The Insurance Shuffle

4 Apr

A-one, a-two, a-hinka dinka doo.

April is “open enrollment” month, which is that single month of the year when you can make whatever changes to your policy you want for no reason whatsoever.  Rather than having some sort of sensible rule like “you can’t change your policy more than once in a six month period” or “your policy changes are dependent on the start date of your policy” or even “change your policy whenever you like, we’ll tell you whether it negatively affects your rate”, no.

YOU CAN ONLY CHANGE IN APRIL WE LIKE APRIL CHANGE IT THEN.

Bee bop a-rebop.

The amount an individual pays into health insurance over the course of their lifetime will always be less than the total benefit they receive.

Seriously.
It’s not even close.

“Hi, my name’s Jeremy.  I’m calling about my insurance plan because I know we’re coming up on open enrollment.  Currently, I’m in Elect Open Access and I was wondering if that’s the best policy for my wife and I to stick with.  Thing is, she’s pregnant.  It’s triplets, actually, and that means she’ll probably be hospitalized a while and there’s a chance the three babies will too.  Since we’re headed for this big life change, is there a switch I should be making?”

“Uh.  It’s up to you.”

“Right.  I know.  But could you assist me?  I don’t really understand the ins and outs of these policies.”

“It’s right there on the benefits sheet.”

“Yeah.  But if someone could maybe walk me through a couple of scenarios to see if… er… I’m sorry, can I get some sort of advisement?”

“Not really.”

“Not reallly?”

“I can email you the benefits sheet again.  How about that?”

Slide to the left.  Slide to the right.

Frustrated, I talked to my dad.  I probably should’ve gone to him first, since he actually sells this stuff for a living.  He looked everything over.

“Two things, Jer.  One: I’ve never seen insurance this expensive.  Is this typical for California?  It’s ridiculous!

“I don’t know.  I guess it’s typical.”

“Two: how much of this are you actually paying for?  What’s your employer’s contribution?”

“They contribute $125.”

“Uh huh.  You know what I’m thinking?”

“Is it along the lines of ‘Sayonara California’?”

“You said it, buddy.”

Step-ball-change.

It’s more or less a given that triplets are going to experience time in the hospital NICU.  Probably weeks.  Carey had heard about a special program in California in which the state takes on the financial burden of NICU care for newborns.  Of course, this is all dependent on a family’s income.  And since we’re part of the ever-shrinking middle class, having triplets, it’s very likely that we’re poor enough to need it desperately, but not quite poor enough to receive it.

Rather than messing with CalChoice (the network that networks HMO networks), I decided to start calling the HMOs themselves to get a straight answer on what this is going to cost.

“So, I’m looking here at the benefits and it says ‘Hospitalization Services’ includes ‘pregnancy and maternity care’.  $450 copay per day, with a maximum out-of-pocket of $1,800.”

“That’s correct, sir.”

“Okay, so I have a question on that.  And I apologize for how specific I have to be about this, but it’s the reality of what’s coming up for my family later this summer.  Here’s the situation: let’s say my wife has to go into the hospital for bed rest at 28 weeks.  She stays in the hospital until she’s at 34 weeks, at which point our doctor performs a C-Section and the babies are born.  Triplets.”

“Okay.”

“But there’s a problem, see, and two of them need help breathing and there are all sorts of weird complications.  They’re premature and they need to stay in the NICU for weeks.  Multiple weeks.  Meanwhile, my wife’s recovering from the surgery and on and on.  So, two months after she first went into the hospital, everyone goes home.”

“Right.”

“You’re saying all that… everything… that’s one, single out-of-pocket for us of $1,800.”

“Correct, sir.”

“!!!  Are you serious?  That’s incredible!  Months in the hospital and we get hit for less than $2,000?”

“Yes.”

“That’s the best news I’ve heard in months!  Wow!  Thank you!  We’re definitely switching over to you.  Ah, that’s so great.”

“Glad I could help!”

“Now, is there anything else I should know about that scenario?  Anything I might get surprised by?”

“Well, one thing.  Let’s say the newborns need to stay in the NICU longer than your wife’s recovery.”

“All right…?”

“Say your wife needs a week to recover, but the newborns need several weeks in the NICU.”

“Yeah, that could definitely happen.  That changes things?”

“The day your wife leaves the hospital, we need to start treating the newborns as separate copays.  They’re now individuals, requiring their own special circumstance.”

“No more $1,800?”

“Well, no.”

“What would I need to pay?”

“It depends on how long the newborns stay in NICU and what they need.”

“It’s suddenly a hell of a lot more than $1,800.”

