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$147,000 paid claims for HG total copay was $5

PostPosted: Jul 05, 2005 2:19 pm
by Juliette Punchello
plus seven emergency room copays of $25.

And as much as I swore I wouldn't do it again, I am thinking about having another baby. Lauren is just turning one and is the best blessing that God ever gave to me. I figure I can be sick for 9 months (or more likely incapacitated for 7.5 months and just sick for the remaining time) to experience the joy of motherhood again.

My job was wonderfully supportive. I was out on disability for the last 7 months of my pregnancy and then they allowed me to take FMLA and keep my medical benefits until Lauren was 4 months old and I had to go back to work.

Is it morally O.K. to do this again to my job? I know that I will most likely be out the same amount of time and I do have responsibilities that someone else will have to cover or will not get done for another year...

Also, will I be able to use FMLA again? And, what about my insurance...will they pay for the entire amount again?

PostPosted: Jul 05, 2005 5:07 pm
by JennyK
I can't answer your questions about insurance and FMLA (call your insurance company and HR person), but I sympathize with your question about whether it is morally okay to have another HG pregnancy in regards to your job.

Before I ever heard of HG, I hoped my children would be close in age. I started a new job when Annie was 7 months old, and felt morally obligated to stay in the job for at least a year before doing it again. Now Annie is 17 months, I've been in this job for close to a year, and we're making our plans for #2.

My boss in my old job, during my first pregnancy (who unfortunately had no control over time off, benefits, etc--government job, government rules) was so wonderful about it. He told me that having a family was the most important thing I would ever do. As I plan for another pregnancy in my new job, I try to remember what he said. If the threat of having HG again isn't enough to scare me away from having another child, I'm not going to let my job stop me. Annie and my future child(ren) are more important than any job I will ever have.

That said, I am making preparations to minimize the blow to my employer (and me). I did wait for a year and am getting disability insurance to cover a majority of my lost wages. I debated whether to tell my employer of my plans, but before I got a chance to decide my cover got blown by the AFLAC agent (grrrrr) and I fessed up. Thankfully my boss was supportive and said they'd help me through. (I'm not sure precisely what that means, but I plan to negotiate it soon!) Since they know it's coming, it won't be a total shock if I have to suddenly check out of the office on disability for several months. Hopefully they will have a plan to cover my workload.

Good luck as you make your decision!

By the way, I can't believe how good your insurance is!!!

PostPosted: Jul 05, 2005 8:51 pm
by bibliojo
I've been struggling with this issue alot too as I've just accepted a more demanding job within the library where I work. My absence will affect not just me but all my co-workers as they will have to pick up the slack and I feel badly about it because these are people I know and like, not just an impersonal company! But as I've been talking to friends about it over the past month or so, these are some of the comments they have reassured me with: "Your job is not your life. Your job is just a part of life, and therefore, you shouldn't put your life on hold for your job" and "How far apart do you want your children? Would you still be happy knowing that if you delay ttc that that gap will widen and that age gap will be for life?" and "A company takes a risk hiring any woman of childbearing age. They have to think that it is possible that a woman will become pregnant while working for them...especially if they already have a child"

I know how you feel...the first time round it was a surprise that you had HG, but this time you know what is going to happen so you feel like you are doing this intentionally to your employer. But going through another pregnancy is the only way you're going to get another child. Us HGers would gladly give up taking disability leave in exchange for an HG free pregnancy! But it's hard for our employers to understand how awful HG is when they have often never will have heard of this condition before we started puking! :)

Anyway, what this all boils down to, is what do you really want? Do you want another child badly enough that you'd be willing to sacrifice your reputation among your co-workers or even your job entirely for that child? For me, that answer is yes. I know that there are other jobs out there and other people I can work with, but my family is my family for life and I'm not going to let other people's opinions dictate my decisions. That said, I haven't decided if I will reveal that we planned this pregnancy or just let them think it was an accident. :wink:


P.S. I'm sorry -- I don't know anything about FMLA, but it sure sounds like you got a good deal! And Jenny, I'm so sorry the AFLAC agent revealed to your employers that you are planning to ttc! :evil: Isn't that against privacy laws??? But I'm glad that they are willing to help you.

