the birth of the baby after a hefty $3,000 deductible.
Moreover, the hospital sent an additional $2,000 charge claiming that they had to treat the newborn of some infection, and the treatment was not covered by the $3,000 deductible.
When my colleague pressed to find out more detail, the hospital explained this was not treating a real infection, but the possibility of an infection. It was a prophylactic treatment.
How did we get to this point? How can the birth of a baby, with a corporate health plan, cost $3000 out of pocket – and how can the hospital send an additional bill for $2,000 for treatment it thinks is needed (but apparently the insurance does not cover in the standard package)?
Don’t we have state rules in the state of Massachusetts mandating that (a) hospitals only charge what the insurance covers, (b) insurance is obligated to cover 99.999% of what is needed during child birth?
And, not to forget, when did we get to the point that corporate plans are even permitted to have such high deductibles? We have discussed this many times in the past when the subject of non-competes comes up. Employees have minimal bargaining position, when looking for a job, to stay and ask detailed questions about the corporate health plan. And weeks after they join, the corporate health plan can change from under them.
There is some history behind this. Corporate health plans offered much better benefits about ten years ago. Then, Obamacare happened. The way things were explained at many companies, corporate health plans had to change due to higher costs caused by Obamacare.
In effect, Obamacare did not create higher costs for the employees of these companies… Nor did Obamacare force these companies to change health plans. But health plan costs, and, possibly, taxes, did go up. And companies found it convenient to pass the health costs to the employees.
Municipal employees, probably, fare no better. If municipalities are in the GIC plan, they have similarly high deductibles.
There are some additional quirks to consider. Once the babies are born, I am told, they becomes a dependent of the plan, and immediately starts accruing costs with their own deductible, separate from the mother.
…So I have asked my friend how he paid for his baby. He said he charged it to his credit card.
at how un-reconciled America is with this whole business of bearing and raising children. It’s like it’s a complete afterthought, some two generations after women entered the workforce in large numbers.
On the other end of things, the new TrumpCare treats *pregnancy* as a “pre-existing condition”:
Pregnancy was treated as a pre-existing condition for decades before Obamacare. This began when the government ruled that insurance companies could not discriminate against women in their coverage. The insurance company response was to classify pregnancy as a pre-existing condition.
I suggest that this stance towards women is no “afterthought”. It is an intentional reflection of sexist and misogynist attitudes that have dominated the GOP my entire sixty-plus year lifetime.
The situation described in this post is immoral, and has been US policy for decades.
Conversely, I am under the impression that Massachusetts state law prohibits the hospital from enforcing collection of the amounts rejected by the insurance company. I wonder if the OP tried simply refusing to pay. I ask because another scam practiced by health care providers for decades is to send bills for such exorbitant amounts in hopes that the recipient will see the bill and simply pay.
My experience has been that when I withhold payment for any amount beyond the state-approved BCBS rates for whatever the procedure is, the provider always applies a credit (with name like “Insurance company adjustment”) to the bill.
The way I understand it from my friend, the $3,000 is the maximum deductible per plan member. After paying $3,000, all health costs are fully covered for that plan member for one year.
That is already outrageous, to have to shell $3,000 out of pocket for a birth delivery.
But, then, the newborn needed some additional treatment as a result of the birth. Here’s where the hospital billed by friend the additional $2,000. We think, but are not sure, that the $2,000 is the newborn’s deductible – kicking in because she is a new plan member.
The insurance company, he says, disagrees with the extra $2,000, and argues that the procedure billed for it was supposed to be included in the birth delivery package – thus, rolled into the $3,000 deductible.
But – here is the second outrage – the insurance company refuses to straighten this out with the hospital. Instead, the insurance company is having my friend talk to the hospital, and coaching him what to say, to get the $2,000 deductible folded into the $3,000.
How did we get to this point? Why on Earth does the patient have to shell thousands out of pocket for a birth procedure – and why isn’t the insurance company having the hospital changes corrected, directly, rather than leaving it up to the patient?
About two hours per week, every week, on the phone with doctor’s billing offices, insurance companies, hospital’s billing offices, all to try and iron out the ongoing problems with bills. It’s absurd. My health insurance company once send me a letter, in the mail, to my house, informing me that since I have moved, I am no longer covered by their plan. I moved? Where to? And if I moved, why are they sending a letter to my “old” address? You can’t make this up.
She spent a year on on bill before it got resolved.
We just had baby #2 & while we haven’t gotten bills yet, our expected cost of $3,000 was the same, and god knows how much more they’ll charge us for the extra night he had to spend under the anti-jaundice lamp.
Private health insurance sucks and Democrats should be united behind a single-payer alternative.