When Your Insurance Doesn’t Cover the NICU

936514_10101215604580548_1296127407_nOh yes. It happens.

My son, Charlie, was born at 37 weeks at a beautiful hospital in Houston, Texas. I was pre-eclamptic, but at the time the only emotion I felt was excitement. I was happy and comfortable with the way everything was going, trusting the decisions of our medical care team. After an induction, an epidural, and a Law and Order marathon (add anticipating the arrival of our baby, and it was the most utopic 24 hours of my life), Charlie was born.

Charlie had a fever when he was born, so he went right to the NICU. Our nurses prepped me for the idea that he’d be taken there pretty swiftly after birth, and, again, I was prepared and comfortable with doing whatever was prescribed for me and for him.

He was there for two days; the nurses were amazing; and then he came home. In my mind, everything was perfect.

A couple weeks after he was born, as we were getting comfortable with new parenthood (I mean, as comfortable as anyone can), and I was preparing for the end of my maternity leave, we started getting the medical bills. We expected most of them, but one for $6,000 took us by complete surprise.

The insurance company denied the claims for all of the NICU services.

Apparently, the NICU was a contracted service from an organization in Dallas. Even though the hospital and doctor were in-network, the NICU was not. Just think about that for a second. You just had a baby: during the labor, someone tells you something isn’t quite right, but it’ll be okay- they just need to take your baby to the Neonatal Intensive Care Unit where he can receive the appropriate medical care.

1157540_10101215599780168_1991802840_nIt’s not a moment where you pause and say, “hmm, okay…but only if its in-network.” It’s not a moment where you say, “Can I call my insurance first?” It’s not a moment where anything other than the health of your baby matters.

Luckily, at the random advice of my mother, we covered Charlie under two-insurances right away: mine as the primary, my husband’s as the secondary. Yes, that means two family premiums, but we did it anyway because we obviously didn’t understand how money works. Clay’s insurance- with the help of whoever the extremely helpful and patient representative was who helped us- ended up covering the cost of the NICU, so we did not have to pay the full $6,000- a particularly helpful relief as brand new parents with a newborn.

But…what if we hadn’t dually covered him, like I’m sure lots of people don’t? What if the secondary insurance didn’t cover the NICU either?

With our subsequent children, I knew to ask. In case you’re wondering what that looks like, you have to pre-approve all services through your insurance, including any anesthesia and NICU services that may not be in-network. With our third baby, our doctor was in-network, but the hospital- to which her office was attached- wasn’t. The insurance agent with whom I spoke informed me that the birth would only be covered if she delivered in her office. I asked, “Don’t doctors usually deliver at a hospital?” Because, how could this make sense? It didn’t.

Her answer:

“I cannot speak as to whether all doctors deliver in a hospital.”

Right. Thanks.

I wish I could end this post with some advice. The best I have is: ask every question about in-network providers you have to. If you’re in a position where cost doesn’t matter and you can just choose your doctor, hospital, and whether to send your baby to the NICU: good for you. If you’re like us and $6,000 is a lot of money (for only a two-day stay), the best I can tell is you is try to make decisions based on health as best you can (THIS SHOULDN’T BE A LUXURY), cover under two insurances if you can, and be sure to ask what needs to be “pre-approved.” I learned that doctors’  offices and insurances aren’t always on the same page: with our second daughter, the doctor’s office seemed to be under the impression that they were in-network for most services, but the insurance representatives I spoke with indicated otherwise. So educate yourself as much as you can, take screenshots of all online-conversations, and get that pre-approval paperwork for the doctor, the nurses, the medicine, the anesthesia, and the NICU. And try not to let the finances dull the light that is having a baby. You’ll get through it, we all do- and hopefully more comprehensive medical care will be available for all of us in the future!


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