"Obamacare Requires Infants To Be Billed Separately"

[Dan]

We've had 4 kids delivered by the Cleveland Clinic.

For the first 3, they billed delivery and post delivery to the mom, so the deductible was easily hit.

This time they split the bill between the mom and the infant for post delivery. This meant that neither side hit their deductible and I'll be paying out $$$$.

I called Clinic billing and they said there's nothing they can do.
I've had success calling the Clinic's ombudsman department in the past, so I did that and they agreed that it seemed strange and inconsistent with how they were billed for delivery/post delivery. They promised a phone call back from billing.

Billing called me and first said that I was mistaken and there was no change, but when I referenced the December 2017 bill she said it was because Obamacare now required them to be billed separately.

True, or is this like an FA saying that the FAA requires that you to not use a carseat onboard a flight?

Seems hard to believe that a new Obamacare mandate went into effect in 2018-2020. Unless the insurance company received or provided new guidance?

How are you billed for deliveries?

[etech0]

AFAIK, employer insurance has been doing that before 2018

[KSMH]

We've had 4 kids delivered by the Cleveland Clinic.

For the first 3, they billed delivery and post delivery to the mom, so the deductible was easily hit.

This time they split the bill between the mom and the infant for post delivery. This meant that neither side hit their deductible and I'll be paying out $$$$.

I called Clinic billing and they said there's nothing they can do.
I've had success calling the Clinic's ombudsman department in the past, so I did that and they agreed that it seemed strange and inconsistent with how they were billed for delivery/post delivery. They promised a phone call back from billing.

Billing called me and first said that I was mistaken and there was no change, but when I referenced the December 2017 bill she said it was because Obamacare now required them to be billed separately.

True, or is this like an FA saying that the FAA requires that you to not use a carseat onboard a flight?

Seems hard to believe that a new Obamacare mandate went into effect in 2018-2020. Unless the insurance company received or provided new guidance?

How are you billed for deliveries?

Crazy the way they handle this!

Insurance is just not worth the cost these days.

For the average person, Its cheaper to pay for the cost of goods purchased and if something major comes up make yourself eligible for mid year coverage [marriage, move.. ETC...]

It might not be preferred but the cost is crazy.

[Dan]

AFAIK, employer insurance has been doing that before 2018

Not for me in 2011, 2014, and 2017.

[etech0]

Not for me in 2011, 2014, and 2017.

Might depend which insurance then, idk

[Dan]

Crazy the way they handle this!

Insurance is just not worth the cost these days.

For the average person, Its cheaper to pay for the cost of goods purchased and if something major comes up make yourself eligible for mid year coverage [marriage, move.. ETC...]

It might not be preferred but the cost is crazy.

I have an HSA with $5,000/person, $10,000/family deductible, so it's pretty much just catastrophic coverage, but my monthly premium is still $1,264.

[Dan]

Might depend which insurance then, idk

I'd assume it's just how the hospital bills it, which changed for me this time.

[KSMH]

I have an HSA with $5,000/person, $10,000/family deductible, so it's pretty much just catastrophic coverage, but my monthly premium is still $1,264.

The most sensible option available to me was
600...  per month with 7k/14k deductible.

Saying my bills are higher, I'd have to shell out some 21k before I see a dime + even for the  expenses I'd be incurring, insurance would say its not considered part of the deductible, and that's  for a variety of reasons such as not in network.... basically everything is a fight [and I'm dealing with one of the easier companies]. Eventually they'd usually give in but not without a fight. 

My child went to the DR. this month a bunch of times, total bills was less then my insurance premium would charge for 1 month!

Everyone knows how crazy the medical bills in this country is, but still worth pointing out for comparison. I was in a upper middle income foreign country, broke my finger, had 2 Dr. come in special mid night, x-ray, and meds for a total of $40.  Upon returning home asked a local clinic for x-ray price [to see if it healed correctly] they wanted $200, I said no thanx, ill take an x-ray when I'm out of country again.



Medical Tourism is becoming more popular then ever.

[Dan]

The most sensible option available to me was
600...  per month with 7k/14k deductible.

$10K family seems to be the max deductible for HSA locally.

[YankyDoodle]

Everyone knows how crazy the medical bills in this country is, but still worth pointing out for comparison. I was in a upper middle income foreign country, broke my finger, had 2 Dr. come in special mid night, x-ray, and meds for a total of $40.  Upon returning home asked a local clinic for x-ray price [to see if it healed correctly] they wanted $200, I said no thanx, ill take an x-ray when I'm out of country again.

Might not be a populist opinion but I promise you, you do not want to be treated in a place where a doctor gets $10 for making a special midnight hospital visit. It’s the insurance costs and hospital costs that are excessive but if you’re arguing that the doctors should get paid that poorly... you will get value commensurate with the payment.

[KSMH]

Might not be a populist opinion but I promise you, you do not want to be treated in a place where a doctor gets $10 for making a special midnight hospital visit. It’s the insurance costs and hospital costs that are excessive but if you’re arguing that the doctors should get paid that poorly... you will get value commensurate with the payment.

I actually didn't argue that, and don't advocate that. A DR. that looks at you for 30 seconds or even 5 minutes charging 100+/- is capitalism, but ask yourself why did capitalism get us there and the answer is, the government requirements, shall that be insurance reporting or training ETC. I do say that government should cut down on all nonsense which would reduce are expenses considerably.

Listen, the guy did his Job, as my finger is healed. The world is huge and people in other countries (not all) get just as good healthcare for typical stuff.

[biobook]

Seems hard to believe that a new Obamacare mandate went into effect in 2018-2020. Unless the insurance company received or provided new guidance?

