When Your Insurance Doesn’t Cover the NICU


936514_10101215604580548_1296127407_nOh yes. It happens.

My son, Charlie, was born at 37 weeks at a beautiful hospital in Houston, Texas. I was pre-eclamptic, but at the time the only emotion I felt was excitement. I was happy and comfortable with the way everything was going, trusting the decisions of our medical care team. After an induction, an epidural, and a Law and Order marathon (add anticipating the arrival of our baby, and it was the most utopic 24 hours of my life), Charlie was born.

Charlie had a fever when he was born, so he went right to the NICU. Our nurses prepped me for the idea that he’d be taken there pretty swiftly after birth, and, again, I was prepared and comfortable with doing whatever was prescribed for me and for him.

He was there for two days; the nurses were amazing; and then he came home. In my mind, everything was perfect.

A couple weeks after he was born, as we were getting comfortable with new parenthood (I mean, as comfortable as anyone can), and I was preparing for the end of my maternity leave, we started getting the medical bills. We expected most of them, but one for $6,000 took us by complete surprise.

The insurance company denied the claims for all of the NICU services.

Apparently, the NICU was a contracted service from an organization in Dallas. Even though the hospital and doctor were in-network, the NICU was not. Just think about that for a second. You just had a baby: during the labor, someone tells you something isn’t quite right, but it’ll be okay- they just need to take your baby to the Neonatal Intensive Care Unit where he can receive the appropriate medical care.

1157540_10101215599780168_1991802840_nIt’s not a moment where you pause and say, “hmm, okay…but only if its in-network.” It’s not a moment where you say, “Can I call my insurance first?” It’s not a moment where anything other than the health of your baby matters.

Luckily, at the random advice of my mother, we covered Charlie under two-insurances right away: mine as the primary, my husband’s as the secondary. Yes, that means two family premiums, but we did it anyway because we obviously didn’t understand how money works. Clay’s insurance- with the help of whoever the extremely helpful and patient representative was who helped us- ended up covering the cost of the NICU, so we did not have to pay the full $6,000- a particularly helpful relief as brand new parents with a newborn.

But…what if we hadn’t dually covered him, like I’m sure lots of people don’t? What if the secondary insurance didn’t cover the NICU either?

With our subsequent children, I knew to ask. In case you’re wondering what that looks like, you have to pre-approve all services through your insurance, including any anesthesia and NICU services that may not be in-network. With our third baby, our doctor was in-network, but the hospital- to which her office was attached- wasn’t. The insurance agent with whom I spoke informed me that the birth would only be covered if she delivered in her office. I asked, “Don’t doctors usually deliver at a hospital?” Because, how could this make sense? It didn’t.

Her answer:

“I cannot speak as to whether all doctors deliver in a hospital.”

Right. Thanks.

I wish I could end this post with some advice. The best I have is: ask every question about in-network providers you have to. If you’re in a position where cost doesn’t matter and you can just choose your doctor, hospital, and whether to send your baby to the NICU: good for you. If you’re like us and $6,000 is a lot of money (for only a two-day stay), the best I can tell is you is try to make decisions based on health as best you can (THIS SHOULDN’T BE A LUXURY), cover under two insurances if you can, and be sure to ask what needs to be “pre-approved.” I learned that doctors’  offices and insurances aren’t always on the same page: with our second daughter, the doctor’s office seemed to be under the impression that they were in-network for most services, but the insurance representatives I spoke with indicated otherwise. So educate yourself as much as you can, take screenshots of all online-conversations, and get that pre-approval paperwork for the doctor, the nurses, the medicine, the anesthesia, and the NICU. And try not to let the finances dull the light that is having a baby. You’ll get through it, we all do- and hopefully more comprehensive medical care will be available for all of us in the future!


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Nickie is currently an Urban Education Studies PhD student at IUPUI. As co-owner of Indianapolis Moms Blog, she is interested in not only supporting and encouraging fellow mothers, but supporting the small businesses of Indianapolis. She also works for a Civil Rights organization, working specifically with Civil Rights in public schools. She is Mom to Charlie (3), Ivy (2), and Emery (1), and married to her baby-raising partner, Clay. She loves to travel with her littles and husband, walk the Monon, City Market, hikes, dogs, and barbecues. You'll find her with coffee in hand, likely talking to anyone who will listen.