Health insurance experts

I need someone who can explain to me how it would work if we put our newborn on both insurance plans, and if it is ever worth it. 

If you want details on the insurance plan options, email me at [username]ovak1 at yahoo dot com

thanks folks. 

I'm no expert.  However, I think it will seriously complicate your life.  Each company will be pointing fingers and trying to bill the other.  I suggest you just pick one.

What Dr Hess said

Yes, you run into all kinds of issues with "double coverage." If you want to make dealing with insurance companies even more difficult, go that route.

I suspect you do not.

Pick whichever of you has the best plan, and just use that one. With babies, I'm going to guess the frequency of the medical visits means you'll want to pay more up front from the HMO/etc with the lower deductible/co-pay/out-of-pocket maximum.

I can't see an HSA plan making sense unless you've already got $15-20k grand in it to start.

+1 to all of the above, plus it often makes sense to combine everyone on one insurance plan.

We just spent a lovely evening going over each of our plans to determine which one would work best for all of us.

It was a PITA, but ultimately it makes managing things easier since there is one common interface to deal with.

We both still have our own FSA solutions so we can help defray costs where possible.

Let’s say that you have well over 6 digits of cost in the first week of baby’s life. Still stick with one plan?

There is potential for an upside to two plans, but it will require some research outside of these forums to figure out if it makes sense  

Primary/secondary insurance

In reply to mtn :

Yes. It's not like they're going to drop you for a big bill as long as you pay for premiums and copays. Dealing with one insurance company for big things is trouble enough, you'd really need to hire someone to manage two different ones or it would become a second job. 

You have one insurance plan, your wife has another. Is that correct?

I'm not sure I see an advantage. Each plan should theoretically be able to sort out the billing ("coordination of benefits"), but the potential for billing errors does go up.

At first glance, it seems to me that you're paying more by not having everyone on the same plan. I'm assuming each plan has an individual and family out-of-pocket max cost. For the sake of easy, round numbers, let's say each plan is $5k individual/$10k family. If you have everyone on the same plan, you're only at $10k before you hit your OOP max. If you and your wife are on separate plans, no matter whose plan the baby is on, you're going to have to pay a combined $15k to hit the family OOP max on one and the individual OOP max on the other. If you have the baby on both plans and split the baby's costs exactly between the two, you'll spend $20k before you hit the family OOP max on both.

Look at it this way:  for the 6-figure big stuff, you’re going to hit the out-of-pocket maximum for the single plan faster. That way they start paying 100% faster. 

Oh, this one- I know this one. 

Step one- is it worth it. The answer is...maybe. the health insurance landscape has changed considerably over the time I've been out of the game, but as I remember, there were two basic ways primary and secondary worked, and it all depended on the plans. The first was a coveralls style. This was common with people that had commercial insurance of some fashion, and somehow ended up on a medical assistance secondary. Primary would automatically be the commerical plan. Say you go to the er and you have a 500$ er copay. (This was pretty standard for asos and self funded plans) you would get the bill for 500$. that bill would be forwarded on to secondary and secondary picks up the balance, leaving you with 0 responsibilities and a sweet scar. 

The other style- non compete/non cover is probably the most common by now- if you both have employer based or open market insurance. This is where it gets tricky. Say you have that er visit again (quit with the grinders already) and you get dinged for another 500$. This time secondary is going to look at all eligible charges, determine if there is anything they would pay, and pay it. If you had a 500$ co from primary, you still do. Really unless you do something monumentally stupid and bounce off any sort of benefit limit (most aso policies I know of go into the millions before theyll drop you, though there was one notorious one for a now defunct airline that had a 100k lifetime limit for any given treatment. That was fun explaining to people after a 3rd trip to hazelden) the second policy in this case probably isnt going to do a whole lot. Youd have to talk to your hr generalist more to know for sure, but that would be my bet. Realistically you have an out of pocket maximum, so even if the baby needs a gold plated incubator,  you're only on the hook for covered charges up to that max. NOW- because there are approximately 8.4 million different exceptions,  comes another one. If say, you have a 10k oop with primary, and a 5k secondary, you're only going to be on the hook for 5k total,  as secondary is going to go 100% once you hit that limit. 

