Girlfriend is pregnant with $3500 deductible and 20% copay

[u/milwaukee4]

My girlfriend has Aetna insurance through her job with a $3500 deductible and $7000 OOP max. Her OBGYN gave us a paper today to sign stating that we will have to pay them $3803 for the delivery because of the $3500 deductible plus $303 for a 20% copay. It also said that this does NOT include the hospital stay fees, which I guess could be another couple thousand or maybe even another $3500 and eat up her entire $7000 OOP max.
She makes $65k a year so she won't qualify for most programs and we could pay it if we have to but I am wondering if anyone has any advice/ideas for us to help lower this massive amount? Some sort of supplemental insurance or a government program that anyone knows of? My insurance deductible is only $500 but we are not married so I don't think that my insurance can be used in any way. Even if we had a shotgun wedding could my insurance somehow be used to help?

edit: she is only 11 weeks pregnant

Thanks In Advance

[u/cottonidhoe]

yes-if you had a shotgun wedding, it would be a qualifying event to add her to your insurance. She could access your 500 dollar deductible etc. If that’s on the table, it’s something to consider. Also consider tax burden differences married vs single and how a dependent factors in. Work out more details before signing the license.

In general, with pregnancy, she will probably spend the 7k. Maybe with that low copay percentage and a cheap hospital with an uncomplicated delivery it won’t quite get there, but it will be close or there. However, she can probably access payment plans if she doesn’t just have a lump sum available after delivery.

Luckily, the baby will be born in the 2025 calendar year?, so she will be able to claim them as a dependent. Her taxes will be cheaper, so she can take home more of her 65k…make sure to account for any unpaid family leave and childcare costs when budgeting, though.

7k on 65k income is going to be considered affordable by most government programs and charities. If you’re in a top 10 most expensive city (specifically NYC SF LA) they may have local programs that acknowledge how undoable that is and can help

[u/Informal-Lynx4583 → u/cottonidhoe]

An uncomplicated vaginal delivery is like 20k at least outside of insurance. She will 1000% meet the MOOP.

[u/cottonidhoe → u/Informal-Lynx4583]

FYI median price for uncomplicated vaginal delivery is 11k-13k, it will heavily depend on OP’s location in the USA.

Even if it’s close to 20k, 20% of 20k is 4k, and she’s paying 3.8k for prenatal care, you can see how it’s right around 7k, so in a rural hospital with no anesthesia or complications I can’t guarantee that they’ll hit 7k.

[u/Informal-Lynx4583 → u/cottonidhoe]

I have yet to see a claim less than $15k in the state of GA- but I do realize this is driven heavily by location. Did Op confirm if this was a HDHP plan? Even if we said it was 12k delivery and they’re on a HDHP you’re not factoring in ultrasounds, labs, potential procedures that go towards deductible /MOOP. It is very easy in an uncomplicated pregnancy to hit the MOOP.

[u/HeftyBreakfast → u/cottonidhoe]

I got an estimate for 30k in a low/mid cost of living area for an uncomplicated non medicated vaginal birth. This was pricing up to June 2024 so it's only gone up since.

That also didn't include any ultrasounds or bloodwork leading up to the birth as well.

[u/Informal-Lynx4583 → u/HeftyBreakfast]

I have always heard the quote of 20k in the metro Atlanta area- so not far off here either.

[u/thrombolytic → u/HeftyBreakfast]

And it's so hard to plan for the bare minimum (and pushes women into choices they might not otherwise make!!!). I, of course, wanted an all natural birth with my first 10 years ago but I had everything you could possibly have for a vaginal birth minus the actual birth, plus an emergency c-section. My son was born with bacterial meningitis and required a 2 week in patient stay in peds. Our bills were over $500k for that. And I had zero control of the outcome.

[u/HeftyBreakfast → u/thrombolytic]

I’m having twins so their estimate for a non complicated unmedicated birth of one baby was immediately not accurate so I don’t even know why they bothered to send it. Since it’s multiples I’ll automatically be giving birth in an OR room within the L&D floor and they will have two teams of NICU nurses on standby outside of the room in case they’re needed. The only thing the estimate helped me realize was that we’ll be hitting our family OOP max by the end of February.

[u/No_Calligrapher9234 → u/cottonidhoe]

But newborn care and appointments will follow to depending on how early in 2025 a healthy baby may have a few appointments (which will Be covered free if you hit the max for the SHARED policy)

[u/cottonidhoe → u/No_Calligrapher9234]

Again, I hope I made it clear they can expect to hit OOPMax, but if the newborn is healthy and doesn’t get sick (rare but not impossible) all of that is preventative care and free! so I really don’t think it can be guaranteed in every possible hospital and area that it will be reached.

[u/oakleafwellness → u/Informal-Lynx4583]

Yep. Texas here and mine was $15,000 almost fourteen years ago. Then added complications and it got high quick. I don’t even want to talk about the c-section costs with the second one, because they were breach. I can’t imagine how much inflation has made the costs go up in the past decade.