June 13, 2005 ~ Sideswiped Again
Monday.
Well. Remember this entry? Just when things were starting to look optimistic again... I was halfway up the river, but someone just traded my paddle for a wire wisk.
The college renews the insurance policy every July 1st.
This year, the insurance company raised the premiums on their plans significantly, so the school decided to switch to a plan with less coverage but a lower monthly premium.
To make it so that premiums did not go up as much, they switched to a plan that has a much higher out-of-pocket yearly limit, much higher co-pays for out-of-network providers, but the same co-pay for in-network care. Now, most people who use the school's plan never get anywhere close to meeting the out-of-pocket maximum anyway, and most people who use the school's plan use providers in-network. Smart plan for most, right?
You know where this is going, don't you?
The midwives are out-of-network (our insurance company does not have midwives period, anywhere, in the network, though they will cover them as out-of-network care), so they are going to cost a lot more now. In addition, the out-of-pocket limit has now doubled to $4,000, instead of the $2,000 that we had budgeted for. Compounding that, the paperwork says that the $500 deductible will no longer count toward that limit. In addition, the co-pay for out of network providers has risen to 40% instead of 30%.
So, we are now looking at possibly $4,500 total plus $400-$500 in un-covered fees, as opposed to the $2,000 total plus $400-$500 in un-covered fees that we had been expecting.
And of course, the premium that is taken out of our paychecks every month is still going up some.
In many ways, even though this particular situation was a major sideswipe to us, I am not terribly surprised. Health care costs have been rising steadily over the last several years. Less and less Americans can afford even basic healthcare, the worse it gets. It was only a matter of time before we were so directly impacted.
Okay. It's later, and we've researched as much as possible given that 1) the human resources director is out until the end of the month and 2) the insurance company apparently cannot answer most questions about the new plan until after July 1st when it goes into effect.
Thankfully, the higher out-of-pocket maximum ($4,500) only counts for out-of-network providers at time of billing. For instance, when an out-of-network provider bills us, we will have to keep paying 40% of those bills until our total out-of-pocket health expenses have reached $4,500. For in-network care, the yearly out-of-pocket maximum has only risen to $2,500. If an in-network provider bills us, we have to keep paying 20% of those bills personally until our total out-of-pocket health expenses have reached $2,500.
Yes, the midwives are out-of-network. BUT. Because their bill will come before the hospital bills, and they will cost less than $2,500 (provided I have no complications during the pregnancy), we may be in luck.
So, since the midwives will only cost a bit over $1,200 plus the $400 not-coverable fee, and we will be paying for them before we pay for the birth center at the in-network hospital, and we've already paid around $600 for the in-network doctor (that's for one prenatal visit and the two ultrasounds! Glad we didn't stay with them...), by the time hospital bills come around, we will probably have spent nearly, but not over, $2,500. So, when the bills come from the hospital, we will only have to pay up to the $2,500 out-of-pocket limit since they are in-network. And then the $400-500 in fees that aren't covered at all.
Whew. Still with me? All told, this will hopefully mean that, barring complications in the pregnancy (please no we simply cannot afford that), this new insurance plan will result in an extra cost of only $500-$1,000, depending on how things play out. That's not particularly wonderful, especially since that much money is a rather huge amount for us, but it is a little better.
Now, just keep your fingers crossed that we won't have any complications, because if we do our costs could rocket up to $4,500, an impossible fee for us.
I wish I didn't have cause to have learned so much about the inner workings of the insurance industry. I hope this is the last time we're sideswiped with sudden changes in medical costs.
I'm really just at the point where I'm not going to let myself despair over it. I'm not going to let myself feel badly for my choices, now that I know how things have panned out, financially, after the fact. There's just no point in it. We could not have foreseen this. It was completely out of our hands or knowledge. We have done everything in our power to prevent it and that wasn't enough.
I mean, there just comes a point, in debt, where you've done all you can and you just have to ride it out and hope. I think we're at that point.
Parenthood is sacrifice, right? I guess we just get to learn that lesson a little more painfully than we expected. I will not let my child (or the care of my child) suffer for this. We will find a way through, though it will probably involve a lot of sacrifices for us.
Still though, it certainly would be nice if people over our heads would quit making decisions that cost us large sums of money. Do you hear me, universe?
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