So I Missed "Open Enrollment" Maternity Rider - Blue Cross Blue Shield NC

Something doesn't sound right. I'm quite positive there's more to this than what you're telling us. I know for a FACT that c-sections are covered by BCBS (because I've had two, both elective, on BCBS). Also I really don't see how you can "miss" the Open Enrollment. You didn't contact them between November and January, and never verified that it had been taken care of? Open enrollment usually lasts 30 days. This seems like the kind of thing I would have followed up on.

You called in November and were told you would receive info in mail. Well when you did not get it, why didn't you call? So you wait until January to call when, I assume, open enrollment is over. You said you are being responsible. Being responsible, would have meant you were on the phone within two weeks of initial call when info was not received. A vaginal birth and a c section are paid different rates. Where is the $20,000 coming from.
Sorry to say, but I think you have to wait until next year.

When you quote $20,000 this is what you would have to pay without coverage. With coverage, would think, depending on deductible, charges would not be outrageous.

I am so confused. When you make changes through open enrollment there are VOLUMES of paperwork to complete either online or with HR. You called in November and didn't receive anything in the mail... but never called again? First mistake.

A c-section is not considered a complication. It's a procedure that occurs either electively as a result of a prior complication or as a result of a complication. In and of itself, though, it's a surgical procedure. I have had two- one with BCBS and it was covered completely because of the complication that precipitated it.

$20K is on the low end. My son was an emergency c-section as was my daughter- both were planned as "natural" deliveries. My son's total was just shy of $40K and my daughter's was $35K. With my son (BCBS), we paid nothing out-of-pocket but received copies of all bills sent and paid for our records. For my daughter (Aetna), we paid about $7,000 out-of-pocket. Neither required NICU treatments, but you have to consider the costs of a labor and delivery PLUS surgery PLUS an extra day in the hospital for you both.

What should you do? Call someone above the person you are speaking to. Put something in writing outlining your recollection of the events. If you can pull your cell phone or home phone records, even better. They asked for your marriage certificate because if you were married within a certain time of your request it's considered a "change of status" which overrides the "open enrollment period". The same thing applies when you have children.

Just FYI... you typically have 30 days from the day of your child's birth to add them to your insurance. When that time comes for you, make sure to send in the paperwork for the social security card and birth certificate BEFORE you leave the hospital. The hospital WILL file it for you and you will need those documents to add your child to your insurance.

Call again. My sister had horrible problems with BCBS and it turned out that the person that she talked to ignored the actual guidelines and denied my sister based on what *she* thought was fair. It happens quite often- not only with insurance, but with many other companies. Customer service is a joke in our day and age!

I hope you get things straightened out.

Seems to be a wide range of hospital charges, depending on where you live. I've delivered at 2 different hospitals in the Chicago area, and have had 3 c-sections. Each one was billed to our insuance company for about $13k.

Don't ask friends and family. Ask the hospital where your OB is on staff. Get their charges in writing. If it is too expensive, consider looking for another practice/hospital with more affordable charges.

I also am a bit confused by how the deadline was missed. Each year when we do our open enrollment, we have to do it all online. We select each plan that we want, see the charges, and get a confirmation printout when we finish. I know the practices of insurance companies can vary from state to state, and from employer to employer, but surely there is a more formal procedure to add such a vital coverage.

Why wouldn't you call to check on it again if you knew you were planning on starting a family this year but hadn't had any confirmation from BCBS?

I think your only hope is to do a written appeal to the insurance company, or to take out an additional individual policy, if possible. Shop around to see what you can come up with--it'll surely cost less to get an additional policy for 1 year than it would cost to pay out of pocket for a c-section.

ETA: For example, get a quote from Humana here: https://www.humana-one.com/secured/individual-health-insu...

You're dealing with a huge bureaucracy.
Here's what I do when dealing with a large institution...
I suggest you need to find O. human there to engage, make contact with, get a direct dial number for follow up.
Initiate by admitting your mistake and throwing yourself on their mercy.
You need a hero.
People live to be heroes, given the opportunity.
So call, get to a person, learn his/her name and get their direct number, then calmly explain what is happening. Start with "Sue, I'm looking for someone to help me out. I'm in a mess and need someone to help me!"
Good luck!

The people to contact would have been your husband's employer HR department, not BCBS. They often have an "oops" grace period after open enrollment that only HR can help you with, but you likely missed that too by now.

Contact HR anyway, to see if they can help. Keep your attitude positive and be humble. Neither BSBS or HR is at fault, so make sure anyone you speak with knows you accept responsibility for the error.

"What do you suggest we do?"

One option is to wait another year before trying to have a baby. $20k out of pocket is a reasonable estimate for a healthy, non-complicated pregnancy.

Anther option is to buy a second insurance policy for yourself that covers maternity.

I can just answer one part of your question - no $20k+ does not sound like too much, unfortunately. I got an estimate of benefits for my upcoming delivery since we pay co-insurance. The hospital charges $31,000 for uncomplicated vaginal delivery and $29,000 for c-section, but this also includes the costs of my pre-natal visits.

Go up the food chain. Threaten to go to the media. Get insistent. Having a baby without health insurance is insanely expensive.