million dollar babies

Gompers, BSN, RN · Nov 26, 2006

I think all insurance companies have deductables so it shouldn't devastate them. However, sometimes they have to pay that doctor bill separate from the hospital bill, and that might add up. Parents of NICU babies are usually set up with SSI stuff right off the bat by social work so that they receive a couple hundred dollars a month to help out with the added expense of having a sick baby, both in the NICU and after discharge. Some insurance companies have ceilings for coverage though, and I believe Medicaid has to pick up the bill after that. There are also situations where an insurance company will refuse to pay for the NICU anymore, stating that the baby should be stable enough for home or newborn nursery.

What is the worst situation is when you have a decent job but no medical insurance. Then you don't qualify for Medicaid, so you get billed for the whole shebang. THAT'S when it can really cause some financial devastation. It happened to a friend of mine - though he only owed the hospital $35,000, not a million. They did make him pay it though, every last penny.

Maybe some of the preemie moms can explain their experiences with insurance?

RNin2007 · Nov 26, 2006

Hey Gompers, thanks for replying. I actually had two preemies of my own d/t pre-e. However, I was much younger, in a bad relationship and had state medical coverage for them (thank god, and i'll never complain about paying taxes in my life). However, I am in a *new* relationship (engaged 5+ years) and about to graduate from nursing school (no way i'd have attempted this while in school). We would really like to be able to raise a child of our own together...i've been doing heaps of research on pre-e and I am going to get preconception counseling from a high-risk perinatologist. I will have good insurance (through hubby-to-be...we are also getting married in June!) but I had no idea what type of coverage we'd have if I ended up with pre-e again. I want to go into this knowing all my options, and be well-informed.

~J

Burnt Out, ASN, RN · Nov 26, 2006

I'm a preemie mom x 2. I have our family coverage through my employer.

With our first child, he was in the NICU for 12 days, in 2 seperate hospitals. He was born at 32 weeks due to preeclampsia and fetal distress. The first hospital, I paid a deductible for me and that was it. I was sent a bill for his NICU care at the hospital and it was in the $20,000. My insurance paid all of that. The 2nd hospital where he spent the last 24 hours of his life, I had to pay a higher deductible ($500) and the rest was covered ($15,000). He was a very sick baby boy and was looking at extended hospital stays and surgeries (Tetralogy of Fallot, cleft lip and palate, hemivertebrae). I do remember his nurses telling us that he would qualify for SSI, but we never got into what was needed.

Our second child was born at 32 weeks as well because of severe preeclampsia/HELLP Syndrome. She spent 23 days in the NICU and she was healthy (besides the normal preemie complications). I paid a deductible for me and her seperately, but had to fight with the insurance on her part. Overall her care was around $50,000 and we were out around $1000 or so for all of the deductibles, but did end up getting reimbursed by my insurance for what I had called and argued with them about.

We have said time and again that we are fortunate to have the coverage we have-it is really good. One thing that bothered me though is that my insurance did not pay well for the ambulance to transfer me both times and the helicoptor that transported our son from one NICU to the other. But that is a rant that I just don't do anymore....everything is paid.

BSNtobe2009 · Nov 26, 2006

Usually when you see insurance companies that pay 90% or 80%, there is a deductable and then it pays ie. 80% of the bill until the maximum yearly out of pocket, that is preset, is reached, and then usually most plans cover at 100% after that.

This usually applies to lesser bills, not big ones.

So, let's say you have a $100,000 NICU bill, you have a $1,000 yearly deductable, coverage at 90% and a yearly out of pocket maximum of $5,000, the most you are going to pay is $6,000.

But let's say you have a bill that is $4,500. You still pay your $1,000 yearly deductable, and insurance pays 90% of the remaining $3,500, so they are going to pay $3,150, so in the end you'll end up paying $1,350 of a $4,500 bill.

Obviously, all insurance companies are different, but more often than not, when you see the the coverages, it generally doesn't mean that is all they cover, but there are some fly-by-night insurance companies that only cover the 90% or 80% and that's it...and to me, they are not even worth paying the premiums for.

Luckily, when the bankruptcy laws changed, you can bankrupt medical bills the same as before....it's the credit card, student loans and other types of debts that the new bankruptcy laws cracked down on and they are very, very difficult to get.

I also know that many, many hospitals, also forgive extremely large debts and take it as a tax write off.

