Posts Tagged ‘Neonatal intensive care (NICU)’

Expectant Parents Beware! Not All Health Plans Cover NICU

Wednesday, January 19th, 2011

The majority of expectant parents know that their obstetrician and the hospital where their baby will be born participate in their health insurance network.  If the baby is born prematurely or needs special care in the neonatal intensive-care unit (NICU), however, the new parents may get a nasty surprise — this level of care may be out of their network.  “Some hospitals do contract with other clinical provider groups to run their NICUs,” said Marie Watteau, the American Hospital Association’s (AHA) director of media relations.  “When selecting a hospital, pregnant women should…verify that all hospital care, including NICU care and physician services, are in network.”

Three quarters of babies who require costly NICU care are born prematurely; the remaining 25 percent have other medical problems.  In 2009, one baby in eight was born prematurely, defined as before 37 weeks of gestation, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics.  Although premature birth rates have fallen recently, they are still 30 percent higher than in 1981.  The Institute of Medicine reports that medical bills and other premature-related costs totaled $26.2 billion in 2005.  That’s $51,600 per premature baby.

Depending on weight and other medical criteria, some premature babies needing NICU care could be declared disabled under the Supplemental Security Insurance program.  That would make the baby eligible for Medicaid.  Although families typically must meet income guidelines to be eligible for Medicaid, “while the child is in the institution, the child’s income alone is what’s looked at for Medicaid purposes,” according to Mary Kahn, a spokeswoman for the Centers for Medicare and Medicaid Services.  After the baby is discharged, however, it is no longer eligible for Medicaid unless the parents meet the income guidelines.