Labor spans 2 years & 2 deductibles

[whyme623]

What is the name of your state (only U.S. law)? FL

I went into labor on Dec. 31 and was admitted that day into the hospital. I physically gave birth Jan. 1. I was charged two seperate calendar year deductibles, each of $1,000. The first from the hospital, which billed for date of service on Dec. 31 and second from the Dr., who billed for delivery date of service of Jan. 1.

Is there any type of provision that I dont know about that if the "event" spans 2 calendar years, they can only charge for the first one? A couple of hours earlier, and it would have cost me $1,000 less.

I've fought many times unsuccessfully with the insurance company... all who's reps "think" they can help... but never really can.

Any information regarding this would be greatly appreciated. Thanks!What is the name of your state (only U.S. law)?

[ecmst12]

Sounds correct to me. You would have had to pay that second $1000 at some point this year one way or the other anyway. But the doctor provided services on 1/1 and would go on that year's deductible. The hospital admission was 12/31 and goes on the previous year. I'm surprised that your deductible for the previous year was not met by your prenatal services. But even so, I see nothing improper. If such a provision as you are hoping for existed, it would be in your specific policy's language. But I would doubt that. And anyway, these are two entirely separate bills for entirely separate (though related) services. One has nothing to do with the other. They're not for the same service codes, performed by the same provider, or paid to the same place.

[lkc15507]

I am so sorry you fell into this situation. Unfortunately, if you were admitted on 12/31, then the facility did have the right/obligation to charge those services on that date, thus making those services subject to deductible and co-insurance responsibilites for that calendar year. Services after midnight 12/31 would fall to the next calendar year and thus subjecting you to both calendar year out of pockets.

I have one tiny suggestion, check your plan for a "roll-over" provision. Years ago this was quite common. Now it is not so common. A rollover provision counts deductible (not coinsurance) met in the last 3 months of a calendar year to apply / meet the next calendar year deductible. Since your carrier did not apply that, it's not likely the provision exists. But, given the last day of the year admit, it is worth double checking. Best to you, lkc15507