Medical Bill and Insurance Planning When You Are Expecting

You are pregnant, anxious and excited about the new addition to your family. You've read all the baby books, are wearing maternity clothes, and took the birthing classes. The baby room is painted and the crib is set. What is left? Let's spend a minute making sure that what could be a multi-thousand dollar event is handled correctly from a financial standpoint.

Having a baby is one of the biggest life changes you will go through, and it is a game changer in terms of your health coverage as well. Even though it is rather routine event in the eyes of insurance companies and medical offices, it is worth having a checklist ready to be sure nothing gets lost in the shuffle. For most young couples, having a baby may be the most important single use of their insurance, so it is important to get it right.

Before the Delivery

waiting for babyWhile you are anxiously awaiting junior's arrival, there are a few things that you can do to make sure the financial process behind having a baby is off to a good start.

  • Speak to your insurance company about what kind of prior authorizations are required. Depending on your plan, you may need to get prior authorizations for the actual birth event and/or several of the events (e.g. ultrasound) leading up to that point. Knowing which events require authorizations will make sure every step from this point on is done with high accuracy.
  • Speak to your insurance company about what kind of notification is required. Notification is simply a step of letting the insurance company know when you are admitted for the delivery. Many insurers require this step for seamless payment.
  • Armed with the information from the above two points, talked to your doctor's office and/or hospital to be sure that they will perform these steps on your behalf. Most do, but it is good to double check.
  • Be sure that your doctors, hospital, and the baby's future pediatrician are all in your plan's network, if it has one. Going out of network can significantly increase your copay or result in a denial. Be sure that you also verify any anesthesiologist (for an epidural or c-section) is in network. This is a common place to be stung by an out-of-network provider.
  • Read your benefits summary so you thoroughly understand what is covered and what is not. How is a day in the hospital defined? Do you get a post-discharge nurse visit at home? How about lactation consultant or other services?
  • If you are uninsured, talk to your hospital and doctors about accepting a prenegotiated cash deal -- usually a deeply discounted prepay arrangement -- to remove any cost uncertainty from the delivery.

During the Hospital Stay

just bornMost of the steps to be performed during the hospital stay will be made easier if the pre-stay steps were done thoroughly. Still, there are some things that the new parents (in particular, the father who may be in a better position to coordinate) can do to ensure they are in good shape financially. Let's make it clear that we don’t expect the new mom to be remembering these things -- she should be focused on her health and recovery and the new baby.

  • If you see a new doctor attending to the patient -- an anesthesiologist or OB/Gyn who you don't recognize, someone should clarify if they are in your insurer's network. Don't worry, it isn't taboo to ask -- you are all on the same team, and they don't want to be surprised by an insurance denial either. This has become a common point of confusion and often an expensive oversight for many patients.
  • Give your insurer a courtesy call to let them know the baby has arrived, and be sure they don't see any issues with your plan that need to be resolved. Chances are that they will tell you all is fine, but the peace of mind is worth a 10-minute phone call.

After the Delivery

newbornOnce the delivery is over and you've brought the baby home, there are two major activities: Adding the newborn to your insurance, and resolving the bills.

  • Work with your HR department (or directly with the insurer) to formally add the newborn to your insurance. To do this, you will likely need to fill out an application specific to this situation, and you normally will have about 30 days to complete it (but check with your insurer to be sure).
  • Follow your medical bills along by reviewing the Explanation of Benefit (EOB) forms as they are received and comparing them with the statements from your providers. Keep in mind that you may have four separate providers in play during this process -- your OB/Gyn, the hospital, the pediatrician, and perhaps an anesthesiologist or surgeon. Each may have a different look and feel to the statement, and may be paid at different times by your insurer.

Ultimately, just remember that you, your healthcare providers, and your insurer are all on the same team. Everyone just wants your baby to come home healthy and for you to be able to focus on your newborn, not your pocketbook. A little preparation and some timely questions along the way will make a big difference in making the process go smoothly.

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