Pregnancy coverage on Insurance

If your insurance company's website doesn't say, how do you expect any stranger to know what your specific class in a specific company covers?  Only one who can answer this question is your insurance company.

Post the company name here, and the sepcific class, and maybe we can look as well.

By the way, when you received your insurance card, you must also have received all the details of what is and is not covered in the packet, along with the hospital list.

its medgulf class a

vakas wrote:

It depends on your insurance package...normally pregnancy is fully covered...normal or c section....but check the hospital list first...other wise you can claim it after wards....

If it is class A, it should cover it.  Still, it is best to go through the literature that came with your card, if you have it, as that will list the limits of each specialty.  If you don't have the packet, call the 24 hour 800 number that's on the website and probably on the back of your card, and ask them the limit for deliveries.  The website is useless as it does not list the benefits.  Forget benefits, it does not even list the different classes they have.

true, the website is disgusting.. and i did get that booklet but i lost it somewhere! i know the limit was somewhere around SR 15000 i guess but i have no idea how much a delivery costs charges on insurance cards as rates for UCAFs are mostly different to what they charge otherwise.. also i dont know that will i have to pay in cash initially for labor and then put claim, or will i have to go for pre approval and no payment in cash ! also is the pre approval to be done by me or by hospital.. these sort of things i wanted to have idea about..

Trapezius wrote:

If it is class A, it should cover it.  Still, it is best to go through the literature that came with your card, if you have it, as that will list the limits of each specialty.  If you don't have the packet, call the 24 hour 800 number that's on the website and probably on the back of your card, and ask them the limit for deliveries.  The website is useless as it does not list the benefits.  Forget benefits, it does not even list the different classes they have.

Preapproval is always done by the medical facility, but I don't think one would be required for delivery... what are they going to say on the form, "the lady is about to give birth, can we proceed?" 

Preapproval is not required for emergencies and deliveries.  And for procedures which require one, the doctor will fill out the form, ask you to take it to the insurance office in the hospital, and they will fax it.  An answer comes back usually in 15 to 30 minutes for most cases.

I remembering hearing somewhere that deliveries cost between 7,000 and 12,000 at most hospitals.  And yes, for class A with most carriers, the limit is 15,000 for deliveries, so you are good to go.

So when are you going to be a father (or a father again?)? 

for doing delivery on insurance coverage (without taking any cash) they surely need to do pre approval.. i suppose !

Trapezius wrote:

Preapproval is always done by the medical facility, but I don't think one would be required for delivery... what are they going to say on the form, "the lady is about to give birth, can we proceed?" 

Preapproval is not required for emergencies and deliveries.  And for procedures which require one, the doctor will fill out the form, ask you to take it to the insurance office in the hospital, and they will fax it.  An answer comes back usually in 15 to 30 minutes for most cases.

I remembering hearing somewhere that deliveries cost between 7,000 and 12,000 at most hospitals.  And yes, for class A with most carriers, the limit is 15,000 for deliveries, so you are good to go.

So when are you going to be a father (or a father again?)? 

and i still doubt insurance companies will easily/happily cover the delivery costs.. they just cant cover a 15k delivery on a 3k insurance card ! they must be having some hidden conditions.. coz from one doc i heard delivery charges are not fully covered in insurance packages etc

They do 120,000 riyal heart surgeries as well, on the same 3,000 riyal insurance plans.  So, a 10,000 riyal, or up to 15,000 riyal delivery is nothing.  Hundreds of births take place daily around the country, and they are all covered by insurance.  I don't know what that one doctor told you, but I think you should ask other families who have had deliveries here, just to put your mind at ease.

As for approval, if you are sitting at home and your water breaks, you rush to hospital.  What are they going to say to you there, go see your doctor, let him/her fill out the form, then take it to the insurance office downstairs, and sit in the waiting room for half an hour till your carrier faxes us the pre approval?  Of course not.  IF a pre approval is required, it will only be as a formality, and will be done all in the background and you wouldn't have to wait for an answer from the carrier before you can proceed to the delivery room, because an approval WILL be given.  Plus, they should take care of all of it, without you having to run around.  Similarly, in an emergency case, they will take care of all paperwork regarding insurance.

Again, call the 800 number on the website.

but the heart surgeries are not a routine thing for all the insured ones.. also they dont mostly know at the time of issuing card that this particular patiet may need a heart surgery ahead.. and in contrast, even when they know that the lady is pregnant before the issuance of card, they still give u an 3k insurance knowing that they will have to pay 15k ahead for delivery after few months.. u must be knowing there is a separate questionnaire about pregnany on application form for the said purpose..

in all these cases they must be keeping pre approval ready with the beginning of 3rd trimester..

