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Julius72

Help Insurance and NewBorn

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Julius72    0

Hello all,

in waiting for HB on next November 20, we are just to choice a insurance plan for us GC while the enrollement is opened (at this time our GC had a Kaiser Permanente insurance, but because in California Kaiser is not very good for surrogacy we must to change), and a new born insurance for the baby (we are international parent coming from Europe).

Our agency proposed to us (for GC) a BluShields, in particular the "Gold 80 PPO". The main benefit is:

- about $526 monthly premium, no deductible and out of pocket of 6,000$. exception listed in notes (I don't find for example for a C-Section, beacuse out GC had over the past two pregnancy both with C-Sec).

Other question is for NewBorn insurance (we are not american citizen so after birth every fee and cost is under our responsibility). We surfed on the internet and we found essentially two:

- newLife insurance (have a deductible to $12500, cover up to $100.000)
- ArtRisk for NewBorn

The first is a insurance, the second one is a coordination provider negotiation.

Please could you give us some help to see if the option for GC is ok? We don't know where to start, we don't know how many visits or exams are needed on average during the pregnancy, if there are some exams that are mandatory or not, and so on.

Please, every information is important to us

Warmly,

Jul

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beachalice    23
7 hours ago, Julius72 said:

Our agency proposed to us (for GC) a BluShields, in particular the "Gold 80 PPO". The main benefit is:

- about $526 monthly premium, no deductible and out of pocket of 6,000$. exception listed in notes (I don't find for example for a C-Section, beacuse out GC had over the past two pregnancy both with C-Sec).

If the agency suggests this policy, I hope that means it has been checked for surrogacy exclusions. 

The premium is due in full every month no matter how much care your GC receives. 

The deductible is the amount you will need to pay in addition to the premium before any coverage begins.  $0 deductible is nice!

The other two numbers you want to ask about are co-pay and co-insurance.  A co-pay is a visit fee that is due either one time or at every visit for prenatal care.  Co-insurance is the amount of the bill you are responsible for after the deductible and co-pay. 

For example: hospital delivery fee of $20,000 for c-section with 20% co-insurance and $100 co-pay:
$0 deductible
$100 co-pay for surgeon
20% co-insurance = $4000 bill for you
The most you would be billed for the worst possible disaster would be $6,000 for your out of pocket

Regarding newborn insurance, New Life and Art Risk are the only two companies I know about. You could also negotiate a cash discount with the hospital.  Or it might be a possibility to call local insurance agents to see if there are any private companies able to offer a policy in your GC's region.  You might also check with your insurance companies to see if they cover infants born abroad - I have heard this is a possibility. 

Traci has been in some training sessions regarding recent insurance changes in the USA.  She may have some more up to date options for you. 

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Julius72    0

Hy beachalice,

thanks for the reply. In the fact for me is very difficult to understand how is working the insurance in USA because where I live the medical bills are free of charge when you go in hospital.

Now I asked to my agency more information, expecially for co-pay and co-insurance specially in case of delivery by c-section. Also to be sure if the insurance covering in case of surrogacy.

Maybe we will choice the NewLife insurance (despite of ArtRisk that is only a broker). Wait Tracy for more information.

And now we wait on 20 November to know if there is a hearthbeat.

 

Thanks

 Jul

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beachalice    23

Jul, 

Most Americans don't even understand our insurance.  I promise. :rolleyes:

If this is the correct document for your GC's insurance,
https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=Gold_80_HMO_1-18_SOB.pdf
it looks to me that you'll pay:
$526 every month for premium (this is membership into the club whether you use it or not)
$0 for doctor appointments (plan on 10-14 visits for prenatal care)
$600 per day the GC is in the hospital (plan on maybe 3-4 days if all goes well)
$35 for doctor appointments to check on your GC after the c-section (plan on 2-3 visits)

This is just my interpretation of the insurance document linked above.  It might not be the correct document, and I might have misunderstood the coverage. 
I hope your agency can help more!

 

Edited by beachalice

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Julius72    0

Hy,

if most American don't understand insurance, imagine not american... :-)

Thanks a lot for useful information, I want to realize just a idea of fees. The insurance plan is the follow:

http://tinyurl.com/yd9rwu6z

Sems that change something, also is allowed to use a non partecipant provider/medic. For example for hospital we will pay 20% of fee. Maybe is better. But is better to use a partecipant network provider. And for this our GC is very collaborative because will search a OB and hospital on the network before.

The agency tell to us that the premium is due for all pregnancy and not for all year. I asked for confirmation, but it's true or false?

It's very a nightmare sometime :-)

Jul

Edited by Julius72
Premium

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beachalice    23

Okay.

Here's what I see:

$526 premium every month
$0 for office visits
20% of the hospital bill up to a max of $6000 if the hospital participates in this plan

What I don't see listed is the coverage for c-section.  It might cost $0 as a part of prenatal care coverage, or it might cost 20% of the surgery bill  as a part of hospital services.  Regardless of the surgery c-section coverage, the most you'll have to pay is $6000 total for delivery (in addition to the monthly premium).

Check your contract to see how long you need to maintain insurance after the pregnancy.  Usually IPs are responsible for medical care after the baby is born for several months.  When your contract is complete, you can stop paying the $526 monthly premium. 

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