Health Insurance Navigator

By Lisa Zamosky

It’s just weeks before your baby is due to arrive. Among the millions of other things on your to-do list, you should make time to take steps to protect yourself from unexpected medical bills associated with your delivery and the health care services your little one will need in the first few weeks and months of life.

I spoke with Amy Ford Keohane, president and chief marketing officer for the Philadelphia-based patient billing advocate organization MedClaims Liaison, who offered these five tips for mothers-to-be:

1) Pre-authorize: By now many of us understand how imperative it is to confirm whether our hospital and, in this case, obstetrician, are in our insurer’s network. What you may not know, however, is that if your doctor is NOT contracted with your insurance company, getting pre-authorization for hospital or birthing center services before you check in is your responsibility (in-network doctors must take care of the pre-auth for you). You can find the pre-authorization telephone number listed on your health insurance identification card.
2) Pre-admit: Most hospitals have a pre-admission process whereby you’re required to fill out a packet of information about your health and insurance coverage, and during which the hospital will confirm your eligibility for benefits. Be sure to fill out and return the forms and carefully review any information given to you. If any red flags are raised during this process, you’ll have the time to contact your health insurer to verify your coverage and benefits.
3) Look beyond your obstetrician: If you plan to take pain medication during your delivery, it’s a good idea, Ford Koehane says, to call the hospital or birthing facility ahead of your delivery date to request an anesthesiologist who is in your insurance company’s network. Your out-of-pocket costs will skyrocket if your pain med doctor doesn’t participate with your insurer. “You can’t assume your anesthesiologist will be in your network, even if you’re at an in-network facility,” Ford Koehane says.

4) Enrolling your baby in your plan. Be sure to enroll your baby in your health plan within 30 days of his or her birth.  “Don’t wait until things calm down. Make this call when you get home from the hospital,” Ford Koehane says. Failure to do so could result in your baby’s medical claims being denied.

And if you get your insurance through work, Ford Koehane says, it’s extremely important to notify your employer when your baby has arrived and have him or her added to your plan. Contact your employer’s Human Resource Department or Benefits Administrator to let them know you have another family member on board.

5) Know your baby’s coverage: In the months before your baby’s arrival, it’s a good idea to check the details of your health plan to understand the services covered for babies and children, including immunizations and well-baby visits, and how much you’ll be required to pay in deductibles, co-insurance, and co-pays.

It’s also a good idea to choose a pediatrician in advance. If you don’t already have one, you can start your search on your insurer’s website, which will have a list of participating doctors.  Just be sure to call each pediatrician before you visit to confirm that they’re still accepting your insurance.

Had a baby? Share your tips for easing the financial issues that come with being a new parent in the comments section.