Trapezius wrote:

As for approval, if you are sitting at home and your water breaks, you rush to hospital.  What are they going to say to you there, go see your doctor, let him/her fill out the form, then take it to the insurance office downstairs, and sit in the waiting room for half an hour till your carrier faxes us the pre approval?  Of course not.  IF a pre approval is required, it will only be as a formality, and will be done all in the background and you wouldn't have to wait for an answer from the carrier before you can proceed to the delivery room, because an approval WILL be given.  Plus, they should take care of all of it, without you having to run around.  Similarly, in an emergency case, they will take care of all paperwork regarding insurance.

Again, call the 800 number on the website.

Your HR department surely know what they have agreed with Mgulf, so they can tell you clearly and rest you can call Mgulf and tell them your account no and they will tell you what is cover and what is not, why getting confused and looking here and there when all the information in only one call away from you.
All the best

DrHassanMalik wrote:

but the heart surgeries are not a routine thing for all the insured ones.. also they dont mostly know at the time of issuing card that this particular patiet may need a heart surgery ahead.. and in contrast, even when they know that the lady is pregnant before the issuance of card, they still give u an 3k insurance knowing that they will have to pay 15k ahead for delivery after few months.. u must be knowing there is a separate questionnaire about pregnany on application form for the said purpose..

Actually, the premium for married females of child-bearing age is about 50% to 60% higher than the premium for males.  Typical class A premium for males is 3-3.5k, but for females it is 4.5-5k.

As for knowing they will have to pay 15k for delivery and still selling you the insurance for 3k 5k, well, that's how insurance works.  Many people hardly use their cards, and due to that, they make huge profits every year.

Finally, every time I post something, you reply with some definitive answer... seems like you know all the answers!  And if you don't, I keep telling you to call the 800 number.

Something beneficial for your wife

https://www.facebook.com/photo.php?fbid … 985&type=1

now that makes sense.. i never knew premium for child bearing age females is high.. but as you told its higher than that can make it happen..

Trapezius wrote:

DrHassanMalik wrote:

but the heart surgeries are not a routine thing for all the insured ones.. also they dont mostly know at the time of issuing card that this particular patiet may need a heart surgery ahead.. and in contrast, even when they know that the lady is pregnant before the issuance of card, they still give u an 3k insurance knowing that they will have to pay 15k ahead for delivery after few months.. u must be knowing there is a separate questionnaire about pregnany on application form for the said purpose..

Actually, the premium for married females of child-bearing age is about 50% to 60% higher than the premium for males.  Typical class A premium for males is 3-3.5k, but for females it is 4.5-5k.

As for knowing they will have to pay 15k for delivery and still selling you the insurance for 3k 5k, well, that's how insurance works.  Many people hardly use their cards, and due to that, they make huge profits every year.

Finally, every time I post something, you reply with some definitive answer... seems like you know all the answers!  And if you don't, I keep telling you to call the 800 number.

thanks alot ! but as my wife is a gynaecologist (practicing in her home country though) so I guess she wont need it.. thanks anyways !

Trapezius wrote:

Something beneficial for your wife

https://www.facebook.com/photo.php?fbid … 985&type=1

You should inquire your company about it. It depends upon the type of contract they have negotiated with the insurance company. In principal, every insured person is entitled to coverage up to SAR 250,000 annually but maternity coverage is limited. Usually it is up to SAR 10,000 that includes C-section. Approval is required for maternity related procedures and it is completed within few minutes so there is nothing to worry about.

Anyways, every company has a different contract you should inquire your HR about it. Or call MedGulf's call center and inquire, they will provide exact terms and conditions applicable on your wife's policy.

MedGulf has agreed price list with all healthcare providers approved under your network. So it isn't your problem to worry about the cost of normal or c-section procedures. Your insurance company will cover it. That also includes incubator for newborn child (check the limit and number of days with your HR). All surgical procedures are offered as package deals for insurance companies.

I work for a technology firm that implements electronic claim management solutions for insurance companies and healthcare providers and therefore my reply is based on the information  I see on daily basis.

you handle UCAFs?

Dear sir,              Iwould like to know that I get my family insurance last month and my wife is pregnent 8 months so its cover or not ihive class a insurance card and isaw that booklet also so its there hospital name where my  wife is admited

Yes we do

tansari wrote:

Yes we do handle UCAF