“Well, yes.”

“How much more?”

“Well, let me look up your maximum annual out-of-pocket-for-family.”

“Because we’d definitely reach it.”

“Oh, sir, yes.”

Lean back. Lean back.

So, we’re now in April and I need to submit our Renewal Change Request forms in the next couple of days.  Unfortunately, there is no special “in case it’s triplets” gift basket from insurance companies and it’s all about keeping things as cheap as possible.  I’m looking at several options that all look good, all with different caveats that could turn evil in a hurry.

That California NICU money?  Who knows.  We can apply and see what happens.

Will Carey be in recovery as long as the newborns are in the NICU?  Doubtful.  But it’s possible if she manages to hang on to them for an exceptional amount of time before delivery/surgery.

Do I feel like I understand less about insurance than when I first climbed aboard this mad merry-go-round?  Would I prefer it all stop and take care of itself?  For just a minute?  Please?

Oh, sir, yes.

Cha cha cha!

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19 Responses to “The Insurance Shuffle”

  1. pam April 4, 2011 at 11:21 am #

    Yeah, I wish I’d thought about it more. We put the boys on my husband’s policy (we each have our own, works out cheapest that way) because the premiums are much lower. But because of the co-pays for their NICU stay, we had to pay about $5000 for them. If we’d put them on mine just for the first year, it would have been a LOT less. Ugh.

    Look into the Aflac stuff too. I think people in California benefit from that a lot if the babies are in the NICU. (It doesn’t work as well in Louisiana, sadly.) I’d look on the Triplet Connection forum, because there are people there that know more about it.

    • Jeremy April 4, 2011 at 11:38 am #

      I do keep hearing about Aflac for people in our situation. We do need to find out more about it. Maybe it’s the way to go…

  2. Andy Kerr April 4, 2011 at 11:51 am #

    Hrm. Just having ONE baby has maxed out our annual out-of-pocket limit, every time we’ve done it. In my case, that’s $6000 or so.

    Save up!

    • Jeremy April 4, 2011 at 11:55 am #

      Yeah, the plan I’m looking at now has a max annual of $6,000, so that may be what we go with. Not enough to sink the ship, but still. Ow.

      Also, happy birthday.

  3. Helen April 4, 2011 at 12:09 pm #

    We were on a High Deductible Plan when I was pregnant with the boys. I met the $3,000 deductible with just prenatal visits and then my c-section was covered. We moved the boys to my husband’s HDP (through his job) and had to pay out another $3K to meet that deductible and then the boys’ 20 day NICU stays were covered. Not too bad!

    Still made my heart stop though when I got a bill for $750K for ONE kid. Thank goodness that was just a billing error and not for real!

    • Jeremy April 4, 2011 at 6:07 pm #

      It sounds like $6,000 seems to be the magic number. I suppose it could be worse.

      Is a 20 day NICU stay typical?

  4. Jennifer April 4, 2011 at 1:06 pm #

    I don’t know what is different in CA then FL, but when my triplets were born at 28 weeks (hoping yours make it closer to full term!!!)Them being premature under a certain weight qualifies them for Medicaid for their 1st year. In Florida it is under 2lbs 10oz. So, if your babies were born early and spend an extended stay in the NICU Medicaid picks up what your insurance does not pay no matter what your income maybe. I spent 2 weeks on bedrest with daily ultrasounds. 2 babies came home after 67 days and 1 spent 6 1/2 months in the NICU. My out of pocket was $5000.

    • Jeremy April 4, 2011 at 6:09 pm #

      Medicaid, that’s interesting.

      67 days, man, that’s a marathon. But 6-1/2 months??? I can’t even fathom. Would that have happened if they’d made it a few more weeks in the womb or was there another issue? That sounds terrifying.

    • Jeremy April 4, 2011 at 6:14 pm #

      Jennifer, I just did a quick scan of your blog and I realized I’ll need to spend a lot more time on your site. What an incredible journey and such a devastating story to lose one of your little ones. I’m sorry, I just can’t imagine and it’s something my wife and I are terrified of (particularly with her Lupus).

      Thanks so much for dropping by. Prayers and good fortune to you, friend. I hope you’re able to find peace and great moments with your children, despite such an enormous circumstance.

