Hello. I'm a father-to-be. Questions about FMLA and others;.

[Hawkeye-X]

Wife is 21 weeks pregnant and we just got our first official ultrasound - confirming the sex of the baby and also making sure he's healthy and happy.

My wife's company has a very decent insurance coverage, and I am on Medicare, but still work part time.

My question is, do we ask the dr to bill for next year's hospital stay and any other necessary expenses to the insurance company so she is covered for the birth before our "out of pocket" expense (we hit the limit earlier this year) is reset again.

What do I do? Any advice or suggestions would TREMENDOUSLY help me.

Hawkeye-X

[Kittycat]

1. Insurance...

won't allow for the drs to bill in advance, because anything can change. The drs billing department will seek preapproval of charges a couple weeks out though. If your wife has an option, when her renewal comes up, where the out of pocket will be lower than the increase in premiums, it might be wise to change for one year. That will also help with the well baby fees - if that is an option. You can request a 'menu' from the drs office listing all the fees for various services. Most here in IL provide that on the first visit (not sure if that's a state requirement, but it seems consistent). The fees include a breakdown of everything from vaginal, c-section, emergency c-section, intervention like epidural, high risk care, etc. That could help you with budgeting. Some drs and most hospitals offer payment plans, as well.

I could be misunderstanding your question though, so let me know.

As for FMLA, the company isn't required to provide pay during that time - but some of that can vary by state and employer. My employer didn't offer maternity leave, if you hadn't been employed for 1 year. I did receive it, but only 8 weeks worth (emergency c-section). Then I went on to FMLA, since my son was in the NICU. During that time, I had to pay my insurance premiums out of pocket, but didn't lose my job. When I wasn't able to return (he was still in the NICU 3hrs away) after FMLA was up, then I did lose my job and health benefits (expected and planned, fortunately for us).

In any event... Congrats on the baby :D

[mwooldri]

2. Congratulations on your pending birth of your son!

As for medical expenses it all goes down to "date of service" and with babies, it'll happen on baby's time, not ours. I suppose if you're paid up on your insurance for the year you'd be OK financially if your wife delivered very very early (like please don't deliver before the end of November - baby might not live!) and since she's actually due late February (I think) early inducing is not an option. Hate to say it but only advice I can say is save what money you can and negotiate with your doctor and hospital. I don't know the ins and outs of your insurance but with ours, the doctors just file and because we have it can't demand payment before rendering the service. If your wife's insurance is linked to a HSA, sock away what money you can in there - take the money off this year's taxes. We have an outstanding balance of a little over a $1000 with my son's urologist and because we've negotiated a payment plan he's able to continue to keep on seeing him.

As for FMLA... I think you got to be working at least a year, and in a company that employs so many people before FMLA protection comes into play. Have a word with your HR department, see what they have to offer. The company I work for now offers paid paternity leave on top of FMLA.

If you have paid your maximum out of pocket for the year I would however consider making the most of it where possible. Certainly if you're on medications it's time to get that 90 day script from the docs and getting it filled, and maybe asking for the refill in the last two weeks before the end of the year so you have a good supply on hand. If you back is out a bit and you could benefit from a visit to the chiropractor now might be a good time to do it if your insurance covers this kind of thing.

I hope the pregnancy goes smoothly and baby arrives safe and well! I know it's natural to fret over finances, but in the worst case scenario the hospital will have to deliver your baby safely one way or another.

All the best, Mark.