Assurant Health - Maternity Benefit - "Normal" Vaginal Delivery

[bluemarlin08]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

I recently had a client that had something similar, doc and hosp wouldn't recode, had to meet the 2500 mat ded and then the 3000 maj med ded.
We have appealed but don't have much hope.

 

[somarco]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

Just a wag, but most carriers have per diem's negotiated for normal delivery. Complications, due to the very nature, usually follow a negotiated rate but higher than a flat per diem.

Rather than blaming the carrier, it could be the provider attempting to upcode for a higher reimbursement.

 

[popeye35]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

Just FYI, I sell Assurant through SF, and I found out in the middle of a sale the other day that as of 05/01/2010 Assurant no longer has a maternity benefite option in Texas. I still got the sale yesterday when the people found out that almost no one still offers a maternity benefit for individual policies in Texas.

 

[TXINSURANCE]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

Sell them world in Texas.

 

[TxOnline]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

"Whats the difference when there is a separate maternity deductible anyhow? "

__________________________________________________


The lady purchased a $5000 deductible Maternity Option (in Texas).
In her opinion, she had a normal maternity & delivery claim.
(We both thought that tears & stitches WERE "normal" & customary with any childbirth.)

She paid her doctor about $2000 before birth.
This applied towards the $5000 Maternity Deductible.
Sonograms & labs applied to Maternity Ded.
Her hospital bill = $12K
Negotiated down to $7xxx.xx
The $7k has now been processed towards Major Medical (not Maternity).

*****
The difference is:
There are 2 deductibles to meet IF all of her maternity-related claims are not applied towards "maternity".

*****
She totally understood that complications WOULD apply towards Major Medical.

We just don't think that this is a "complicated" delivery; but, rather, a normal/usual occurrence during a normal childbirth delivery.

*****
I was hoping to find out if:
- Anyone else had crossed this bridge ???
- Assurant JUST started processing maternity claims like this ???

Wasn't looking to cause a rock-throwing session.
Just a helpful thread of answers (for ALL of us who MIGHT cross this bridge).
ALL of us, who sold Assurant's Maternity Options (nationwide), COULD find this thread helpful over the next few years.

 

[TXINSURANCE]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

The $7k has now been processed towards Major Medical (not Maternity).

I didn't realize the entire $7k hospital bill was processed in that manner, that is odd. This would be a dream if someone had a non maternity plan, but your point is well taken regarding the two deductibles.

What was their medical deductible?

 

[somarco]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

Maternity claims for all carriers can be processed in the same manner and both deductibles apply.

I had something similar happen on a claim with Humana. They purchased a Monogram and indicated at the time they did not want maternity. About 5 months later the husband called to say she was pregnant and wanted to know what his options were.

You know the answer, so he negotiated with the doc and hospital with a target of $5,000 for the "package". In her 7th month she developed a severe blood disorder as a result of the pregnancy. This shifted the claim from non-covered to covered under the complications provision.

He had already paid about $3k at that point but he had to start from scratch on the complications. He hit $7500 real quick.

The total claim went to $160k and Humana paid all but $7500 (the Monogram deductible).

Mom & baby are fine.

If the hospital coded their portion as a complication of delivery the claim was processed properly.

Note there is a difference in complication of maternity and complication of delivery.

If you have a beef, it is with the hospital, not the carrier. At least that is the way I see it based on what has been posted.

If a provider codes it one way the carrier is obligated to pay as coded unless there is obvious fraud.

 

[ABC]

Re: Assurant Health - Maternity Benefit - "Normal" Vaginal Delive

I am not a big fan of Assurant but I think they are correct in the coding of this claim. Its a complication.


If the health care provider is not willing to play ball then your client has to pay.