Tuesday, January 7, 2014

Countdown to TTC: Week 38


Calculate the Costs

As a result of the holidays and various other obligation, I am getting behind on writing up my "weekly" posts, but I have been working toward my goals and trying to remember everything I experience so I can eventually write up my backlog of activities.  A few weeks ago, I decided it was time to think seriously about medical expenses of a future pregnancy.  As we enter the new calendar year (the year in which I sincerely hope I will be able to conceive my first child), I intend to begin experimenting with prenatal vitamins and other supplements I want to take to have a healthy conception and pregnancy.  But diving into this more medical aspect of the process made me curious about the actual costs of pregnancy and childbirth.

Of course, there are perhaps more unknowns than knowns in this arena (Will I be able to have the vaginal birth I desire? Will I experience any pregnancy complications? Will my health insurance coverage change before I become pregnant?), but I decided the responsible thing to do would be to research what the costs might be for my current health insurance provider given some reasonable assumptions.  In addition, I was interested in figuring out what my maximum possible out-of-pocket expense would be given my current insurance situation.  Although I wouldn't be willing to place any bets on the accuracy of these calculations, they should give me an idea of what I should be aiming to save over the next several months.

Step 1:  I began my calculations by going onto my insurance provider's online member site and using their cost estimator tool (a nice service if you have access to it).  I asked for an estimate of the total medical costs associated with a pregnancy and vaginal hospital delivery in my geographic area (see below for the output).  The results I got were a bit confusing, but it seems to me that the numbers given for each expense category were total expected billings (not amount owed out of pocket, as I would have expected). 

Step 2:  Once I learned what the expected total billings would be for this type of pregnancy and birth, I had to consult my health plan's summary of benefits to determine what proportion I might be expected to pay of these total expenses.  My medical deductible and pharmacy deductibles are $250 and $100.  Once those are met, my plan expects me to pay the following for prenatal care and delivery costs:

Step 3:  Now that I had figured out the expected costs (assuming a vaginal delivery and a pregnancy that was not high risk) and what proportion I would probably have to pay, I could make some estimates.  I began by evaluating the maximum possible costs.  Knowing my deductibles and the additional out-of-pocket maximum for my plan, I determined that $2350 was the absolute most I would have to pay for a pregnancy that spanned only one policy year (I could of course be unlucky and accrue some high prenatal costs in one policy year and then some additional high costs for labor and delivery in the next policy year when new deductibles and out-of-pocket maximum would apply).  So, worst case scenario has me paying as much as $4700 for one pregnancy. 

Step 4:  Finally, I wanted to estimate the real expected out-of-pocket cost of the standard vaginal delivery pregnancy the cost estimator summarized for me.  Assuming a $200 copay for the delivery facility (even though the cost estimator predicted no charge for this actually), plus 20% coinsurance on all the medical tests and doctor's bills (although some portion of this would no doubt constitute no-charge prenatal care), and the full estimated amount for pharmacy, I came up with an expected total cost of $1836.  It would also be reasonable to predict an amount a few hundred less than this if much of my doctor's costs came from fully covered prenatal care and if my birth hospital did not charge a facility fee.  On the other hand, any sort of complications or need for additional tests or specialized care would quickly bring this up to the maximum possible cost. 

So, in summary, I learned that I should probably expect to spend a couple thousand dollars on my birth.  Even if I switch insurance plans (which I actually expect to do), I will most likely select one that has a similar deductible and out-of-pocket maximum.  I also realized that small changes in my assumptions can make a substantial difference in how much I would overall expect to pay for a single pregnancy and birth.  This could be a scary realization, but I think my response to the information is reasonable.  I will make tentative plans based on what is most likely to happen, but I will also be prepared for things not to go according to plan.  Probably a good approach to new parenthood as well, now that I think of it...

What about you?  Do you or did you know down to the dollar how much your pregnancy should cost?  Have you come by any useful information about paying for pregnancy and childbirth or tips for dealing with health insurance providers?  What are some top dos and don'ts when it comes to pregnancy-related medical expenses? 

For more in this countdown series, see last week's challenge about Eating right while eating out.

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