There might have been changes since 2018.  Trump campaigned on a platform to "repeal and replace" Obamacare, and although the Senate's first attempt at repeal was stymied by McCain's famous thumbs-down vote, there have been smaller changes that chip away at it.  Trump cut off government subsidies that supported Obamacare (in October 2017) and perhaps insurance companies and/or hospitals changed their billing practices to adjust to that decrease in government funding.

I would start by reviewing the details in your insurance policy and calling the insurance company,  finding out from other new parents what's being done locally, and then returning with this information to the Ombuds office.  It does seem peculiar that there would be a sudden change.  Unless perhaps there was some change in the specifics of the mother or baby's health care needs this time around.

[YankyDoodle]

I actually didn't argue that, and don't advocate that. A DR. that looks at you for 30 seconds or even 5 minutes charging 100+/- is capitalism, but ask yourself why did capitalism get us there and the answer is, the government requirements, shall that be insurance reporting or training ETC. I do say that government should cut down on all nonsense which would reduce are expenses considerably.

Listen, the guy did his Job, as my finger is healed. The world is huge and people in other countries (not all) get just as good healthcare for typical stuff.

Maybe we are not arguing but a few additional points:

Doctors do not get paid because of capitalism. Doctors get paid a fixed rate based on what insurance companies (and effectively the federal government via Medicaid and Medicare who the ins it made companies typically follow) decide is appropriate. Of that rate, doctors make a small fraction of it (if it was performed at a hospital). If medicine was run like a a regular business, doctors would routinely make millions (because people would be willing to pay tremendous amounts of money when it comes to their health) which would be unfair and inappropriate. Medicine cannot be run as a regular capitalist market. But you cannot then argue that doctors shouldn’t be paid a fair rate for their level of intelligence/education. Most doctors can easily make hundreds of thousands+ in business or law etc (true capitalist markets). You will have a massive brain drain if you can’t offer them something remotely similar in income.

In other countries maybe $10/night is a good salary for other high-functioning jobs but I am certain that anything similar here will lead to a massive reduction in health care.

[Dan]

There might have been changes since 2018.  Trump campaigned on a platform to "repeal and replace" Obamacare, and although the Senate's first attempt at repeal was stymied by McCain's famous thumbs-down vote, there have been smaller changes that chip away at it.  Trump cut off government subsidies that supported Obamacare (in October 2017) and perhaps insurance companies and/or hospitals changed their billing practices to adjust to that decrease in government funding.

I would start by reviewing the details in your insurance policy and calling the insurance company,  finding out from other new parents what's being done locally, and then returning with this information to the Ombuds office.  It does seem peculiar that there would be a sudden change.  Unless perhaps there was some change in the specifics of the mother or baby's health care needs this time around.

Insurance says nothing changed on their end or in "Obamacare" and hospital would get paid either way. Voicemail left for the ombudsman.

[Joe4007]

If medicine was run like a a regular business, doctors would routinely make millions (because people would be willing to pay tremendous amounts of money when it comes to their health) which would be unfair and inappropriate. Medicine cannot be run as a regular capitalist market.

While I wouldn't argue that there should be no regulation at all, I'm not sure why you feel doctors would earn millions. Sure, the few great ones would, but otherwise I don't see a reason why the laws of supply and demand wouldn't work in the medical field.

[Dan]

Insurance says nothing changed on their end or in "Obamacare" and hospital would get paid either way. Voicemail left for the ombudsman.

Ombuds will escalate to a financial manager. This will all be a waste of time, but maybe I'll get a local paper to investigate when I hit a brick wall.

[yelped]

Ombuds will escalate to a financial manager. This will all be a waste of time, but maybe I'll get a local paper to investigate when I hit a brick wall.

Iirc, I had the same issue with the now defunct Health Republic insurance of NY in 2016. They split the charges between the mother and the child resulting in me having to pull out of my pocket to reach the second deductible. They also had very ambiguous language regarding individual vs. family deductibles. They agreed with me later on that the language was not clear enough, but wouldn't budge, though.

[ExGingi]

https://www.healthline.com/health-news/these-parents-were-covered-by-health-insurance-but-their-newborn-son-wasnt#If-you-still-receive-a-sky-high-bill

[ckmk47]

I actually didn't argue that, and don't advocate that. A DR. that looks at you for 30 seconds or even 5 minutes charging 100+/- is capitalism, but ask yourself why did capitalism get us there and the answer is, the government requirements, shall that be insurance reporting or training ETC. I do say that government should cut down on all nonsense which would reduce are expenses considerably.

Listen, the guy did his Job, as my finger is healed. The world is huge and people in other countries (not all) get just as good healthcare for typical stuff.

Most countries with socialized medicine have long wait times to get procedures.  And waiting for diagnostic tests, surgery, etc is not "getting as good healthcare for typical stuff."
My father was in Montreal when he broke his hip at a wedding.  An immediate conference of American and Canadian machers advised that it would take all night in the Emergency Room just to get ex-rays, and likely days to have surgery.
So B"H for the machers present, we were able to transport  him to NY, where he had surgery by late  morning.  And B"H he's up and around.

[Euclid]

Most countries with socialized medicine have long wait times to get procedures.  And waiting for diagnostic tests, surgery, etc is not "getting as good healthcare for typical stuff."
My father was in Montreal when he broke his hip at a wedding.  An immediate conference of American and Canadian machers advised that it would take all night in the Emergency Room just to get ex-rays, and likely days to have surgery.
So B"H for the machers present, we were able to transport  him to NY, where he had surgery by late  morning.  And B"H he's up and around.

It works the other way too, many Americans travel to Canada to buy medication.

https://kutv.com/amp/news/get-gephardt/americans-are-traveling-to-canada-to-save-money-on-medication