Finances

Mamas on Bedrest: “Out of Pocket” But In The Best Hands

March 25th, 2013

Hello Mamas,

Last post I shared with you the story of Mama H who is having some pregnancy complications and really needing some answers. So far, she has had to change OB’s and is waiting for her current OB to gather enough information to not only give her a diagnosis, but also a prognosis for whether or not her pregnancy will progress to a healthy child.

I have since heard back from Mama H and learned that she is being treated by one of the best OB’s in her town in India (India, we are getting around!!). As would be expected she is extremely anxious and wanting to know if her baby will survive (If you’ll recall, she lost the child she was carrying a year ago.).

In our last post I reminded Mamas on Bedrest not to be shy about getting a second opinion if their questions and concerns are not being met to their satisfaction. I still hold to this recommendation because I believe that having as much information as possible when making potentially life changing decisions is critical. I am also a strong proponent of not letting money be a deciding factor. Here’s why.

Being that you are on bed rest, it’s safe to assume there is a suspected complication with your pregnancy. You need to see a specialist, but the specialist recommended is $300 and not on your insurance plan. Do you pay out of pocket or wing it? Let’s look at the possible outcomes.

1) You hem and haw, but decide to shell out the cash for the peace of mind. You meet with the specialist and while your condition is abnormal, it does not warrant any major treatment or intervention other than bed rest. You go on to have an uneventful bed rest pregnancy, deliver your baby at 39 weeks (after spontaneous initiation of labor) and have a healthy baby.

Compare this scenario to what could have happened.

2) Mama A is going along in her pregnancy and at what was to be a routine 2nd trimester prenatal visit, her OB recognizes something abnormal. She recommends a Level  II ultrasound. She refers Mama A to a special radiology clinic that does the ultrasound but neither the Maternal Fetal Medicine specialist in charge of the center nor the ultra sound is covered by insurance. When all is said and done, this entire visit will be nearly $750. Convinced She can’t possibly afford the procedure and really “liking” her OB, Mama A decides to stick with her and trust that she will attend to all her needs with no complications.

Mama A goes into labor at 32 weeks. When she gives birth to her son, he is noted to have a loud heart murmur consistent with a hole in his heart that requires major medical attention. The neonatologist who attends the birth mentions that had this abnormality been detected during the pregnancy at the Level II ultrasound, Mama A would have been started on  prescription medication and the heart defect would likely have closed itself. Mama A’s little boy is treated and does go on to lead a healthy normal life. But Mama A’s little boy spent several weeks in the NICU and by the time he went home, Mama A’s family was some $500,000 in debt.*

If Mama A had had the Level 2 Ultrasound and taken medication she may have spent a total of $1000. Now I am not saying that this is a trivial amount of money. But I am relatively sure that Mama A could have weathered $1000 far better than $500,000.

Sometimes the best answer to a situation is not the easiest, most obvious or most inexpensive answer. Sometimes that best answer at the time really hurts and blows your budget to bits. But it has been my experience that to be a “out of pocket to be in the best hands” has always served me well. Everyone has to make their own decisions and I am in no way trivializing expenses (I know debt intimately!!!), but I am suggesting that we all look beyond the monetary for the true value for which we seek.

 

*This is a totally fictitious scenario and Mama A is a totally fictitious mama!!!

Mamas on Bedrest: What to Look For When Shopping For Health Care Insurance

March 13th, 2013

Hello Mamas,

I am newly single and find myself in the precarious position of needing health insurance. (Or will need it shortly!) To be honest, I had no idea where to begin! As a health care provider, I am keenly aware of the importance of adequate health care coverage. As I type this I have a family member who is without coverage and newly diagnosed with a rare form of cancer. Strange stuff pops up and it is imperative that you be prepared.

Health care coverage in the United States is a hotbed issue. With the passage of the Affordable Care Act in 2011, health care coverage is available to many more Americans, yet there are still many people who do not have adequate health care coverage. Additionally, far too many people play what I like to call “Health Care Roulette”. I see this primarily in younger, healthy people who feel that shelling out a couple of hundred dollars each month is a ludicrous expense, but also in families where they struggle to keep a roof over their heads. The young figure they  aren’t on medication, have no illnesses and they mistakenly believe that they are at very low risk. This is a sad, risky line of thought. Young folks are often the ones who jet away on ski vacations, take exotic adventure vacations, hike, bike and engage in other vigorous activities in which unexpected accidents can occur. A broken bone requiring surgical reduction and setting can run thousands of dollars. If you are uninsured, you are responsible for that medical bill. And let’s not forget ourselves, Mamas on Bedrest, in this category. How many of you really anticipated going on bed rest? Yet as many of you are well aware, without health insurance, a hospital bed rest stay or even a complicated labor and delivery can put a family thousands of dollars in debt or worse-bankruptcy. So with all of that in mind, I set about finding reasonable, affordable health care or myself.

