million dollar babies

LydiaNN · Nov 27, 2006

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 ?

Almost always there is some sort of government program that pays for a substantial portion of these babies' care. Even those with insurance can exhaust their lifetime benefits within a child's NICU stay if their needs are extensive enough. Many times the babies (but not the parents or any siblings that don't have extraordinary health care needs) qualify for Medicaid based on a process that is called ''institutional deeming'' in my state. I do know that other states have waiver processes, but I'm not sure what they're called or how they work.

RNin2007 · Nov 27, 2006

I've learned a lot about how this works by reading this thread. Now I wonder if an insurance company can deny you coverage d/t pre-existing condition?

~J

mom23RN · Nov 27, 2006

I've learned a lot about how this works by reading this thread. Now I wonder if an insurance company can deny you coverage d/t pre-existing condition?
~J

We often hear about that with Blue Cross/Blue Shield. They are "non profit" in the state of Michigan. They say that they don't deny anyone. They don't... they just charge so much if you have a preexisting condition that you can't afford to get it.

Do you mean preexisting as in trying to deny because of a baby's preexisting condition before birth? If you're covered during maternity I believe that the baby is automatically covered as there can be no "preexisting condition". If you're trying to switch coverage after baby is born then some can deny or just charge you accordingly.

BSNtobe2009 · Nov 28, 2006

I do know there is a federal law that prohibits a health insurance company from denying insurance, even at a jacked-up rate, to a newborn if the mother is already covered. She has 30 days to add the infant after birth as a dependent, and the benefits must be retroactive to the date of the birth. I learned that from my Human Resource Generalist when I called to add my daughter because I was afraid they would refuse to cover her.

I have no idea of how it would work if the mother didn't have insurance at all.

Zippedodah · Nov 28, 2006

i have a friend whose baby was in my unit. this baby was 26 weeks, had mulitiple problems, readmissions, vsd repair, caths, etc. total hospitalization almost one year. she also works at the same hospital i do. they met their million dollar lifetime cap with her. they had to apply to medicaid to cover her expenses. now, this child is no longer eligible for health care insurance for her life. if they had been on welfare, this wouldn't even be an issue. and yes, there have been families that have lost their homes, etc due to hospital bills. most places are ruthless when collecting their money and the old adage, well, if you pay $5 a month, they can't do anything is a thing of the past.

our unit is close to $1800 per day, just for the bed. that doesn't include meds, o2, etc.

it is so unfortunate that the working class seem to get the short end of the stick.

BSNtobe2009 · Nov 29, 2006

I have a question, I hear all the time about people losing their homes due to medical bills, but in 10 years of working with housing loans I have NEVER seen a medical lien on a piece of property.

Zippedodah · Nov 29, 2006

it is probably because they have to sell their house to make the payments, so yes, they are losing their home. they have to rent usually after that or move in with family. this has happened to a few families that have long term kids. fair? no not at all. also, miss a payment, ruin your credit.

BSNtobe2009 · Nov 29, 2006

it is probably because they have to sell their house to make the payments, so yes, they are losing their home. they have to rent usually after that or move in with family. this has happened to a few families that have long term kids. fair? no not at all. also, miss a payment, ruin your credit.

depending on how bad the debts are, as a rule of thumb, besides your mortgage, if you are in debt double your salary, you need to file for chapter 7. that is what it's designed for. selling a house or not, you still have to have a place to live and save for retirement, or else you'll be 70 and eating dog food.

filing for bankruptcy doesn't ruin your credit like it used to. in fact, you usually get tons of credit cards to start rebuilding your credit because they know the courts won't allow you to file it again. that 's a heck of alot better than selling your home, cashing out the equity, losing all of your savings for many, many years, and then having to start all over again.

with excellent re-established credit, 3 years out of chapter 7, they treat it like any other borrower who never filed bankruptcy, and after 4, you are usually back up to 700 score status.

lenders also disregard medical debts when deciding to lend. we don't even take them into consideration if they are over $1500.

Nyoro · Dec 3, 2006

In Japan, national government grants cover the medical care for any child born under 2500g, which ends up covering almost all the preemies. The only thing parents have to pay for is "nutritional needs" and "room"... Non-vitamin nutritional supplements aren`t covered - thickeners, milk, etc. I guess that the room charge is some micro percentage of the NICU space. On average, it`s around $200 to $300 a month.

I`ve never heard of any big problems with parents paying for NICU stays, even long term ones. The grant only applies for a year, but usually any care after that is covered until 2 by the city. (Depending on the city though, that can range anywhere from 18 months to 12 years.) If the child is in hospital care for over 2 years then they usually have some sort of condition that would make them eligible for some other grant.

When my son was in the NICU (25 weeker, 437g, in for 5 months), we would get monthly statements from our insurance telling us how much was actually spent on his care, along with a tiny bill for what wasn`t covered. The first couple months ran about $200,000 a month if you don`t count the first week... The first 3 days were $50,000 a day! I can see where this would really ruin your finances - even if you were only paying 20%.

I always did wonder how that worked in the US though - especially with drug related preemies, etc. The parents definitely wouldn`t have any way to pay... We`re lucky in that I`ve never even heard of a drug related preemie in our NICU - Japan just doesn`t have that problem. (Thank God!)

-Nyoro

(Volunteer at an NICU in Japan)

gauge14iv, MSN, APRN, NP · Dec 3, 2006

In Texas they cant touch your house unless you don't make your house payments.

Sweden · Dec 6, 2006

In sweden parents don´t pay for anything during the childs hospital time! Our taxes are high (about 35% on a normal nurse income) but we also get a lot back.......

I´m coming to california to work (hopefully next year) and can´t even understand how your system works? Do you keep track of everything used on the baby (supplies, medicines, equipment) and then bill the parents/insurance company? :uhoh21:

Anna

Zippedodah · Dec 7, 2006

Sweden, that about sums it up. They area charged certain things by the day, and then there are items we use that are charged to the patient. Everything we use has stickers so we just put the stickers on a piece of paper at the baby's bedside and the secretaries bill from that.

I wish we had better coverage for all things long term.