My wife and I got married end of December 20th, 2020. She was pregnant with our daughter at that time.
She was immediately added to my employer sponsored health insurance, Blue Cross Blue Shield Federal Employee Program Basic, effective January 3rd, 2021, in anticipation of what we assumed would be a high out of pocket cost of childbirth under her employer provided EPO plan through UMR. This plan also limited us to Beaumont (my wife former employer) providers/Institutions. So anything outside of Beaumont Healthcare will be considered out-of-network and not covered at all.
Prior to her due date January 14th, 2021, my wife resigned from her healthcare job due to the physical job on January 8th, due the the physical job requirements becoming increasingly difficult for her as she approached her due date.
Once I added my wife to my insurance, both BCBS and UMR healthcare plans wanted to know about each other including start and end (term) dates.
While updating BCBS on other insurance, My wife and I called UMR who advised her term (end) date of her UMR insurance was January 8th, her last day of work. I called BCBS and told them this as well as updated this information in the app.
So I was under the assumption that BCBS was primary for any services after January 8th, 2021. This was great because I anticipated our only out of pocket costs for labor and delivery being $175 under my plan and we decided to give birth at Henry Ford Hospital anyhow because according to our doctor, they were the only ones that could induce my wife at the stage she was at per their policy.
So my wife gave birth to our beautiful baby girl on January 12th, 2021 at Henry Ford Hospital
Fast forward to today, according to the Explanation of Benifits documents we were receving, it appeared BCBS has picked up almost all of the cost of labor and delivery, $47,000 dollars, except for $175 as we anticipated.
However, we get a bill from UMR. Confused, we call UMR who states that my wife’s term date was actually January 31st, 2021.
We call BCBS and they state that according to whatever rules that dictate who is primary/secondary, UMR was actually primary until the term date of UMR on January 31st, 2021. She advised to update them on the actual term date with UMR and they would likely want all their money back.
My wife and I were sick to our stomachs! $47,000!
We called UMR and told her we litterally made the decision for my wife to deliver at Henry Ford instead of Beaumont because we were initally told by UMR that her term date was January 8th and therefore assumed that BCBS was my wifes primary and in reality my wife’s only insurance after the 8th. I told her that had we known this we would obviously have delivered at Beaumont because UMR is an EPO plan that stipulates anything outside of Beaumont is out-of-network and not covered.
She also said it may not be as big a deal as we think because BCBS would pick up what was not covered by UMR as Primary. She did say to check with BCBS because she does not know all the nuances. She also said she did not know if BCBS would pay leftover if the primary, UMR, classified it as out-of-network. To clarify, Henry Ford is considered in-network with my BCBS plan.
Our heads are spinning and we have had extreme anxiety the last few days. We literally made all the decisions that we did leading up to our child to avoid situations like this and high out if pocket costs?
Help! Any thought or ideas on the most likely outcome? Are we gonna be straddled in medical debt now and having to pay $47,000?
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My wife and I got married end of December 20th, 2020. She was pregnant with our daughter at that time. She was immediately added to my employer sponsored health insurance, Blue Cross Blue Shield Federal Employee Program Basic, effective January 3rd, 2021, in anticipation of what we assumed would be a high out of pocket cost of childbirth under her employer provided EPO plan through UMR. This plan also limited us to Beaumont (my wife former employer) providers/Institutions. So anything outside of Beaumont Healthcare will be considered out-of-network and not covered at all. Prior to her due date January 14th, 2021, my wife resigned from her healthcare job due to the physical job on January 8th, due the the physical job requirements becoming increasingly difficult for her as she approached her due date. Once I added my wife to my insurance, both BCBS and UMR healthcare plans wanted to know about each other including start and end (term) dates. While updating BCBS on other insurance, My wife and I called UMR who advised her term (end) date of her UMR insurance was January 8th, her last day of work. I called BCBS and told them this as well as updated this information in the app. So I was under the assumption that BCBS was primary for any services after January 8th, 2021. This was great because I anticipated our only out of pocket costs for labor and delivery being $175 under my plan and we decided to give birth at Henry Ford Hospital anyhow because according to our doctor, they were the only ones that could induce my wife at the stage she was at per their policy. So my wife gave birth to our beautiful baby girl on January 12th, 2021 at Henry Ford Hospital Fast forward to today, according to the Explanation of Benifits documents we were receving, it appeared BCBS has picked up almost all of the cost of labor and delivery, $47,000 dollars, except for $175 as we anticipated. However, we get a bill from UMR. Confused, we call UMR who states that my wife’s term date was actually January 31st, 2021. We call BCBS and they state that according to whatever rules that dictate who is primary/secondary, UMR was actually primary until the term date of UMR on January 31st, 2021. She advised to update them on the actual term date with UMR and they would likely want all their money back. My wife and I were sick to our stomachs! $47,000! We called UMR and told her we litterally made the decision for my wife to deliver at Henry Ford instead of Beaumont because we were initally told by UMR that her term date was January 8th and therefore assumed that BCBS was my wifes primary and in reality my wife’s only insurance after the 8th. I told her that had we known this we would obviously have delivered at Beaumont because UMR is an EPO plan that stipulates anything outside of Beaumont is out-of-network and not covered. She also said it may not be as big a deal as we think because BCBS would pick up what was not covered by UMR as Primary. She did say to check with BCBS because she does not know all the nuances. She also said she did not know if BCBS would pay leftover if the primary, UMR, classified it as out-of-network. To clarify, Henry Ford is considered in-network with my BCBS plan. Our heads are spinning and we have had extreme anxiety the last few days. We literally made all the decisions that we did leading up to our child to avoid situations like this and high out if pocket costs? Help! Any thought or ideas on the most likely outcome? Are we gonna be straddled in medical debt now and having to pay $47,000?
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