Apr 23 2012

An unexpected medical expense

Oh! My poor little Johnny. He fell and hit his head last night and clearly needed stitches. We had paramedics come out and dress the wound and tell us what to do, and then we drove to the ER. They stitched him up and he did so great!

He actually fell asleep during the stitches part, and before that he was content to just chill out and play games on my iPod. I’m considering it a miracle, because what 3-year-old goes to sleep on his own for that?! Later, I asked him about it and he said he was just closing his eyes for a minute.

No. He was snoozing. Woke up a few minutes after they were done, a little disoriented and wanting to know if it was time to go home yet. Yes!

He’ll be alright and I’m optimistic the scar will heal well.

I called our health insurance this morning to find out how far we were from reaching our deductible, and what the damage will be financially.

Our health insurance has a $4k deductible, which we have to reach before they start paying 90% of the balance from $4-8k. After $8k, they pay all of it. I hope we don’t ever have a medical year like that.

Shane’s employer contributes $2k to a health savings account, which is the first $2k used out of that $4k. And, we didn’t use all of those funds from 2011, so that rolled over.

Since Shane only worked at his company for part of the year in 2011, they gave us a pro-rated amount.

Looks like we’ll have about $900 or so out of pocket before we hit that $4k deductible.

The health insurance company couldn’t narrow it down further, since they need to wait for bills from the hospital and our follow-up visit from the family doc. I know ER visits are super-expensive for even the most mundane of things, so I’m betting we’ll have to pay enough to hit the deductible and possibly more beyond that.

We haven’t spent or allocated our income tax refund yet, so we’ll pay our medical bill from that.

I am just counting my blessings here. First, Johnny is going to be fine. It was scary, but it could have been much worse. I’m so thankful that he behaved well throughout (though his sister was a bit of a … toddler about it). I’m also thankful that we have health insurance, and that we will be able to pay our bill without it causing us hardship.



9 Responses to “An unexpected medical expense”

  1. Glad to hear he is ok. My little guy so far has avoided stitchable injuries though he got a big goose egg last weekend. If shanes company offers Aflac I’d highly recommend looking into it. Even if you just got a catastrophic plan like an ICU plan it would help cover the out of pocket expenses and help make up for non medical expenses not covered by insurance (gas, food, daycare, etc). We have an accident, hospital, and cancer plan to go with our$6,000 out of pocket max. Hubby has to have nose surgery this year and our Aflac policies will help us make up for our costs: gas (procedure is an hour away) and my own time away from work.

    Anyway, glad he’s safe and will heal up ok. Kids are just so much fun. :)

  2. Go Johnny!!! Stitches make a man. Don’t get me wrong I would have cried like a teenager watching the Notebook but as long as he came out a rockstar we can send him into manhood. Good job Johnny.

    $4000 deductible? Really???? Why? This hurt more than the fall. That seems really high. Is that annually?

  3. My insurance at my previous job worked this way. $2500 deductible, and my employer covered the first $500 of that. Beyond that $500, we were responsible for 100% of the remaining $2000 deductible, and anything after that was covered 100%. It is a real pain for people who fall in the “donut hole” of needing more than $500 in medical care but less than $2500. But it was nice when I was pregnant, because I knew exactly how much we’d owe out of pocket when all was said and done. It made things simple.

    Preventative care like check-ups and annual gyno visits was covered 100% before deductible at least, but yeah. Let’s just say I’m glad my pregnancy only spanned one calendar year, because otherwise I would have had to pay that $2k deductible twice. Yikes.

    I’m really confused about our current insurance, because it’s a different system. We have co-pays, but also a deductible. But based on our experience so far, it seems like the co-pays go toward the deductible, but we’re not responsible for anything beyond the co-pay for covered expenses.

    For instance, when Judah had an ER visit, our co-pay was $200 out of pocket (the hospital gave us a $50 discount off our co-pay for paying in cash. What? Okay!), so it ended up being $150. I grumbled about the co-pay, but when we received the itemized bill and I saw what we would have paid with my previous insurance, I was relieved that that’s all we paid. The bill was much more than that, so it was a relief to know we weren’t responsible for a percentage on top of that.

    I need to figure out how they handle hospital visits and pregnancy in the near future. (Ahem.) Will I just pay the $20 co-pay for each prenatal visit? Or will it be the $40 “specialist” fee (ouch)? I think the hospital co-pay is a percentage instead of a flat fee, but I need to double check.

    Thanks for the reminder that I need to figure all of this out! Insurance is so stinkin’ confusing. And like I said in my email and on FB, I’m glad Johnny is okay! Yeesh. These toddlers are crazy.

  4. Yep it’s a $4000 annual deductible, so thankfully it accumulates. It’s only April, too!

    Shane’s company covered the first $2k so in normal years we’d have to do the next $2k, but thankfully we had about $1200 or so roll over from 2011, so that lowered our out of pocket amount.

    Good call, Karen for checking into the maternity stuff so you can know what to expect!

  5. We also have a $4000 deductible. My wife’s company will match the first $500 of HSA deductions, and we get a $900 bonus annually for meeting certain health goals.

    ER visits tend to be expensive, but not ridiculously so. Getting admitted is where the big bucks tend to kick in. I spent one day in the hospital having my gallbladder removed and the total bill before insurance was $25k.

  6. Insurance…what a headache.

    I have a child with special medical needs and I have to tell you if you don’t know your policy and what you are responsible for you can get yourself into a real pickle fast!!

    So glad Johnny is ok…what at trooper to fall asleep!! Way to go!

  7. I’m glad that he’s ok. I always get nervous when i hear about children’s accidents. Why was the bill so ridiculous? $900????????????

  8. Me too, Dannielle! I haven’t received the bill yet. The last time we went to the ER, the bill was something like $3-4k! But, we only had to pay $100 because our insurance was much better.

    We might have to pay up to reach our deductible. We’ll see. Hopefully the bill will come soon so I can know where we stand.

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Hey! I'm Kacie, wife to Shane and mother to Jonathan (7), Vivienne (5) and Amelia (2) . I write about my family's finance: how we save money, improve our spending, and plan for the future.

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