5 ms·

I'm having identical twins, classified as high risk. The cost is mind-boggling. I've already paid $7000+ out of pocket, and they have not even been born yet.

I'm having identical twins, classified as high risk. The cost is mind-boggling. I've already paid $7000+ out of pocket, and they have not even been born yet. Costs are mostly related to having to do ultrasounds all the time, and one MRI.

why-el 7y ago
I am really sorry to hear this. :/ You are bringing two wonderful human beings to the world and the system is failing you badly.
lawnchair_larry 7y ago
What insurance plan can result in $7k out of pocket for unborn children?
- irrational 7y ago
  A very poor one it sounds like. Even a high deductible plan shouldn't have an out of pocket expense that is that high.
  - djdidf 7y ago
    7000 deductible is pretty common
  - EvanAnderson 7y ago
    All my plans since 2013 have been $12K+ deductible. (Self-employed in Ohio.) Every medical event is a major shopping and price comparison exercise, and nearly every provider refuses to quote hard-and-fast prices. (You also get treated very badly by some practices who act terribly put-off that you'd have the lack of decency to ask about prices. You get that treatment double when it's about a procedure for your kid. P/A in the ER was a straight-up asshole when I questioned if a x-ray of my daughter was strictly necessary.)
    - pkaye 7y ago
      Curious what is your yearly premiums? Is it a high deductible plan?
      - EvanAnderson 7y ago
        The current year is a high deductible plan (as all of mine have been since starting self-employment in 2004) but is not HSA-eligible. (Most years we've had an HSA-eligible plan, but some years none were available or they were vastly more expensive than the non-HSA eligible, which makes no sense.) We found a way to get an employer-sponsored plan thru my LLC this year and that dropped the premiums to just under $12K w/ a $13.6K family deductible. The marketplace plan we were on last year, had we renewed for 2019, would have been $17.5K in premiums w/ the same deductible. Neither is HSA-eligible.
        pkaye 7y ago
        I was punching some numbers into Covered California marketplace and for $12K you could get some pretty good plans. And if you qualify for the subsidy it is much lower. Some of the HMO plans have no or low deductibles.
        EvanAnderson 7y ago
        Sounds like California has a much nicer market than we do in Ohio. I had one provider to choose from in the Marketplace for my county in 2019. Their "Silver" plan was what we had in 2018, chosen over the "Bronze" because the lower-priced "Bronze" was 20% co-insurance on inpatient care versus 100% coverage after deductible on "Siler". Aside from that company's plans those who purchased on the Marketplace in my county for 2019 had no other choices.
- guntars 7y ago
  Any high deductible plan will do that, but he’s covered after that. It’d also be conducive to his wallet if they get born before Jan 1st.
  - EADGBE 7y ago
    > It’d also be conducive to his wallet if they get born before Jan 1st. Agreed. Also, being born even on December 31 2019 qualifies you for having another dependent in your household for the entire 2019 taxes, so it's a double whammy. A due date after September-ish ensures you're only paying the medical treatments/screens/hospitalization/etc for that year and that year only (vs, as you mention, a due date that happens potentially anytime between Jan-August). It's tricky. Unfortunately.
- pkaye 7y ago
  High deductible plans for one.
- asark 7y ago
  Aside from the high deductible plans mentioned, even a fairly modest one can reach that if you split the pregnancy over two years :-( Yes, folks outside the US, we here in America try to time pregnancies over bullshit details of how our insurance plans work. At least anyone who's thought about it does. Those who haven't get a nasty surprise, and pay (up to) double.
  - mensetmanusman 7y ago
    It helps me to think of healthcare costs here as a tax. On average, the US pays a bit higher taxes than the EU with this consideration :)
- TuringNYC 7y ago
  I can only speak about NYC but this was a common cost range even with diamond plans from corporations. A lot of it can be fine print and delta balance billing.
- BeetleB 7y ago
  Many high deductible ones, where you are covering multiple people (e.g. a spouse and a kid). And almost everyone where some medical professional, somewhere in the chain of hospital visits, happened to be out of network - someone you had no idea would be involved. Examples would be where the doctor sent lab results to another doctor for analysis, etc.
- slavapestov 7y ago
  We have a United Healthcare PPO through Apple, it's considered a "good" plan. We paid about $6k out of pocket for a pretty standard hospital birth.
lanrh1836 7y ago
