community

all boards


birth clubs



my blog

Sort:
01-11-2013 at 11:52 AM
shellyup
Not Ranked
Joined on 05-17-2008
180 Points
shellyup is not online. Last active: 04-23-2013, 4:25 AMNewbie

Please help! What would you do? Healthcare/Insurance issue...

Here is my issue, Ladies, I really hope you can help - and, maybe you too might want to look into your insurance and make sure this doesn't happen to you:

 So my OB, who I delivered with for my daughter's birth (she's now 3yrs old) has decided to change the hospital they exclusively will deliver at - and, I'm 8 months pregnant, the "new' hospital is in another state (now 45 minutes away from me) and - the BIG issue - turns out that even though the OB assured me that I was "covered" under my healthcare plan - upon further investigation with my healthcare provider, there are 2 tax id numbers that the new hospital can choose to bill - one is covered, the other is not.  OMG.  So I started with the OB - what the heck? Can you explain, I asked -  Did you know about this, I asked. And, most importantly - at my DH's recommendation (thanks honey!) I asked, "Can you put it in writing that I will not be billed under the tax id that is not covered?" - The billing person in my OB office said her contact at the new hospital will (be able to put it in writing), and said her contact asked me to email him personally so he could help. (My first red flag).

Turns out: one tax id (the covered-one) is for "hospital services"   So, I'm covered for my OB, obviously, and "hospital services" - great, BUT -

 the OTHER tax id with is NOT COVERED, as explained by the hospital person in our email exchange is for "Physician services"

My mind says - "Physician services" could be anything (outside of room service and my OB-related charges)!? Yikes!

What about: 

- Anesthesia/Anesthesiologist
- the Pediatric physicians (because, btw, my pediatrician does not have a license in the state of the "new" facility) and associated charges
- associated charges for circumcision
- lab/bloodwork
- associated charges for a C-section; God forbid, but what if something goes wrong and they need someone other than my OB to assist?

 I checked, and I can switch OBs under my healthcare plan this late in the 'game' with out accruing any additional costs.

 My question is this:

Should I switch OB's so late in the game?  I'm disappointed in my OB, have lost faith that they have my best interest at heart, and also, have never really connected with any of the 4 Dr's in the practice, so it wouldn't be a heart breaker for me, and, I fear making them upset with all my questions now then trusting them when I am most vulnerable later - BUT - they know me (medically), my history, I'm 8mo along and in the home-stretch, and it would be so time consuming and nerve wracking to meet and get to know an entirely new OB, and, what if this is a common-thing? that no matter what facility I deliver in, there will be variable tax id's?

  Please, ladies, what would you do?  I'm stressing over this, but don't have time to get caught up in feeling victimized or frankly, p.o'd - instead, I need to take charge, have a plan, and move forward in the most positive and (financially!) sound  direction...we could be talking the difference of thousands of dollars out-of-pocket, here.

I'm in the process of: 

1 - getting a full list of this second (not covered) tax id services, that I could potentially be billed for, so I can assess if it's even possible (that I may be billed)
2 - calling another hospital to ensure that all of the tax id's they bill are covered (as a backup plan)
3 - letting my OB know the latest findings with their new fancy-schmancy hospital (although they still have not called me back!  I'm sorry, but I can't help but place blame on them a bit - they should have known about this! AND, what about all the other soon-to-be mommy's that have my same healthcare coverage?  they have no idea, and could at this very moment be receiving an astronomical bill!)
4 - already contacted my pediatrician to get an OB referral

Thank you soooooo much in advance!  Any advice you can give would be great!

 

 
01-11-2013 at 12:04 PM
mommysange...
Not Ranked
Joined on 08-13-2011
11,079 Points
mommysangels is not online. Last active: 03-07-2013, 8:11 AMBronze

Honestly, if that happened to me I would switch in a heartbeat. I would be so upset and just find a new ob that delivers at the hospital your insurance covers 100%. I know it's hard to connect to a new dr., but you have to decide if you trust your dr. enough and want to pay the $$$ or do you want a new dr. and pay nothing. I choose B, lol.

01-11-2013 at 12:05 PM
mz07
Not Ranked
Joined on 04-06-2010
3,711 Points
mz07 is not online. Last active: 05-24-2013, 2:46 PMNewbie

Have you contacted your insurance company? The way mine words what they cover for maternity is, in layman's terms, anything needed to safely deliver the mother and take care of the baby. In other words, they might not distinguish between hospital and physician services if everything falls under maternity services. Does that make sense? 

They might (might is emphasized, because of course they're an insurance company) be able to help you figure out what questions to ask, etc.

 Good Luck!


