- Wedding: October 2019 - Chateau Lake Louise
I am a provider billing specialist for a large NFP health system, so here’s my take.
Are these amounts that your insurance has advised you that you owe, or is this based on a bill you got from the hospital? Sometimes the Explanation of Benefits you get from your insurance reflects a higher amount than you actually end up owing the facility. There are additional write-offs and adjustments that can occur from the facility, so you should only concern yourself with those bills, not the EOB from your insurance to determine your final balance.
I am a bit surpised to see a deductible that high paired with such a high premium. Clearly in this particular case, the ship has sailed, but how did you select your plan? Did you talk to an insurance broker? Did they advise you on weighing premiums vs out of pocket costs?
Being self-employed, can you and your DH create flexible spending accounts? If so, setting aside pre-tax dollars to pay for those out of pocket expenses can be a very good move when you have a high deductible plan. It might make more sense to move to a plan with lower premiums and higher OOP, but fund your FSA more aggressively to lower your overall tax burden.
I would review other options in your marketplace. You should have options that are either high premium OR high deductible/OOP, not both. You can prioritize which makes more sense for you; a higher monthly cost up front, or higher patient portions on the back end.
Unfortunately in this case, the relatively high deductible on your policy is at fault here. Some plans waive the deductible for OB care, but if that isn’t the case here, then it’s possible you didn’t meet it prior to hospitalization. Even after you meet your deductible, there’s usually coinsurance that can run up to 20% even in network.
Personally, I think the only way to really address the overrun of costs – both to individuals and providers – is single payer. The motivation to increase the burden on the patient and pressure providers to reduce costs – often at the expense of quality – is squeezing everyone at both ends and damaging outcomes as well as the financial well-being of millions of people. Reducing variability and expanding coverage to everyone would help stablize costs and increase reimbursement while extracting the motive of profiteering from driving healthcare decision.
Do feel free to call the hospital and ask for someone to discuss your bill with you if you have any questions. They should be able to help you understand how they arrived at those figures.
I’m sorry you are in this situation. It’s crummy. Hope you and the baby are doing well, otherwise.