If you knew you would be having a baby one year, wouldn’t it make sense to pay a higher premium for a better plan with a low or 0 deductible? Or does the math still not work out?
- gavanwoolery 7y ago
  I did switch to the best available plan at the soonest date I could, but that was halfway into the pregnancy
- TuringNYC 7y ago
  1. Not all companies give you such options 2. A lot of the cost is in fine print of things not covered, e.g. during our delivery two of the many many medical personnel were out of network and we ended up paying a huge co-pay for that — but it wasn’t like we could have checked ids for each doctor entering the room etc for insurance acceptance. They entered, they did something, they billed.
  - RHSeeger 7y ago
    I feel like a law should be passed saying that, for any patient with a medical networks, any out of network related charges must be signed off on; individually. Failing that, record yourself telling the hospital staff (or get it in writing) that any out of network charges will not be payed unless expressly signed for ahead of time.
    - whamlastxmas 7y ago
      Or maybe we can just pass a law saying everyone deserves access to healthcare and have a single payer system to avoid this bullshit
    - nkrumm 7y ago
      To some extent there is some legislative action (particularly at the state level) that addresses this. The term commonly used here is “Balance Billing”, though that refers to a variety of “surprise” bills.
souprock 7y ago
You didn't say why, which is fine, but I hope there is something more significant than just "twins" and that there is an actual intent to change treatment based on all that testing. If you wouldn't take specific action based on the results, then the exposure is unjustified. Satisfying curiosity is not a proper justification. See the Chinese ultrasound study. It's a study that is impossible to perform in the USA because it wouldn't pass ethical review. Ultrasounds were proven to cause structural changes in the brain. One can reasonably assume that structural changes are bad.
- analog31 7y ago
  Certain pregnancies are automatically elevated to "at risk" status, and AFAIK twins are one of the check boxes. Another is maternal age.
  - EADGBE 7y ago
    > Another is maternal age. See: Geriatric Pregnancy/Advanced Maternal Age Pregnancy (Pregnancy after the age of 35).
- gavanwoolery 7y ago
  From the onset, they were classified as high risk due to being mo/di twins (monochorionic/diamniotic). It is now known that these pregnancies are much higher risk due to entanglement and other issues ("high risk" being a relative term). As it turns out, the doctors were right to assume this risk, as one of the twins has already received brain damage from (what they hypothesize) was inadequate blood flow. I'm generally against anything but procedures that are absolutely necessary, and the ultrasounds and MRI certainly were not voluntary on our part. Personally, from all the research I have gathered it seems like ultrasounds are quite safe, although I am not an expert. As for taking action, I had the same dilemma. Before we knew anything was wrong, one of the doctors ordered an MRI based on a hunch. I did not want to do the MRI unless it gave us some sort of information we could act on, and abortion was out of the question, legally and morally speaking under these circumstances. But we did it anyway, and at least the information has prepared us for what to expect.
DoubleCribble 7y ago
If your hospital is like many/most of all US hospitals despite only one hospital room, only one set of nurses and doctors, only one mother... you get to pay the full price of delivery charges for each baby! They should be required to hang a sign outside L&D, "Half a womb still pays for the full room." just so you don't have a(nother) heart attack when the bill arrives in the mail.
- gavanwoolery 7y ago
  Oh I'm aware of this. They even charge double for each ultrasound!
pfranz 7y ago
Sadly, it's infeasible to predict costs in the US. When my wife was pregnant I pulled up our insurance's "example pregnancy out of pocket cost* (*not expected to reflect actual costs)" PDF. It showed something like $650 out of pocket for all prenatal and delivery costs. The actual cost ended up being closer to your's. I called my insurance to ask what I could expect to pay assuming a normal pregnancy after being amazed at the cost already billed. They suggested I a) call my doctor's office and get each billing code for each procedure expected b) call their billing office to get each cost for each c) call my insurance with these numbers and get out of pocket expected costs. I just can't imagine trying to compare costs between multiple hospitals or OBs. I tracked medical costs fairly closely and noticed things like a quick procedure would get 2 separate coded procedures. Someone I know familiar with medical records said that kind of thing was commonplace. So for a laymen, it seems ridiculous to anticipate costs even for routine things.

