Insurance, Part 1

Health insurance is always important however when your baby is in the NICU, it takes on even more importance. Our daughter’s hospital bill was well over $2 million and that doesn’t count doctor fees, procedures or specialists. Here are a few tips to think about now to hopefully save you some headaches later.\

Thirty day rule – once your baby is born you have 30 days to add him/her to your insurance policy. Thirty days may seem like a long time but when you’re worried about many other things that time can pass by quickly.

Double Coverage – if you have the option, have your baby put on the insurance policies for both parents. This will help reduce the costs you have to pay and ensure that your baby gets the most coverage available to him/her. Note: when a baby is covered by two insurance policies, primary insurance is based on the parent’s birthday month (i.e. if mom is born in March and dad is born in November, than mom’s insurance will be primary).

Review your policy – there are several key things to check on your policy:

• Lifetime cap – some insurance policies have a lifetime cap. Check and see what your coverage offers because your baby could easily surpass that just with his/her stay in the NICU.
• Coverage amounts – some insurance covers 100% of some things and then a percentage of other things. Find out what the coverage is in advance so that you can anticipate what you will have to pay.
• Deductible – some insurance policies come with a deductible. Make sure to check and budget accordingly.

Keep track of everything – I’ll discuss more tips for this in the near future. Basically, don’t throw out any paperwork because you don’t know when you will need it. Also, keep a phone log for every time you speak to a customer service agent – write down who you spoke to and when. This could become important if you have to appeal/challenge a decision.

Laundry

Having a baby means doing a lot more laundry. This is true even if your baby is in the NICU. In order to keep patient items separate, most (if not all) hospitals will have you take your baby’s clothes and bed items home to be washed. Blankets, sheepskin, clothes and any other baby specific bedding will be separated and placed in a specific bag for you to take home and wash.

Since baby skin is often much more sensitive than our own, most people advocate using a special baby detergent to launder clothes. To save time and money, some people use regular detergent that is dye and perfume free. If you decide to use a regular detergent, I would still advise keeping your baby’s items separate while they are in the NICU. I’ve created a list of some the major brands that carry baby-specific laundry detergents.

Dreft
Seventh Generation (environmentally friendly)
Method Baby Laundry Detergent
All Baby
Caldera Sweet Pea
The Laundress
Purex Baby
Oxyclean Baby – Stain remover and soaker

Some people suggest air drying the sheepskin bedding for your baby. I would suggest using a drying rack or hanging the sheepskin from hangers in your bathroom. If you have other small children in the house – keep these items away from them as they could introduce new germs that may be harmful to your baby in the NICU.

When bringing clean clothes back from to the NICU, we used perfume free garbage bags. This way we knew the bag was unused and could be closed. Ziploc makes large bags for storage that could be used as well.

Questions

Since most parents can’t be with their baby 24/7 in the NICU, you end up calling in to check on your baby during the times that you can’t visit. Here are some general questions to ask that should give you a basic idea of what’s going on. If your baby is having any specific issues, make sure to ask detailed questions about their status/progress.

Did he/she have a good night/morning/day?
- Hopefully this will tell you if your baby seemed comfortable and content or if something happened to indicate that there is a potential problem.

How much does he/she weigh?
- Keep in mind that babies are normally only weighed once a day (at night) so it isn’t necessary to ask more than once.

Did the doctors say anything when they came by? Are there any new orders for today?
- Doctor’s normally start their rounds around 9am and they check on the most critical patients first. Any new orders should tell you if they are making any changes to things like medicine, feedings, breathing devices, etc.

How did his/her feedings go?
- You should be able to find out if your baby is tolerating feedings or doing well with the bottle.

A word of advice – if you call in and your baby’s nurse is on a break, try calling back when they are done. The relief nurse will most likely only be able to tell you what is on the chart since they aren’t the one watching your baby. Your baby’s regular nurse will be able to provide a full report.

Holding Your Baby

Holding your baby, especially for the first time, is an extremely exciting and special moment. It can also be very intense and nerve wracking when your baby is in the NICU and still very small and/or fragile. I had to wait nine days to hold my son and a month to hold my daughter. With both experiences, I learned a few things that I would like to pass on to hopefully help you in your own experience.

Don’t be afraid to ask – When your baby is born small or has medical issues, making sure they are stable is the first priority. During those first days or weeks, you may think that it isn’t possible to hold your baby. Or that someone will let you know when it is okay. While the nurses all know how important it is for you to hold your baby and will try and facilitate that, it doesn’t always work out. Nurses may assume that you have already held your baby or that someone else has already talked to you about it. If you aren’t sure, ask. Even if you have to wait, you will know what sort of milestones your baby needs to reach before you can hold him/her. As things progress and seem to be getting closer to the holding point, ask again.

Timing – Find out the best times to hold your baby. If your baby is on a ventilator, the amount of effort that it takes to get your baby out and into your arms may require that you devote at least an hour to holding your baby. You may want to time holdings with feedings. The nurses usually prefer to have you hold your baby after they have done their assessment. Ask the nurses about what scheduling times work best for them and your baby. In the beginning you may only get to hold your baby a couple of times a week however as he/she gets older and stronger you should be able to hold him/her every day.

Relax and Focus – When you are holding your baby try and relax. It can be hard as you worry about wires and tubes, how your baby will handle the experience and the general activity around you. Focus on your baby. Talk to your baby about your day, what you are thinking or pretty much anything that comes to mind. Try not to watch the monitors and the numbers. When you are at home you won’t have the monitors so learn to notice your baby’s physical cues for getting tired, uncomfortable or tense.

