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Wow, that is a horrific situation, I truly hope it turns out well for your family. Does your policy have an out-of-pocket maximum? My HR department always give

Wow, that is a horrific situation, I truly hope it turns out well for your family. Does your policy have an out-of-pocket maximum? My HR department always gives us hypothetical situations and the out-of-pocket maximum is often portrayed as the saving grace that makes things like this not destroy your finances. Is this true or is my skepticism well placed?

foxfired 7y ago
The counselors at the hospital told me same thing. The out-of-pocket maximum was set to be $5,000 for the insurance. But they also gave us a ceiling (which I don't remember the exact amount at the moment). I was advised that to get Medical which, I did right away, and it is supposed to be retroactive.
- wincy 7y ago
  Wow that’s crazy! I thought I was down on my luck last year when I got fired while my wife was pregnant. But medicaid has covered 100% of my daughter bills at the hospital. She’s been in the NICU for 8 months now. So even though I make a software engineer’s salary I haven’t had to pay anything. It’s weird that being unemployed saved me from the same hardship as you. I hope it all gets sorted and wish you all the best.
  - deleted 7y ago
    [deleted]
  - JBlue42 7y ago
    Wishing the best for your daughter and family as well
- scruple 7y ago
  This is frightening to read. How is this possible? My wife and I have 3 week old fraternal twin girls (wife is a living, breathing superwoman who carried them to full-term, despite being on strict bedrest from 26 weeks due to pre-term labor scare). We haven't gotten the bill yet but we had assumed that we were in the clear at this point because we've already reached the max (many, many months back, in fact).
  - jjeaff 7y ago
    You will probably get an insane bill. But don't get disheartened. Our plan had an out of pocket max and several different doctors (like anesthesiologists) tried to bill us directly because they were out of network. It took a lot of back and forth and many months but after all was said and done, we didn't pay a dime over the out of pocket maximum. This is apparently par for the course.
    - scruple 7y ago
      For posterity, we received our bill. My wife's antepartum stay (~3 weeks) was almost 2x the cost of the delivery. In total, the bill was just over $100k. Her out of pocket maximum, $3k, covered the entire pregnancy and delivery.
benmaraschino 7y ago
Not always true. That OOP max often only applies to providers who are considered in-network for your insurance plan. Oftentimes, there's no way to guarantee that all the providers you see during an episode of care will be in-network; you could have a surgery with a surgeon who's in-network, and at a facility that's in-network, but get blindsided by a huge surprise bill from an out-of-network assisting surgeon or nurse or anesthesiologist, or by an out-of-network consult when you're in the ICU recovering after surgery. This is one example: https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur... There's been some progress in states (including CA) to cut down on these sorts of billing practices, thankfully, but it's still a major issue elsewhere, even if you have an ostensibly gold-plated health plan. Many plans are starting to remove caps on out-of-network bills, too: https://khn.org/news/2016-ppo-plans-remove-out-of-network-cost-limits-a-costly-trap-for-consumers/ https://khn.org/news/2016-ppo-plans-remove-out-of-network-co... I assume something similar may have happened to OP, but there are a lot of other ways they can run up the bill. These kinds of billing practices are insane and need to stop.

foxfired 7y ago

The counselors at the hospital told me same thing. The out-of-pocket maximum was set to be $5,000 for the insurance. But they also gave us a ceiling (which I don't remember the exact amount at the moment). I was advised that to get Medical which, I did right away, and it is supposed to be retroactive.

wincy 7y ago
Wow that’s crazy! I thought I was down on my luck last year when I got fired while my wife was pregnant. But medicaid has covered 100% of my daughter bills at the hospital. She’s been in the NICU for 8 months now. So even though I make a software engineer’s salary I haven’t had to pay anything. It’s weird that being unemployed saved me from the same hardship as you. I hope it all gets sorted and wish you all the best.
- deleted 7y ago
  [deleted]
- JBlue42 7y ago
  Wishing the best for your daughter and family as well
scruple 7y ago
This is frightening to read. How is this possible? My wife and I have 3 week old fraternal twin girls (wife is a living, breathing superwoman who carried them to full-term, despite being on strict bedrest from 26 weeks due to pre-term labor scare). We haven't gotten the bill yet but we had assumed that we were in the clear at this point because we've already reached the max (many, many months back, in fact).
- jjeaff 7y ago
  You will probably get an insane bill. But don't get disheartened. Our plan had an out of pocket max and several different doctors (like anesthesiologists) tried to bill us directly because they were out of network. It took a lot of back and forth and many months but after all was said and done, we didn't pay a dime over the out of pocket maximum. This is apparently par for the course.
  - scruple 7y ago
    For posterity, we received our bill. My wife's antepartum stay (~3 weeks) was almost 2x the cost of the delivery. In total, the bill was just over $100k. Her out of pocket maximum, $3k, covered the entire pregnancy and delivery.

benmaraschino 7y ago

Not always true. That OOP max often only applies to providers who are considered in-network for your insurance plan. Oftentimes, there's no way to guarantee that all the providers you see during an episode of care will be in-network; you could have a surgery with a surgeon who's in-network, and at a facility that's in-network, but get blindsided by a huge surprise bill from an out-of-network assisting surgeon or nurse or anesthesiologist, or by an out-of-network consult when you're in the ICU recovering after surgery. This is one example: https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur... There's been some progress in states (including CA) to cut down on these sorts of billing practices, thankfully, but it's still a major issue elsewhere, even if you have an ostensibly gold-plated health plan. Many plans are starting to remove caps on out-of-network bills, too: https://khn.org/news/2016-ppo-plans-remove-out-of-network-cost-limits-a-costly-trap-for-consumers/ https://khn.org/news/2016-ppo-plans-remove-out-of-network-co... I assume something similar may have happened to OP, but there are a lot of other ways they can run up the bill. These kinds of billing practices are insane and need to stop.