PostPosted: Jul 05, 2005 9:41 pm
by aaronsmommy
I believe that FMLA allows you 12 weeks per year, you can look up the details here

As for your insurance, most policies have an annual and a lifetime maximum (for most decent policies they are usually on the order of a million or more) but some are as low as $30,000 so it would be good to check. A long as you are well below that maximum and your policy hasn't changed much, you should be okay. HG can be really expensive - my bills came to over $750,000, but I had an HMO, so with their contracts, they only ended up paying about $300,000, and I can certainly see how the costs could have staked up more.

PostPosted: Jul 05, 2005 10:26 pm
by bibliojo

$750,000!?! :shock: That's three quarters of a million! Okay, now I am REALLY shocked at what you guys in the US have to pay for medical care.


PostPosted: Jul 05, 2005 10:33 pm
by aaronsmommy
Oh yeah, it's crazy!

I wanted to make sure it was clear, I paid about $1000 total, the rest was just written off as the HMO contract discount.

What that means is that the only people who have to pay the really high inflated numbers are people who pay the bills themselves (not that $300,000 in spare change!) Now that makes sense now doesn't it????

PostPosted: Jul 05, 2005 10:39 pm
by aaronsmommy
Oh, and about the guilt thing, I really feel that had my employer treated me well (instead of being nasty and then firing me over the whole thing) I would have felt a lot of devotion to them and likely stayed for a very long time - very valuable in my field where turnover can be very costly.

I did feel guilty, anyway, at least until I was fired.

PostPosted: Jul 05, 2005 11:56 pm
by mammaclare
I am feeling the same way--and I am the ONLY breadwinner for my family. So I have the "my job or my life/children" debate internally at least twice a week.

Also, any employer with FMLA only has to keep your job for that 12 weeks. They can fire you at will after that point. So, while my employer allowed my 16 weeks medical leave/Short term disability early on and then also didn't put up a fight when I went back out at 36 weeks until 6 weeks after delivery, I am still afraid that there would not be that same generosity this time around. Also, I had a partner in my previous position so my customers were still covered--if I were to be out months now, there would be NO coverage for those accounts at all. So, they may claim that they *have* to fire me for business reasons. All very scary.

I don't think that I would be fired, but if I were, we would be in a mess. A really really really big mess. And that terrifies me. So, I can see where you are in your internal debate.

Again, as for FMLA, it is 12 weeks. Also, most employers run it concurrently with STD, so you don't have the full amount to use after you deliver--this is why I had to go back to work at 6 weeks postpartum. Your employer sounds incredibly generous--you are very lucky!

PostPosted: Jul 06, 2005 8:57 am
by aaronsmommy
One thing that is included in the federal disability leave laws is that companies must always follow written and unwritten policies regarding leave. I think that would make it harder to do something different the second time unless there is a written policy that is actually different from what they did, or if they treated you differently than other employees by actually allowing the leave.

Unfortunately, this is probably the part that gets harder to prove and fight for. Also, just because it isn't legal doesn't mean they won't fire you - you just get to go after them, if you want.

PostPosted: Jul 06, 2005 10:10 am
by JennyK
Regarding missing work, another thing I try to remind myself is that a lot of women get put on bedrest during pregnancy and have to miss weeks or months of work. This has happened to several friends of mine. Although they hate being on bedrest, they don't feel guilty about missing work. So why should we? (I, for one, have a problem shaking the feeling that it's somehow my fault that I get HG or I'm not tough enough.) The fact that we know it's coming and others usually don't have warning shouldn't make a difference. We have to miss work just the same--and in some cases we are in a position to give our employers the courtesey of notice that it will happen so they can prepare. Wouldn't we all trade HG for feeling perfectly healthy but having to stay on the couch (which is the situation my friends have faced)? Would you feel differently if you didn't have HG, but at 25 weeks were told you had to be on bedrest until delivery?