My daughter was in for 2 months and the bill, at my calculation, was over $130,000 for both the hospital and the doctors. My insurance, that was excellent, paid every last dime, I didn't even have a deductable because I used an in-network facility and doctor (going out of network, is just NOT worth it, if the doctor isn't on my plan, I find another one, yeah, you might like the doctor, and they might be really good, but they are not the only good doctor in town). I always, always, get the MAXIMUM coverage that my employer provides, because all it takes is one incident like mine, one car accident, one bout with cancer, and you will be worrying more than about getting well.

mom23RN · Nov 26, 2006

My son was not a preemie but he lived most of his life in the PTCU. We had an HMO at the time. About a month after we were there the social worker had us fill out papers for medicaid. It seems that if your child spends more than X number of days in the hospital you are allowed to be picked up by medicaid even though we had insurance through the hospital where I was employed. I know people complain about HMOs but we were in the hospital for 9 or his 10 weeks and we owed NOTHING. Thank goodness.

LydiaNN · Nov 26, 2006

Most states have Medicaid waivers that allow you to deem your child once medical expenses surpass a certain portion of your income. Also, Title V programs frequently cover the conditions that necessitate lengthy NICU stays. Even a wealthy family qualifies for that if the medical expenses are expected to surpass 20% of their income.

BSNtobe2009 · Nov 26, 2006

Most states have Medicaid waivers that allow you to deem your child once medical expenses surpass a certain portion of your income. Also, Title V programs frequently cover the conditions that necessitate lengthy NICU stays. Even a wealthy family qualifies for that if the medical expenses are expected to surpass 20% of their income.

That is an AWESOME thing to know, considering I am self-paying for insurance right now. I am constantly worried about being financially ruined in the case my daughter has a long hospital stay.

danissa, LPN, LVN · Nov 27, 2006

freaked out when I see how much it costs in the states to have preemies. here in old GB, we have the good(?) old NHS, and anyone requiring treatment for themselves ,their children or their loved ones does not pay a penny! Well, people like myself, my hubby and most of the working population pay every month a very hefty tax and national insurance from our pay, which covers the folks that never have the intention of working a day in their lives!!! If I got what was on the top of my payslip, I would be one happy woman, and my kids could all have the latest trainers, etc!if half of these folks who contribute zilch were in the US, they might think again, or am I wrong, would medicare(??? is this right?) cover their bills? makes you fume a wee bit:madface:

LydiaNN · Nov 27, 2006

freaked out when I see how much it costs in the states to have preemies. here in old GB, we have the good(?) old NHS, and anyone requiring treatment for themselves ,their children or their loved ones does not pay a penny! Well, people like myself, my hubby and most of the working population pay every month a very hefty tax and national insurance from our pay, which covers the folks that never have the intention of working a day in their lives!!! If I got what was on the top of my payslip, I would be one happy woman, and my kids could all have the latest trainers, etc!if half of these folks who contribute zilch were in the US, they might think again, or am I wrong, would medicare(??? is this right?) cover their bills? makes you fume a wee bit:madface:

Medicare is for senior citizens, most of whom have paid into the system their entire adult lives (not as much as their health care costs, of course, but that's a different story...) Medicaid is the health coverage program for indigent people, and yes, some of them have contributed little if anything to the system. Others have disabilities, many involving mental health issues. Still, there is a huge population of people that don't qualify for Medicaid and their only healthcare comes from the misuse of emergency rooms or the rare clinic that provides care regardless of ability to pay. I guess my point is that one way or another, the working man pays and there are always people who abuse the system, whatever that system may entail.

danissa, LPN, LVN · Nov 27, 2006

Medicare is for senior citizens, most of whom have paid into the system their entire adult lives (not as much as their health care costs, of course, but that's a different story...) Medicaid is the health coverage program for indigent people, and yes, some of them have contributed little if anything to the system. Others have disabilities, many involving mental health issues. Still, there is a huge population of people that don't qualify for Medicaid and their only healthcare comes from the misuse of emergency rooms or the rare clinic that provides care regardless of ability to pay. I guess my point is that one way or another, the working man pays and there are always people who abuse the system, whatever that system may entail.

Thanks mercyteapot for clarifying the difference between medicare/medicaid. So do the population that don't qualify for medicaid have their preemies looked after on a long neonatal stay for nothing ?

MegNeoNurse · Nov 27, 2006

Hmm, I don't know for sure about the micropreemies that are in the unit forever, but I *pray* that those parents have a good insurance plan.

I know that this past weekend, there was a family that came up to visit the unit and their baby had his 1 year birthday and brought little presents for all the babies in the unit. (So sweet!) Anyway, this kid was born 34 weeks AGA and was in our unit for about 4 weeks. When they were leaving, I was walking behind them in the hallway to go to a different department to grab something and the dad said "I hope that's enough, oh well, what did we spend like $100,00 in that place?" So uh, I don't know if they had crappy insurance or what but dang!

It really is a case by case basis. Depending on procedures, medications, etc. those can really jack the price up. E.g. aprostaglandin costs $1,500 for a single dose I do beleive. YiKeS!