One thing at a time – When I was holding my son I used to instantly start rocking in the chair (who can resist in a rocking chair) and talking to him. A nurse pointed out that preemies get overwhelmed easily so start with one thing at a time. Once you are holding your baby, let him/her get used to that and then add one thing at a time. If you’re talking, don’t rock. If you’re rocking, don’t talk. After awhile your baby will start to be able to handle more.

Keep It Clean

It has been proven time and again that one of the most effective ways to get rid of germs and keep healthy is frequent hand washing. Babies who are premature are extremely susceptible to any virus or germ so it essential that you stay as healthy as possible. This can become even more difficult when you have small children. Here are some tips and products that can help make it easier to keep you and your kids (and their hands) clean.

Wash Your Hands. A lot. Try and wash your hands as much as possible. If you go to the store, wash your hands when you get home. Wash your hands frequently at work, especially when you go through public places.

Wash Your Hands for at least 20 seconds. That is how long it takes to wash all of the germs off of your hands. Try singing Happy Birthday as you wash your hands to make sure that you are washing long enough. And don’t forget about the top of your hands – they need some cleaning too!

Make It Fun
Kids often do a quick and not very through job of washing their hands. A nurse once told me that she had her nephews make “soap gloves” while washing their hands. This ensured that it took them longer and that they covered the front and back of their hands. We quickly implemented that and now our son loves to make soap gloves.

Companies are now coming out with soap that encourages kids to take longer washing their hands and have fun doing it.

SquidSoap by Airborne – According to their website: “It's the only liquid-soap dispenser with a specially designed pump that stamps a child's hand with vegetable dye. It takes about 20 seconds of thorough hand washing to remove the ink mark, leaving the child with clean hands.” Cool stuff. It’s fun and it helps you know if your kid has really washed his/her hands.

Dial ColorClean – This was featured in the February issue of Parent’s Magazine. This new antibacterial soap has “Timer Beads” that break open while your child washes her/his hands. The beads turn green or blue and slide around so your child really has to work hard to clean the soap off. I love that companies are getting innovative about this kind of stuff.

Hand Sanitizer – Companies like Purell have made hand sanitizers a standard for cleaning hands. Throw a bottle in your purse, diaper bag and car. When your baby comes home, keep a bottle in key areas where your baby will be so that you or your guests can quickly clean their hands. Our son thinks that Purell is fun so we have him use it after he has sneezed, coughed or touched his nose.

Choices
Give kids a choice about what soap they can use. Choose two soaps with different colors and scents so that kids can see a noticeable difference between the two.

Reward/Contest
Create a sticker reward chart for kids to use when they wash their hands. Give them a prize after they have washed their hands a set amount of time. Have a contest to see who washed their hands the most in one day.

Keep Track

Did you know that you can deduct medical-related mileage and medical expenses from your taxes?

If you haven't already, start keeping track of your trips to the hospital or doctor offices. For 2007, the standard mileage rate for the cost of operating your car for medical reasons is 20 cents per mile. That can add up and you should take advantage of it.

• Keep a notebook in your car and list each visit that you make to the hospital. Note the date and where you were traveling from. This will ensure that you keep an accurate record.
• Use your car's trip odometer to track how far away the hospital is from your house, office or anywhere else your routinely travel from to get to the hospital.
• Once your baby is out of the hospital, keep track of mileage for doctor visits as well
• Keep all receipts for medicine, equipment, and insurance co-pays. These expenses can also be deducted from your taxes.

Check with your tax preparer on all guidelines and rules before filing.

Visitors

When your baby is in the NICU, family and friends will naturally want to visit. Keeping these things in mind will help keep you sane and your baby healthy.

NICU rules – every NICU has their own rules about who can visit. Most have a two-person bedside limit with one person being a parent. Some NICUs allow only grandparents or siblings to visit. Others leave it up to the parents. Once you know the rules – please try and follow them. It makes it easier on everyone.

Preparing Visitors. Visiting a baby in the NICU can be an overwhelming experience. Here are some steps you can take to help make the visit a better experience for everyone involved.

Your baby – if your baby was born very small or with a lot of issues, prepare your visitors for what they will see. Let them know that there are a lot of machines, wires, and tubes hooked to your baby. Show them a picture (if possible) so that they have an idea of what they will be seeing.

The NICU – let visitors know that when they go into the NICU rooms, they need to act is if your baby is the only baby there. People are naturally curious about babies and given the openness of most NICUs, this idea can be really hard to understand. Explain that patient privacy is important and this rule is in effect for everyone.

Being Healthy – Everyone you know will be excited to see your baby. As the parent, you need to make sure that everyone realizes that keeping your baby healthy and germ-free is important. People have different ideas of what healthy means – maybe they were coughing earlier but now they are fine. Or their kids are sick but they don’t have a cold. If someone has experienced cold symptoms or has recently been exposed to someone with a cold, they should wait to visit your baby. This can be really hard to explain but if a baby gets an infection, it can be fatal. I got two colds while my daughter was in the NICU and as much as it hurt, I didn’t get to see her for 7 days while I got completely healthy.

Washing – Most (if not all) NICUs require you to wash and scrub your hands before entering. Make sure that all of your visitors do wash their hands. If the NICU has a suggested time limit – try and stick to it. This will help keep your baby healthy.

Timing – Try and space out visits/visitors so that you don’t have a revolving door of people coming to see your baby all at once. This will make it easier on you and the nurses who have to get their work done while you are there.

Interaction – Depending on what is allowed for your baby, encourage visitors to talk to and/or touch your baby. This interaction may be determined by your baby’s status or by you. Make it clear ahead of time so that people aren’t surprised when they get there.