It gets more in detail than that,  but this is the gist of it. Lemme know if you want more. 

Thanks folks. Talking with the hospital tomorrow to figure out how it works for our specific situation.

Also could use your good vibes. Baby mtn needs them; she’s not even 3 days old and already on her second NICU. To say I’m terrified would be an understatement. 

In reply to mtn :

Good vibes being sent to you, momma, and baby mtn!

First, good vibes - bringing a new life into the world is hard enough without having to get NICUs involved. May the best that medical science has to offer be brought to bear quickly.

Second, take a deep breath, and look at your insurance plan documents. The phrase you are looking for is "maximum out of pocket". Beyond this number, your insurance plan will cover 100% of any costs. Some plans used to have lifetime limits on coverage, but the ACA banned them in most cases other than short term insurance plans (which would not have covered the baby anyways).

My overall take here is that you are not going to benefit by signing the kiddo up for both of your insurance plans, and you're only going to create a nightmare for yourself if you try. Choose the plan with the lower out of pocket maximum. You can always re-assess next open enrollment.

Lots of good vibes coming your way mtn! Keep us posted on the kiddo. 

Ok, so what I want to do for 2018 is compare the 7 plans available to us (3 plans for me, 4 for her) and find the one with the smallest monthly x2 + OOPM?

Are you in open enrollment now? I thought the open question was about which plan to enroll your new baby in (between your current and her current).

Given your current situation - check your provider networks carefully. Make sure that your pediatrician, along with any specialists you may need for baby mtn, are in-network in any plan that you're considering. After ensuring that, it's then an exercise in finding your lowest total expense (premium + deductible + whatever payment responsibility looks like between deductive and out of pocket maximum).  Game out three different scenarios - where you don't quite meet your deductible, where your care expenses come in somewhere between deductible and out of pocket maximum, and where you hit the out of pocket maximum. 

szeis4cookie said:

Are you in open enrollment now? I thought the open question was about which plan to enroll your new baby in (between your current and her current).

This is a life changing event if the baby was just born.

I dont have much to add other that I would do one plan. I tried the 2 plan thing when my first kid was born and it was a pita with little benefit. 

With that being said, as people above me said plenty of good vibes and keep us updated. 

Thinking of your family mtn. I hope this week ends better than it’s been. How is momma doing?

mtn said:

Also could use your good vibes. Baby mtn needs them; she’s not even 3 days old and already on her second NICU. To say I’m terrified would be an understatement. 

Best of luck and medical science to you folks, mtn.  My thoughts are with you.

My nephew's daughter was born very premature after a difficult (at best) pregnancy.  She spent quite a bit of her first couple months in the hospital.  By the time she was 18 months old you never would have known, and a few years on she is a happy, heathy, robust little kid.  Babies are resilient things!  

Ugh. Trying to figure out if the hospital we are at is covered under my wife’s plan(s). 

She works at Hospital A. Hospital A, and affiliated hospitals, are tier 1. Tier 1 out of pocket maximum is very small. Then there is Tier 2, which has out of pocket maximums that are about double of mine. And Tier 3, which is ridiculously expensive. Like, 4x the cost of mine.

The C-section was performed at Hospital A. Baby mtn was in NICU there, when they told us that she needs to be transferred to a NICU that has a specific specialty. There are 3 of those in the state. They recommended we go to the closest one, Hospital B, which while they wouldn’t admit it was the best, did say that’s where they’d send their kids. Hospital B appears to be tier 2. I am currently talking with the insurance company trying to argue that it should be tier 1–there are no tier 1 hospitals in the state with this specialty, and the tier 1 hospital we were at (that my wife works at) referred us here. How is it this complicated?