How to save money and get what you want

Recently, I’ve picked up a new hobby. It’s called calling medical providers and my insurance company to get the medical coverage I want at the price I want, or at the very least at a price lower than what I’ve been billed.

This hobby initially started when I stuck my finger in a blender, and decided to go to the ER to get my finger stitched up. Thankfully, the ER is just 2 miles from my house, and I only had to wait 2-3 hours before someone saw me. Sadly, this is much better than most ER stories I hear.

If I would have had the sense to stick my finger in the blender between 8AM and 5PM on a Monday through Friday, I could have saved hundreds of dollars by visiting an urgent care physician. Alas, it was 11AM on a Saturday, and my choice was no stitches or visit the ER. I went with the ER.

Being something of a tightwad, I was not eager to visit the ER, as I knew the price tag would come in around $2500. Thanks to some savvy negotiating techniques (ie calling and asking for a lower bill, just because), I came out with an out of pocket expense of a mere $1500 dollars. The savings were a fifty-fifty split between my insurance negotiating on my behalf and the few (dozen) phone calls to lower my bills.

If you have medical bills, you should be calling the providers and asking for a discount. This is my script. “If I pay today, is there anything you can do to lower my bill?” Usually the answer is a 15-20% discount. Then I use the line, “Is there anything else you can do to lower the bill?” One time, I got an additional ten dollars off for filling out a survey, but usually the answer has been no. Okay, so I’m not too savvy, but I’m still saving money.

Which brings me to my next topic, which is preemptively saving money on medical expenses.
When you stick your finger in the blender… Make babies

Last time I show the finger… I promise (fingers crossed though)
The timing of my finger smoothie incident was the first weekend of May, which for most people means nothing, but has a certain significance for me in that it coincided with me receiving new insurance cards for myself and my son. I realized that the insurance year had re-started the first day of April. Just one month into the insurance year, and I was already 1/3 (or 2/3 as I assumed at the time) of the way to meeting my $3500 deductible.

Normally, this wouldn’t be that good of news, but my husband and I had already started talking about how many more kids, so that night I told Rob that I thought that it was my opinion that we should start the baby-making immediately. Initially, we had thought we would finish the renovation and then worry about babies, but the strong financial incentive to have a baby this fiscal year pushed us over the edge. And now I’m closing in on the end of the first trimester, with a baby due two weeks before my the insurance year resets. I guess I like living on the edge.

As a disclaimer, I don’t recommend having children just because you had a conveniently timed medical emergency. But if you were thinking about having kids anyways, I say go for it! I am not a certified financial planner, nor am I really qualified to give advice about family planning, so maybe don’t listen to me.

Coverage Gap Exceptions

This guy = no complications with insurance!
With the end of my first trimester closing in, I’m on the hunt for the best possible deal when it comes to delivering our newest bundle of joy. With my older son, I saved close to $2500 by choosing a birth center rather than a hospital, so I started looking into birth centers around my new home town. It turns out that here in Raleigh, people aren’t nearly as into “natural and alternative” medicines as they are in Minneapolis. Go figure.

I have one friend here (total hippie) who had a home birth, but right now our house is just a little too grody for me to consider a home birth a viable option. Another friend gave birth at a birth center that is 40 miles from my house, but I can’t imagine every single 30 minute appointment becoming a two or more hour ordeal, and everyone else has delivered at Rex Hospital. Thankfully, Dr. Google pointed me in the direction of a poorly named Birth Center (Baby & Company, sounds like a toy store) a mere 15 miles from my house.

I visited the birth center and determined that it is in fact the best place for me to deliver even though their marketing team could use a little work. Well, I thought it was the best place to deliver until I found out that it would be out of network. Instead of $3500 out of pocket, I would be looking at $6800 out of pocket. Umm, I love natural medicine as much as the next person, but not $3300 worth of natural medicine.

Which is why I have started the hobby of calling my insurance company. I am in the process of applying for a gap exception. A coverage gap exception is an appeal to your insurance to treat an out of network provider as an in network provider because there is otherwise a gap in coverage. To have a gap exception approved, you must prove that there is no in-network provider within a “reasonable distance” who can give you the service you are requesting.

Typically, the process for a gap exception will start with a referral from your primary care physician who will refer you to an out of network specialist. This letter is an important form of documentation. The specialist will then need to provide you with their name, address, tax id, CPT codes and Diagnostic Codes. Once you have all of that, you can call your insurance and request to start the process for coverage gap exceptions. It should be a relatively simple phone call, though I was very discouraged throughout the process.

You see, the Birth Center 40 miles from my house is a mere 29.8 miles from the outer edge of my zip code. Which falls within the 30 mile reasonable coverage range, so I am fairly certain that my initial request will be denied. Once you get denied, you can appeal which I’m led to believe includes the opportunity to talk with a real live person. I am hopeful that I can convince a real person that 40 miles is not a reasonable distance to drive during labor, not to mention for 15+ prenatal appointments, and 4 postnatal appointments.

If this doesn’t pan out, I’ll be delivering at the same hospital where I got my fingers stitched up. They recently opened up a mother-baby delivery center, and they have a nascent (pun!) midwife program there. I will probably be stuck in the hospital at least 24 hours (as opposed to the 4 hours at the birth center), but I have pretty strong persuasion skills, and midwifes tend to be the most hippie of all the medical professionals, so I think I can talk my way out of the customary second night in the hospital. Staying over just one night (as opposed to the customary two), would cut my costs by another thousand dollars which would actually put the hospital as the cheapest option.
Figuring out your delivery is the best way to save money in Baby’s first year
Although childcare is the biggest expense you’re likely to face in your child’s first year, the second largest is the delivery itself. Especially if you are on a high deductible plan. Your insurance will be billed anywhere from $7K to $14K for a vaginal delivery with no complications, and as a consumer, you’re going to pay some of that. My advice is to figure out how to minimize your costs ahead of time.

I’m thankful that my delivery tastes and preferences tend to be on the cheaper side, and that I feel comfortable being flexible with my delivery situation. For many women, it’s tough to find a midwife or a doctor that makes them feel comfortable and ready to deliver. If you fall into that situation, take your time getting educated on the multitude of options that are available, even if they don’t at first appear to be the most convenient. With natural birth and birth centers on the rise, it’s becoming more common for insurance companies to either cover them or accept gap exceptions (although the 30 mile thing might cause problems for you too).

Also, if you are a high risk pregnancy, birth centers are not for you, but you can often find midwifes who are willing to aid you through a natural birth in the hospital setting provided that it continues to be safe for you and the baby. Do your research, know your consumer rights, and if a normal birth isn’t your preference advocate for yourself to the best of your ability. You might be able to get the insurance company to bend to your will.

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