Lilypie First Birthday tickers 
01-11-2013 at 12:08 PM
ggatlanta
Not Ranked
Joined on 08-01-2012
11,555 Points
ggatlanta is not online. Last active: 04-23-2013, 9:25 AMBronze

Gosh, awful situation. I would switch - and I am usually the "tough it out, you've gone this far with your doctor" type.

If your choice is:

* Do a ton of paperwork and correspondence to confirm that you will be covered with a doctor you're not really in love with, but never be totally certain you're fully covered, then possibly have to re-do all of your calls and paperwork if there's an issue after baby comes; or,

* Make a few phone calls to find a new doctor who can see you in time, and if you think it's a good fit, do your new patient paperwork, a new hospital registration, and then enjoy the rest of your pregnancy, knowing that your insurance won't get mixed up by the unusual hospital / doctor combination.

Then I would definitely do the second one!

(When it comes to insurance and hospital billing, you really have no control. All the emailed agreements from hospital staffers will not help you if the insurance company denies some part of your claim - it'll be, "fax this, copy that, oh wait, so-and-so is the only one with authority to handle XYZ, call her tomorrow at...". Yuck. My PT office used the wrong code on my insurance bills for a few visits last spring, and I am *still* cleaning it up. Seriously.)


 Baby Birthday Ticker Ticker 
01-11-2013 at 12:08 PM
SouthernMo...
Not Ranked
Joined on 06-20-2012
2,754 Points
SouthernMom70 is not online. Last active: 01-24-2013, 12:47 PMNewbie
I would switch OBs in a heartbeat. No way would I face potentially paying thousands of dollars out of pocket when I have perfectly good insurance.

 BabyFruit Ticker Lilypie Kids Birthday tickers Daisypath Anniversary tickers 
01-11-2013 at 12:13 PM
graciesmur...
Not Ranked
Joined on 07-30-2009
11,211 Points
graciesmurf is not online. Last active: 05-25-2013, 4:33 AMBronze

SouthernMom70:
I would switch OBs in a heartbeat. No way would I face potentially paying thousands of dollars out of pocket when I have perfectly good insurance.

This.

Plus, I would have a hard time trusting my OB when they gave me an insurance answer without knowing 100%.


Image and video hosting by TinyPic  BabyFruit Ticker 
01-11-2013 at 12:16 PM
TMWarren85
Not Ranked
Joined on 07-04-2012
18,900 Points
TMWarren85 is not online. Last active: 05-25-2013, 6:38 PMBronze

Wow- this sounds like something that you don't need stressing you out right now! For me personally when I was pregnant with DD I would have spent all the time trying to figure out what it would cost to stay with my OB and go through the headache and potential financial insanity. BUT- my OB was in the room for all of 15 minutes, enough time to glove up for the last push and was gone by the time they cleaned up DD and gave her back to me. I'm not saying it's not worth it to have the same provider care the entire length of your pregnancy but if it comes down to you potentially losing a lot of money when baby gets here or finding a new doc, I'd find a new doc that accepts your insurance plan. 

I know from personal experience that you can make all the calls you want, get all the codes and compare, ask questions but at the end of the day something always falls through the cracks. I saw a physician once at a stand along urgent care clinic that was covered by my insurance, but when the filed they coded it as an emergency room visit, not a physician visit and it was the difference in a $250 bill or a $3,500 bill. It took TWO years to get it straightened out... 


Lilypie First Birthday tickers 
01-11-2013 at 12:20 PM
b0710
Not Ranked
Joined on 12-13-2010
15,077 Points
b0710 is not online. Last active: 05-24-2013, 3:27 PMBronze

SouthernMom70:
I would switch OBs in a heartbeat. No way would I face potentially paying thousands of dollars out of pocket when I have perfectly good insurance.

I agree with this.  Even though it's no where near ideal, I don't think it's worth the chance of all the headache and costs.  If you ended up with extra bils that you received by sticking with the same doctor, you could be following them around for months or longer trying to get it all worked out.  

 I think for your sanity, switching would be easiest, especially if you've had a fairly issue-free pregnancy. 

 


Image and video hosting by TinyPic  Baby Birthday Ticker Ticker  Baby Birthday Ticker Ticker 
01-11-2013 at 12:20 PM
dande2129
Not Ranked
Joined on 12-09-2011
22,508 Points
dande2129 is not online. Last active: 05-22-2013, 10:52 AMSilver

Insurance stuff makes my head spin. However, I'd be promptly contacting your insurance company about billing/healthcare questions, not your OB. Your OB is not your insurance company and I'd be concerned that they were giving me false or inaccurate information.

