Fine Print and The Difference of Medical Insurance

“Your insurance doesn’t include maternity coverage.”

About four years ago, V heard those words at her OB/GYN when checking out of the appointment where we confirmed we were going to have a second child (MC). The job I had at the time had horrible benefits and purchasing insurance through the company would come north of $900/mo for me, V, and O. When I got the job, everyone I had talked to suggested that we get coverage on our own for a significant discount, which we did (~$450/mo for everyone).

Stupidly, I didn’t read the 75 pages of fine print that made up the insurance contract and missed the half a paragraph that excluded pregnancies and maternity coverage nor did I know it was impossible to find an individually-purchased plan in Texas that did include maternity (no longer the case, thanks to Obamacare).

We had paid about $2,000 out-of-pocket when O was born and while we didn’t have that set specifically set aside when we found out we were pregnant again, it wouldn’t be an issue to have our ducks in a row within the next nine months.

Until that response from the billing clerk at the doctor’s office.

We had MC in the same hospital (actually, in the same room even), delivered by the same doctor as O. Instead of paying $2,000, we were able to get a “discounted” price, through haggling with the hospital and the doctor, and prepaying both, of about $12,000.

$12,000 out-of-pocket for a healthy, vaginal, non-medicated, no-complications delivery.

Fast-forward three years. The same little girl, MC, needs to have a relatively minor operation. As the pre-op calls come in from the billing departments wanting me to prepay my out-of-pocket portion, I did the math. The total cost, billed to insurance, is expected to be about $11,500. With the insurance we have now, our out-of-pocket cost will be around $1,000.

The difference this time is I’m working for Automattic which offers us great health insurance benefits (among many others and we’re hiring).

The employer-associated health insurance is flawed, though I don’t know the solution.

Lesson learned: Read the fine print.

photocredit: flickr”

3 thoughts on “Fine Print and The Difference of Medical Insurance

  1. Reading stories like this pain me. I don’t intend to spout about the “superiority” of the Canadian system (which has it’s own problems, believe you me), but for both boys, I paid $0. Nothing out of pocket for a private room, C-section, and several days stay, for each one. Reading about $12,000 scares the daylights out of me; there’s no way I would ever, ever have been able to pay that then, nor now. Kudos to you for pulling that off.


  2. When I had jaw surgery last year the hospital charged me $81,000 for one night’s stay. Fortunately my health insurance paid that (with a hefty $76,000 dollar negotiated discount). It’s not just insurance that’s broken, hospital charges are ludicrous….


  3. Pingback: The Month of Blogging | Brandon Kraft

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