Of course I say all this, but still struggle with the same guilt issues myself! Thankfully my employer has given me enough assurance that at least I'm not worried about losing my job over it.

Joanna--the AFLAC agent didn't come right out and tell my boss, but she said enough that I felt I had to explain. She probably didn't violate a privacy law, but was pretty tactless!

PostPosted: Aug 02, 2005 1:30 am
by teddi
Ok, ok. I got burned from my job for taking an non FMLA covered disability leave....

FMLA remember---- to qualify you have to have worked 12 months (so wait a full twelve months since the day you went back to work) and have also worked 1250 HOURS.

Then yes, you requalify under FMLA.

PostPosted: Aug 02, 2005 1:38 am
by teddi
I wonder how much my last pregnancy cost Kaiser. I wonder if there is a way to find out?

I did pretty good w/the home IV therapy- I had to push for it, but heck it saved them lots of dough.

But I figure I used the infusion clinic about 15 times. Only had 3 ER visits (less than the 12 or so in my first pregnancy) in for about 36 hours total and one L&D trip (but not admitted). 6 diagnostic ultrasounds. Did have two CT scans though, and I know those are pricey. Then the 10 days in w/the pancreatitis. Probably about $8,000 - $10,000 of Zofran. All my other drugs (maybe $1000), home health supplies. If you add the NICU stay for my Hmmm, I wonder how much.

PostPosted: Aug 02, 2005 8:49 am
by aaronsmommy
Too bad you never see bills with Kaiser (actually it's kind of nice, huh)

I think yours was probably up there too, especially with the 2 NICU stays. Mine included 6 1/2 weeks of me in the hospital, 2 1/2 weeks of Aaron. 6 months of home health care with TPN and Zofran.

PostPosted: Aug 02, 2005 11:18 am
by nomore
My pregnancy with Madison cost well over $100,000 too. And, like Aimee, we paid a mere total of about $1500. The TPN is VERY costly.....

This pregnancy so far its been 3 ER visits, one co-pay waived as I was admited- so $300 (my impatient stays are $100 a clip). And 4 Infusion Center visits at $35 a pop. Then the PICC line placement in Radiology at $35. And misc presciptions - probably totaling $125.

All Home Care is covered at 100%..... so my zofran and IVs are free to me right now.

Also, I just wanted to add that I qualified for Long Term Disablity (Once my short term ran out) when i was prego with Madison. It paid through the rest of the entire pregnancy and then to 6 weeks post partum. I got a FMLA leave of 16 weeks (company policy), but of course was not cleared to work full time once I ran out of FLMA time. Then I had to make the choice of try part time and if I fail have NO disabilyt to fall back on OR consent to quiting and staying on LTD until delviery. Dr was in favor of the 2nd choice. So, thats what I did. Dont regret it in the least. I too felt bad about letting co-workers down, but then when they "fired" me.... I certainly felt LESS bad about it :)


PostPosted: Aug 02, 2005 11:29 am
by JennyK
Wow, I feel like I'm getting a crappy deal. We don't have an infusion clinic, so to get an IV I have to be admitted to labor & delivery or use home health. I have to pay 50% for all hospitalizations and 50% for home health. At least most things count toward my maximum out-of-pocket liability of $2000--but home health does not. I'll have to pay for that until the cows come home.

PostPosted: Aug 02, 2005 1:17 pm
by teddi
Yikes... that's terrible Jenny. That could get real expensive real quick. And then if money was tight, you feel compelled to use the ER to pay less...or go w/out longer. Yuck.

W/my first pregnancy, I paid $0. Literally, as I had double coverage with Kaiser. This time, each ER visit was $50, and I had my Rx's co-pays. My Zofran though was only $20 for a bottle of 30 pills. Not bad. I probably only paid about $400 ???