I consider myself very lucky. I happened to mention my plight to my accountant and she had some ready resources for me. As I am self employed, I will be able to deduct all of my health care expenses off of my taxes, including the cost of  the policy. But even better than that, she referred me to a very reputable, knowledgeable insurance broker who has set me up with an incredible health care plan. She herself is single and self employed. We are only a couple of years apart in age, so she pretty much set me up with a plan that she would use for herself. I am quite happy with what she has offered me. Here are the highlights.

Co-Payments- I opted for a plan without co-payments. First and foremost, I rarely go to the doctor. I go annually for my gynecological exam and otherwise only go perhaps for a physical examination or an urgent illness/injury. By using providers within the network, I will be assured of a fixed cost for the visit (covered by the insurance). If I go “out of network” I will have a fixed payment for the office visit and will be responsible for any additional charges. But in general, I can apply what I pay to my deductible and later recoup some costs. Also, opting for no co-payment keeps my premium.

Deductibles-I got a pretty good deal here as well. As a single person in relatively good health (got dinged a bit for my age!) I have a reasonable deductible and it will integrate prescriptions into that deductible. My deductible is also my maximum out of pocket expense. Deductibles can be tricky and I highly advise getting some help here. My broker really gave me good information on this and I am quite pleased with her advice.

HSA Account – Being self employed and a Health and Wellness professional, having a health savings account is a must for me. Along providing me with a way to save up funds in the event of a catastrophe or even if I choose to do some alternative treatments, there are tax advantages or business owners. HSA’s are also available if you have a high deductible health insurance plan, so ask your insurance agent if you are eligible for an HSA. While this may not help you now, it would be a great way to pay for a midwife or birthing center or treatments (such as a birthing tub) in the future, which are often not covered by conventional insurance plans.

Supplemental Accident Coverage-This coverage provides added benefits in the event of an accident; you know the type-you break your leg while skiing in Switzerland? This additional coverage will enable you to be flown home and pay for some medical expenses and not be hit with a gastronomical bill. It won’t cover everything, but it will make a dent and provide much needed cash immediately.

Life, Dental, Vision Insurance-I also have the option of adding these coverages to my policy. Yes, they come at additional expenses, but their monthly payments are far less than paying for expenses out of pocket. Again, check with your insurance broker/agent for more details.

I realize that this topic may seem out of line with Mamas on Bedrest, but in actuality it is very pertinent. I can’t tell you the number of mamas who call me when they find out that Maternity care is not a covered benefit of their insurance policy and they need to purchase an additional rider. (Like that’s going to happen if they are already prescribed bed rest!). It’s really important that you look at your insurance policies from time to time, I recommend yearly at the enrollment period, and make sure that you have all the coverage that you and your family need. Many people view health care insurance as an expensive luxury. But if you get without adequate health insurance coverage, it can mean the difference between exemplary care with the best treatments possible and just getting by.

 

 

Mamas On Bedrest: FMLA is “Useless” for 40% of The Workforce

February 25th, 2013

Hey Mamas,

I was just cruising through my e-mails and got a Google alert about Family Medical Leave (FMLA). The article, published on Journalgazette.net, chronicles the story of Danelle Buchman of Clarkesville, MD. Buchman lost her job as a result of being out, and nearly dying, giving birth to her second daughter.

Buchman, now a mama of 2 little girls, had a uterine artery rupture while she was pregnant with her second daughter at 32 weeks gestation. Her daughter was delivered by emergency c-section and Buchman had an emergent hysterectomy to save her own life. When Buchman recovered and returned to her job, she was first demoted and given a 33% salary cut. She was subsequently fired. It’s not that Buchman had done anything wrong, quite the contrary. She had an outstanding employment record. But her time off due to illness resulted in her termination.

This is not unusual. The US Department of Labor conducted a study and they found that 40% of employees are not eligible for the unpaid leave with job protection benefit offered by FMLA. While this law has been on the books for 20 years now, a full 40% of US employees cannot benefit from it because they work for companies that employ fewer than 50 employees, were employed for less than a year with the particular company or had already used the FMLA benefit within the past 24 months and are hence exempt from the FMLA provisions. So Buchman who was out fighting, for her life, was legally fired as a result.

The law is also very difficult to enforce. Companies are not always obligated to allow the unpaid leave and there have been nearly 6000 court cases against companies that fired workers or otherwise penalized them for taking advantage of FMLA.

Once again, The lack of any sort of paid family leave is leaving families in a financial lurch. It is a travesty that the United States has such little regards for families. The United States, along with Papau New Guinea and Swaziland remain the only countries out of 177 that offer no sort of paid parental medical leave. And while family friendly organization such as the National Partnership for Women and Families and Working Mother are fighting diligently for paid family leave, that reality is still, by many estimates, years away. And that won’t help people like Buchman.

“I was lucky. My husband had a job, and we went into crazy credit card debt. But so many people who don’t have the support system I had are one accident, one illness away from losing their livelihood.”

And that is the fearful fate of many Americans. We can do better and we here at Mamas on Bedrest & Beyond will continue to support and help those on the front lines continue this all important fight.