why-el 7y ago

I am really sorry to hear this. :/ You are bringing two wonderful human beings to the world and the system is failing you badly.

lawnchair_larry 7y ago

What insurance plan can result in $7k out of pocket for unborn children?

irrational 7y ago
A very poor one it sounds like. Even a high deductible plan shouldn't have an out of pocket expense that is that high.
- djdidf 7y ago
  7000 deductible is pretty common
- EvanAnderson 7y ago
  All my plans since 2013 have been $12K+ deductible. (Self-employed in Ohio.) Every medical event is a major shopping and price comparison exercise, and nearly every provider refuses to quote hard-and-fast prices. (You also get treated very badly by some practices who act terribly put-off that you'd have the lack of decency to ask about prices. You get that treatment double when it's about a procedure for your kid. P/A in the ER was a straight-up asshole when I questioned if a x-ray of my daughter was strictly necessary.)
  - pkaye 7y ago
    Curious what is your yearly premiums? Is it a high deductible plan?
    - EvanAnderson 7y ago
      The current year is a high deductible plan (as all of mine have been since starting self-employment in 2004) but is not HSA-eligible. (Most years we've had an HSA-eligible plan, but some years none were available or they were vastly more expensive than the non-HSA eligible, which makes no sense.) We found a way to get an employer-sponsored plan thru my LLC this year and that dropped the premiums to just under $12K w/ a $13.6K family deductible. The marketplace plan we were on last year, had we renewed for 2019, would have been $17.5K in premiums w/ the same deductible. Neither is HSA-eligible.
      - pkaye 7y ago
        I was punching some numbers into Covered California marketplace and for $12K you could get some pretty good plans. And if you qualify for the subsidy it is much lower. Some of the HMO plans have no or low deductibles.
        EvanAnderson 7y ago
        Sounds like California has a much nicer market than we do in Ohio. I had one provider to choose from in the Marketplace for my county in 2019. Their "Silver" plan was what we had in 2018, chosen over the "Bronze" because the lower-priced "Bronze" was 20% co-insurance on inpatient care versus 100% coverage after deductible on "Siler". Aside from that company's plans those who purchased on the Marketplace in my county for 2019 had no other choices.
guntars 7y ago
Any high deductible plan will do that, but he’s covered after that. It’d also be conducive to his wallet if they get born before Jan 1st.
- EADGBE 7y ago
  > It’d also be conducive to his wallet if they get born before Jan 1st. Agreed. Also, being born even on December 31 2019 qualifies you for having another dependent in your household for the entire 2019 taxes, so it's a double whammy. A due date after September-ish ensures you're only paying the medical treatments/screens/hospitalization/etc for that year and that year only (vs, as you mention, a due date that happens potentially anytime between Jan-August). It's tricky. Unfortunately.
pkaye 7y ago
High deductible plans for one.
asark 7y ago
Aside from the high deductible plans mentioned, even a fairly modest one can reach that if you split the pregnancy over two years :-( Yes, folks outside the US, we here in America try to time pregnancies over bullshit details of how our insurance plans work. At least anyone who's thought about it does. Those who haven't get a nasty surprise, and pay (up to) double.
- mensetmanusman 7y ago
  It helps me to think of healthcare costs here as a tax. On average, the US pays a bit higher taxes than the EU with this consideration :)
TuringNYC 7y ago
I can only speak about NYC but this was a common cost range even with diamond plans from corporations. A lot of it can be fine print and delta balance billing.
BeetleB 7y ago
Many high deductible ones, where you are covering multiple people (e.g. a spouse and a kid). And almost everyone where some medical professional, somewhere in the chain of hospital visits, happened to be out of network - someone you had no idea would be involved. Examples would be where the doctor sent lab results to another doctor for analysis, etc.
slavapestov 7y ago
We have a United Healthcare PPO through Apple, it's considered a "good" plan. We paid about $6k out of pocket for a pretty standard hospital birth.

