@joeestacy I would bet that it will be whatever the out of pocket maximum is for the baby (out of pocket maximum for the dependent)
As for financial assistance, the hospital and/or NICU should have a dedicated person or team that can assist you with this and make sure you are in any and all programs you need to be in.
@joeestacy My out of pocket maximum was also $6000 and that's what I paid total. There were a handful of things that weren't covered by insurance but it cost no more than $100 total.
Keep in mind that's the in-network out of pocket maximum. If it's out of network, it could be higher. The hospital we were at and all the doctors were in network.
@joeestacy You won’t have to pay the out of pocket max! In New York a baby that is hospitalized for 30+ days qualifies for Medicaid and they will cover what your primary insurance does not.
@almondy7995 OP said they were in NYS, can confirm this is true in NY. My baby qualified for Medicaid due to length of stay, we wouldn’t have qualified otherwise based on income. Paperwork was tricky, but we paid less for my sons 6 week NICU stay then my 2 day hospital stay thanks to this.
@joeestacy Have you spoken to the social worker about Medicaid and/or Social Security Disability? There are some conditions that merit what's called an "on the record" decision, which means you don't have to go to court- you can simply file for Medicaid. A >30 day hospital stay qualifies in a lot of states.
My boys were inpatient for a lot longer, but we've pay next to nothing for their care. No, seriously, we've paid like $75 in copays. It's fill-in insurance, so ours is still billed first, but then Medicaid picks up the rest.
SSD will only backdate a month, so please, consider calling your local Social Security office tomorrow morning.
@gloryriver We also did Medicaid as secondary and I think in nearly four years we’ve only paid a $26 prescription copay Medicaid wouldn’t cover for all of our 24 weekers medical needs including a several million dollar NICU stay
@uga1785 Not when the child lives at the hospital. If they aren't in the family residence, the family income doesn't matter. That's why it has to be over 30 days.
Look into Institutional Medicaid. It is not income based and NICU babies with stays over 30 days automatically qualify in NYS. Don't pay a dime until you have applied.
@pinsuariba1983 This is the right answer! My baby was in the NICU in NYS for 90 days and I had bills for 85k at one point on my account but this was inaccurate. I lost so much sleep because I was getting denial letters almost daily from my insurance. The hospital and the insurance go back and forth a lot fighting over codes and different payouts but really I was g responsible for any of it. I had to ask several times to talk to the social worker but she did get Medicaid set up for my daughter. I think it actually back dates 90 days. You should be good but get it filled out ASAP. Once I had my daughter’s Medicaid info I had to call hospital billing a few times to get all the bills resubmitted but they were extremely helpful and nice. Don’t pay anything! NYS has a lot of protections in place. Even if you were out of network they wouldn’t be able to charge you without getting your consent so you are covered!
@joeestacy Over a dozen years ago, my kid’s stay was ~$500,000 for approximately 8 weeks.
Prices have gone up, I’m sure, since then. A lot of it will also be dependent on the level of care needed.
Typically, most insurances will have a per person out of pocket max/ year. Plan on paying that, most likely. If you’re (un)lucky enough to have your NICU stay span over 2 calendar years, double it.
@snowcity Six years ago, our 52 day stay started out at over a million! Of course once insurance negotiated it down, they paid way less. And then we just paid our OOP max. Thank goodness!
ETA: OOP max x2 cause we did have a Christmas baby.
@snowcity My guy was just over 200k for 19 days in spring of last year.
2 days cpap as a precaution (he was hooked up but on room air, 3 days of blood sugar regulation through umbilical line, 2 days jaundice therapy, then off to feeder/ grower. Thankfully, he did not need a lot of intervention.
@joeestacy Talk to the Patient Advocate at the hospital. Most states have a rule that NICU babies automatically qualify for Medicaid for any NICU stay longer than 30 days. If baby has Medicaid, your out-of-pocket should be $0