      • Jennifer April 4, 2011 at 9:17 pm #

        Yeah my outcome was a marathon of issues starting with undiagnosed twin to twin transfusion…There were 5 sets of spontanious triplets born in my city within 3 months (atleast that I know of) every single set made it to 32 weeks except mine and as you prob read mine was not Preterm labor that made mine come early. No freaking out because of my outcome. Every single set came home within 6 weeks and they are all “normal”. I have another local friend that made it to 36 weeks and brought her’s home with her. I am actually following a blog where the lady just delivered her babies on the 29th at 35 weeks and did not even have to have a c-section! Whew that is amazing to me. I have fingers crossed and lots of prayers headed your way for a safe unevenful pregnancy. P.S. I also met a mom in the NICU that delivered at 24 weeks 1 day and has 3 very healthy babies 🙂 Look foward to lots more updates 🙂

        • Jeremy April 6, 2011 at 9:03 am #

          Thanks for your prayers, encouragement and for sharing your incredible story, Jennifer. My wife and I have constant scenarios running through our brains and it helps so much to have your perspective.

  5. Sarah April 4, 2011 at 5:00 pm #

    We were in the “very lucky” category on a few fronts. Rich’s insurance policy at the time was awesome. I made a $15 co-payment at my first visit and that was it. We paid nada for my c-section, Anna’s 3 surgeries and Anna’s 3 weeks in the NICU.

    Two of my three didn’t need any NICU time at all. They spent 2 days in the Special Care Nursery and then came home with me. Anna would have done the same if it hadn’t been for her spina bifida. You never know – your little munchkins might surprise you and stay put until 36 weeks.

    • Jeremy April 4, 2011 at 6:19 pm #

      Sarah, that sounds like the kind of deal you sign in blood with a flaming quill. That’s incredible! Truly, your insurance is the envy of all other insurances.

      36 weeks would be a dream come true (well, I probably shouldn’t speak for Carey, but I think she’d take it if offered to her). I have to confess I know next to nothing about Spina Bifida, but you’re clearly a great mom.

  6. Kim P April 5, 2011 at 5:59 am #

    6k seems to be the magic number here too. When we had the boys all our co-pays added up to about that and now we’re on a health savings account which means our maximum out of pocket is 6k per year – BUT – it’s all pretax dollars, so more like paying 4k post tax. That might be something to look into too? We keep going back and forth between what would be best if we did decide to get pregnant again. If we had regular insurance and an uncomplicated pregnancy with a singleton (unlikely) we’d be out about 1k for the entire pregnancy with a regular insurance policy. But with the HSA we’d be out 4k post tax dollars total and that would cover everything – no matter how many babies are in there.

    Insurance is such a tough thing to decide on. We had it so good with the girls – 250 copay and they were 29 weekers in the NICU for 6.5 weeks. They covered absolutely everything. I doubt we’d ever get a deal like that again! 😉

    • Jeremy April 6, 2011 at 9:05 am #

      Tax issues are a good thing to keep in mind, we always forget about that side of it. Well, I do anyhow.

      Congratulations on your girls!

  7. StayatHomeTripletDad April 5, 2011 at 8:44 pm #

    $5k – $6k sounds about right for us too. We both maxed our flexible spending accounts to give us $6k pre-tax. Between the hospital, the Dr.s and the drugs I am sure we spent more than $6k the first year. Sorry:) The rule of thumb that the NICU people will tell you is to shoot for them leaving the NICU on their due date. Most leave earlier but a lot of times you are working against a 2 to 1 ratio. For every day they missed in the womb they need 2 in the NICU. For instance… we delivered at 33 weeks. They probably would have been fine at 34 or 35 weeks so they spent 3-4 weeks in the NICU.

    One of ours needed to see specialists so we kept spending money even after they got home. It adds up QUICK! I think the total cost was around $250k.

    Breath! It will work out, who needs retirement money anyway:) lol

    Al

    • Jeremy April 6, 2011 at 9:07 am #

      Sorry, Al, you’ll need to repeat that. I read “total cost was around” and then I assume you wrote some sort of number there, but I can only see a blurry area because my brain seems to be rejecting the information.

      • StayatHomeTripletDad April 6, 2011 at 11:45 am #

        Yep, thank God for insurance! After looking at all that then add possible private education k-12, college, possible graduate school and weddings the U.S. Budget Deficit doesn’t look all that bad:) lol

        On a funny note… one night (around 31 weeks) my wife yelled out “That’s it! I want them out! They can fend for themselves!” She made it two more weeks before high blood pressure got to her.

        Have fun!

        Al

Trackbacks/Pingbacks

  1. Insurance Snafu… « Mod Vegan - April 26, 2011

    […] and rhythmic post on the woes of health insurance several weeks ago on his blog, Tips On Triplets. Check it out.  April 26, 2011  modvegan Categories: Uncategorized LikeBe the first to […]

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