lanrh1836 7y ago

If you knew you would be having a baby one year, wouldn’t it make sense to pay a higher premium for a better plan with a low or 0 deductible? Or does the math still not work out?

gavanwoolery 7y ago
I did switch to the best available plan at the soonest date I could, but that was halfway into the pregnancy
TuringNYC 7y ago
1. Not all companies give you such options 2. A lot of the cost is in fine print of things not covered, e.g. during our delivery two of the many many medical personnel were out of network and we ended up paying a huge co-pay for that — but it wasn’t like we could have checked ids for each doctor entering the room etc for insurance acceptance. They entered, they did something, they billed.
- RHSeeger 7y ago
  I feel like a law should be passed saying that, for any patient with a medical networks, any out of network related charges must be signed off on; individually. Failing that, record yourself telling the hospital staff (or get it in writing) that any out of network charges will not be payed unless expressly signed for ahead of time.
  - whamlastxmas 7y ago
    Or maybe we can just pass a law saying everyone deserves access to healthcare and have a single payer system to avoid this bullshit
  - nkrumm 7y ago
    To some extent there is some legislative action (particularly at the state level) that addresses this. The term commonly used here is “Balance Billing”, though that refers to a variety of “surprise” bills.

souprock 7y ago

You didn't say why, which is fine, but I hope there is something more significant than just "twins" and that there is an actual intent to change treatment based on all that testing. If you wouldn't take specific action based on the results, then the exposure is unjustified. Satisfying curiosity is not a proper justification. See the Chinese ultrasound study. It's a study that is impossible to perform in the USA because it wouldn't pass ethical review. Ultrasounds were proven to cause structural changes in the brain. One can reasonably assume that structural changes are bad.

analog31 7y ago
Certain pregnancies are automatically elevated to "at risk" status, and AFAIK twins are one of the check boxes. Another is maternal age.
- EADGBE 7y ago
  > Another is maternal age. See: Geriatric Pregnancy/Advanced Maternal Age Pregnancy (Pregnancy after the age of 35).
gavanwoolery 7y ago
From the onset, they were classified as high risk due to being mo/di twins (monochorionic/diamniotic). It is now known that these pregnancies are much higher risk due to entanglement and other issues ("high risk" being a relative term). As it turns out, the doctors were right to assume this risk, as one of the twins has already received brain damage from (what they hypothesize) was inadequate blood flow. I'm generally against anything but procedures that are absolutely necessary, and the ultrasounds and MRI certainly were not voluntary on our part. Personally, from all the research I have gathered it seems like ultrasounds are quite safe, although I am not an expert. As for taking action, I had the same dilemma. Before we knew anything was wrong, one of the doctors ordered an MRI based on a hunch. I did not want to do the MRI unless it gave us some sort of information we could act on, and abortion was out of the question, legally and morally speaking under these circumstances. But we did it anyway, and at least the information has prepared us for what to expect.

DoubleCribble 7y ago

If your hospital is like many/most of all US hospitals despite only one hospital room, only one set of nurses and doctors, only one mother... you get to pay the full price of delivery charges for each baby! They should be required to hang a sign outside L&D, "Half a womb still pays for the full room." just so you don't have a(nother) heart attack when the bill arrives in the mail.

gavanwoolery 7y ago
Oh I'm aware of this. They even charge double for each ultrasound!

pfranz 7y ago

Sadly, it's infeasible to predict costs in the US. When my wife was pregnant I pulled up our insurance's "example pregnancy out of pocket cost* (*not expected to reflect actual costs)" PDF. It showed something like $650 out of pocket for all prenatal and delivery costs. The actual cost ended up being closer to your's. I called my insurance to ask what I could expect to pay assuming a normal pregnancy after being amazed at the cost already billed. They suggested I a) call my doctor's office and get each billing code for each procedure expected b) call their billing office to get each cost for each c) call my insurance with these numbers and get out of pocket expected costs. I just can't imagine trying to compare costs between multiple hospitals or OBs. I tracked medical costs fairly closely and noticed things like a quick procedure would get 2 separate coded procedures. Someone I know familiar with medical records said that kind of thing was commonplace. So for a laymen, it seems ridiculous to anticipate costs even for routine things.