Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

My insurance only covers 80% of my maternity stay...anyone else in this boat?

If so how much will you/did you end up paying out of pocket? I have no idea what to expect and am having trouble getting someone on the phone who can tell me....anyone else deal with this or something similar??


Asked by stepmom929 at 3:52 PM on Apr. 7, 2009 in Pregnancy

Level 12 (920 Credits)
This question is closed.
Answers (10)
  • It depends on deductible and out-of-pocket maximum. That 20% that you refer to is your "coinsurance". With some plans, you must meet your deductibe, and after that you would pay 20% up to a maximum amount. Some plans waive a deductible for maternity and you pay strictly that 20% up to the maximum. Some plans do not have a deductible (very few plans). Alot of the rate will depend on the contract that the hospital has with your insurance company. I had a c-section, which is more expensive than a vaginal delivery. The rate the insurance company had with the hospital was so low that after my deductible I only had to pay a couple of hundred of dollars in coinsurance. Ask you insurance company "What is my deductible?" "What is my out-of-pocket maximum?" And "Does my out-of-pocket maximum include the deductible?"

    Answer by kara_g. at 4:29 PM on Apr. 7, 2009

  • Yes. You pay the difference.

    Answer by Anonymous at 3:53 PM on Apr. 7, 2009

  • We paid $3000 out of pocket.

    Answer by Anonymous at 3:54 PM on Apr. 7, 2009

  • Mine was the same I paid 20%. I think total I paid $4000..went to the hospital once for false labor/high blood pressure and was sent home & it includes all my ob visits. Otherwise it was a normal birth no complications...oh yes and my ins. didn't cover my dd's nursery stay so that was atleast $2000 of the bill.

    Answer by ria7 at 3:55 PM on Apr. 7, 2009

  • yea, a lot of insurance only covers 80 percent and you pay the other 20 percent.

    It varies depending on your doctor, what tests they do, if you are induced or have a cesarean etc.

    You could always look into a birth center w/ a midwife. the 20 percent you end up paying is a lot smaller. If you even have to pay for the whole thing out of pocket, it still costs a lot less than the 20 percent of a hospital. I looked at the bill for my insurance, and OUCH... I could get prenatal care, and delivery from a home birth midwife or birth center for 3000 dollars or less. It was much more for the hospital.

    Answer by celticreverie at 3:55 PM on Apr. 7, 2009

  • Some hospitals offer financial assistance if you cannot afford to pay the difference. Talk to the billing dept. if you are in that situation.

    Answer by Anonymous at 3:56 PM on Apr. 7, 2009

  • that 3000 dollars I mentioned is without insurance, if insurance covers it.. it's much less.

    Answer by celticreverie at 3:56 PM on Apr. 7, 2009

  • My insurance pays the whole thing....i have Mass Health. Go to your health insurance place and ask them if you can get the best kind of health insurance...unless you make too much money...

    i dont make enough money to get on a crappier insurance..

    Answer by Anonymous at 4:04 PM on Apr. 7, 2009

  • ALong with what everyone else said... check with the hospital after you get your bill.

    I had to pay my deductable +20% on my last Csection. It was a LOT.

    BUT... if I could pay it all at once, the bill was cut in half.

    I whipped out my VISA card & then was able to pay off the balance within just a few months.

    Answer by Laura1229 at 4:04 PM on Apr. 7, 2009

  • You actually have good insurance....mine only covered 50%. (I have a new job now so new insurance that covers the same as will probably pay somewhere around $2000.00) My hospital had a "Patient Assistance Program" where you had to prove that you were not elligible for medicaid but couldn't pay the balance and they would drop the costs. You should check with your hospital. We ended up just paying it because it was such a pain to get the paperwork done....

    Answer by jenellemarie at 4:18 PM on Apr. 7, 2009