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12-19-2012 at 7:08 PM
Candace523...
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Candace52309 is not online. Last active: 05-06-2013, 10:42 PMNewbie

Insurance question

Sorry, not sure where to ask.

So baby # 2 is due 2 days after my EDD. My DD was 2 wks late (which is a trend in my family, i guess we like to over bake 'em)

So if baby #2 goes past EDD will I have to pay me deductible AGAIN? I thought I would, but I have heard ppl say that I wouldn't, but I cant find any info on it.

I'm not planning on an induction. I would rather pay another 2000 plus 30% than do an induction an increase the risk of a c-section.

Do ant of you know the rules regaurding babies going past renewal date?


4/14/2003: I said "yes" to dinner and a movie 5/23/2008: I said "Of course" to his propsal 5/23/2009: We said "I do for life" 10/28/2011: We found out God granted us a miracle, we were 8 wks prego after being told we could't have children 6/23/2012: We welcomed our beautiful daughter Alexandra: 6lbs 7oz, 21in at 42 weeks 0days at 1:32 a.m Daisypath Anniversary tickers  
12-19-2012 at 7:19 PM
drpayne
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drpayne is not online. Last active: 05-24-2013, 8:12 PMSilver
It's always going to be billed by date of service, unless they allow you to prepay a portion of it. But yes, if your deductible starts over jan. 1, then you have to meet it again.

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12-19-2012 at 7:46 PM
SarahRae85
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SarahRae85 is not online. Last active: 05-18-2013, 11:33 AMBronze

Deductibles reset on January 1, not your due date or 365 days from when you met your deductible the first time.

If she's born after January 1, then yes, your deductible will reset and you'll have to pay it all.


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12-19-2012 at 7:51 PM
Candace523...
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Candace52309 is not online. Last active: 05-06-2013, 10:42 PMNewbie

With my employer our renewal is July 1st.

I believe if I go into labor on the 30th I'm holdin s/he in until midnight, lol

But I did find out they will do a "split settlement claim" if you are hospitalized during the renewa. period.


4/14/2003: I said "yes" to dinner and a movie 5/23/2008: I said "Of course" to his propsal 5/23/2009: We said "I do for life" 10/28/2011: We found out God granted us a miracle, we were 8 wks prego after being told we could't have children 6/23/2012: We welcomed our beautiful daughter Alexandra: 6lbs 7oz, 21in at 42 weeks 0days at 1:32 a.m Daisypath Anniversary tickers  
12-19-2012 at 8:17 PM
eltar08
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eltar08 is not online. Last active: 05-24-2013, 12:40 PMNewbie
Just an FYI, your benefit accumulators (annual deductible, out-of-pocket maximum, etc.) resent based upon when your employer elected to have the plan year run.  The majority of insurance plans run calendar year (1/1 - 12/31) but your client might have a different plan year (e.g 7/1 - 6/30 or something else entirely).  So if you're not sure of the timing, you definitely want to check your plan documents/with HR.

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12-19-2012 at 8:33 PM
SarahRae85
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Candace52309:

With my employer our renewal is July 1st.

I believe if I go into labor on the 30th I'm holdin s/he in until midnight, lol

But I did find out they will do a "split settlement claim" if you are hospitalized during the renewa. period.

Ah, see, I interpreted EDD as "expected due date", which is what that acronym commonly stands for here, which is where I was confused. 


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12-19-2012 at 8:51 PM
Kingston54
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Kingston54 is not online. Last active: 05-20-2013, 11:24 PMGold
SarahRae85:

Deductibles reset on January 1, not your due date or 365 days from when you met your deductible the first time.

If she's born after January 1, then yes, your deductible will reset and you'll have to pay it all.

I don't have a deductible, so I am not sure - but this sounds like what would be the correct answer to me!


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12-19-2012 at 10:12 PM
dclsboo235
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dclsboo235 is not online. Last active: 05-12-2013, 8:33 PMBronze
Call your insurance provider and ask.

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12-20-2012 at 12:36 AM
starz57182
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starz57182 is not online. Last active: 05-19-2013, 10:49 AMBronze

My insurance renews on July 1st as well. My first baby was born in the third week of July, and yes, I had a whole new deductible to meet at that point. The nice thing in my situation is that I don't pay co-pays for my office visits, and my office doesn't bill for any of the visits until you have the baby. So the large bill from the OB office actually went toward the deductible that started after July 1st, even though the majority of my visits happened in the previous plan year, before July 1st. 

The lame thing is that I had a hospital visit and a couple ultrasounds before July 1st, so my deductible was close to met, and I had to start over when she was born.

Not sure what date they would use if you went to the hospital on June 30th but didn't actually have the baby until July 1st though. I know that as far as the stay goes, it didn't technically start until she was out. The standard hospital stay is two nights. If I had her before midnight, that would have been the first night. I got to the hospital around 5 PM, but didn't actually have her until around 1 AM. So that's when my official "stay" started, and I stayed two nights after that. Based on that, I assume the stay was billed for the day of birth, and not the day of arrival. I don't have the bills in front of me to check that though ;)

What might get tricky is if you have an epidural or any other sort of procedure on the 30th, but don't have the baby until the 1st. I *think* that it would all be billed as part of your stay, and that would probably be after the 1st, but I'm not sure, and all insurance is different anyway.  


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12-20-2012 at 7:25 AM
Kie310
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Kie310 is not online. Last active: 05-24-2013, 7:52 PMGold
Yup. Jan 1 you get a "clean slate" for insurance and everything goes back to $0. So you have to start your deductible all over again. Sadly it's one of the reasons that I decided to make my RCS on this side of the new year and basically forgo any attempt at a VBAC. I know this baby would be late (my due date is 1/3/13) and we have a high deductible plan -- meeting $3K again come Jan would really suck ass.

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12-20-2012 at 8:30 AM
SWOG31
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SWOG31 is not online. Last active: 05-24-2013, 11:54 PMBronze
I have a high deductible plan, so this was a worry of mine. However, I was told that all the payments I made for my regular doctor's visits don't actually get turned in to my insurance until date of delivery. The only payments that have been turned in have been payments I made for u/s and labs. It's good and it's bad because technically in 2012 I've paid more oop for medical than I'm suppose to, but the upside is that I will have prepaid my deductible for 2013 and won't get stuck with a big hospital bill in January.

So, if you doctors office turned in all your payments at date of your appointments, then you should probably expect to pay your deductible again.

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12-20-2012 at 11:42 AM
hmontty
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hmontty is not online. Last active: 05-13-2013, 12:32 AMSilver

I'm confused...so you are saying that your due date is just a couple days before your insurance renewal date?

Yes, if you give birth after your insurance renewal date, you will have to pay your deductible again. Everything gets set to zero.

However, if you are admitted before your renewal date, even if you receive care after that date, it all goes into the previous year. So if you renew on Jan. 1, and you give birth on Dec. 31, you are covered under the previous year/deductible, etc., even if you stay in the hospital until Jan. 2 or 3.

With DD, my insurance renewed on April 1. She was born by section on March 29, and we left the hospital on April 2. It was all covered under the previous year's plan.


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