A question sort-of related to my story today: I’m having a baby in a few weeks. My OB is in-network. My hospital is in-network. But I’m not sure about the anesthesiologist — largely because I don’t know who he or she will be! How can do I avoid a surprise bill?
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That’s not correct. Baby should be under your insurance after birth essentially as a “family plan” — shared deductible and OOP max
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You're both right; it depends on the plan. Some employer-sponsored plans, usually HDHPs, have separate OOP caps for the individual as well as the family, i.e. a max OOP for the entire plan alongisde max for each covered indiv. (Separate deductibles though? Dunno. Maybe? America!)
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My employer sponsored HDHP (which I use) has a family deductible and a family OOP max, as do many others, not separate per individual. However it's easy to check -- this info is usually in a big table in anything explaining the benefits of the plan
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It’s called an embedded deductible and it is becoming more and more common under all types of coverage in the US due to maximum out of pocket limit requirements and a multitude of other factors.
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I am aware they exist. However it’s not universal nor a requirement. So one just has to look at the most basic plan details to know what a specific plan offers
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There have been required embedded OOP maximums since 1/1/16. If your family ded is higher than the ind. ACA limit, you have an embedded individual limit of the ACA limit. Plan has to start paying for any individual w/ fam coverage if they hit the ACA ind limit.
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I guess the medical school I work for is non-compliant because that isn’t how it works for me. However seems unlikely they are non compliant and rather there is more to this
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Well it doesn’t apply to grandfathered plans, though those rarely exist now. But if you’re on a NGF plan, with a family deductible above $7350 (2018 ACA individual OOP limit), you should be getting coverage if you hit $7350 by yourself before you hit family max.
End of conversation
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