ETA: Also, bear in mind that the cost of circumcision is not typically covered by insurance companies, so that is something to ask them specifically about. (I saw that on your list) In addition, the baby's pedi is different than your physician and therefore is billed separately, as are the anesthesiologists. These are definitely questions to raise with your insurance company so that you aren't surprised by any bills that are leftover after insurance, if you do, in fact, get any.


 Baby Birthday Ticker Ticker  Baby Birthday Ticker Ticker 
01-11-2013 at 12:30 PM
JJ3813
Not Ranked
Joined on 10-11-2012
4,946 Points
JJ3813 is not online. Last active: 05-09-2013, 8:26 PMNewbie

Yikes...sorry you have to deal with this additional stress.

I would switch. I feel like even if someone assures you that you aren't responsible for paying for certain things, there's really no guarantee that you won't find a bill in the mail a few weeks later. There are always loopholes that unfortunately, insurance companies are more familiar with than you are, because it's their profession.

If it helps, I switched practices when I was 20 weeks. I know it doesn't really compare to how far along you are now, but they were able to get me in right away and I really really like all of the drs...I liked 2 of the drs at my old office but there was one who was dreadful and I was terrified of having appointments with her, let alone having her be the one to walk into the delievery room.

Maybe ask around to get recommendations for drs in your area. It might be a rushed transition but it would probably eliminate most of the billing concerns you currently have.

Thank you for sharing this though, certainly gives us another problem to keep on our radar.

 Good luck with your decision :)  

 
01-11-2013 at 12:37 PM
StarBe
Not Ranked
Joined on 07-02-2012
11,794 Points
StarBe is not online. Last active: 05-12-2013, 8:42 AMBronze

1) Ultimately - I would find a different OB. There would be way less stress involved in the end.

2) If you are determined to stick with your OB - you definitely need to contact your insurance carrier and not your OB... this is between your insurance and the "new"  hospital basically.

That said - my brother (completely unrelated to pregnancy) has chronic Kidney stones and his DR became out of network. Based on "continuing care" as the insurance company phrased it he was able to continue seeing his current dr. Obviously there was no hospital involved but it may fall under the same "continuing care" procedure depending on your insurance.

***I would continue to get everything in writing***


 BabyFruit Ticker Nursing Bras at Nurtured Family  
01-11-2013 at 2:04 PM
rm2013
Not Ranked
Joined on 09-14-2012
23,974 Points
rm2013 is not online. Last active: 05-25-2013, 12:21 AMBronze
I'd switch. Use your insurance to find one of THEIR preferred hospitals and an innetwork OB. Makes life so much easier. Like PPs said all the assurances in the world aren't worth diddly squat if the ins company doesn't take your side.

Also, you may have it backwards not sure but at least for my insurance, "physician" services is for your OB and the babys pediatrician and all the other services are considered hospital services. For example, for my NT scan the perinatal specialist fee was billed as physician and the ultrasound and radiologist charge were billed as by the hospital.

Daisypath Anniversary tickers Lilypie First Birthday tickers 
01-11-2013 at 2:21 PM
chesnutrid...
Not Ranked
Joined on 11-12-2008
3,447 Points
chesnutridge is not online. Last active: 05-24-2013, 11:03 PMNewbie
Switch. I would also be concerned about going to a hospital out of state.

 Baby Birthday Ticker Ticker 
01-11-2013 at 4:08 PM
AppleJacks...
Not Ranked
Joined on 06-04-2012
4,842 Points
AppleJacks81 is not online. Last active: 05-25-2013, 5:36 PMNewbie
I'd switch doctors. At my hospita you get whoever is on call when you deliver. I didn't even see my ob. If everything is going well and your baby is healthy, I don't think switching would be too bad. Fwiw, the cash price for my induction and eventual c section and admission three years ago was around $17k. I wouldn't risk paying even a percentage of that if you don't have to.

 Baby Birthday Ticker Ticker  Baby Birthday Ticker Ticker 
01-11-2013 at 4:10 PM
stever
Top 500 Contributor
Joined on 04-08-2008
21,638 Points
stever is not online. Last active: 05-24-2013, 5:42 PMGold
I'd switch. Regardless of the billing issue, I would worry about that drive.
01-11-2013 at 4:44 PM
Courtneybe...
Not Ranked
Joined on 08-08-2012
2,408 Points
Courtneybelle is not online. Last active: 03-15-2013, 11:21 AMNewbie
ggatlanta:

(When it comes to insurance and hospital billing, you really have no control. All the emailed agreements from hospital staffers will not help you if the insurance company denies some part of your claim - it'll be, "fax this, copy that, oh wait, so-and-so is the only one with authority to handle XYZ, call her tomorrow at...". Yuck. My PT office used the wrong code on my insurance bills for a few visits last spring, and I am *still* cleaning it up. Seriously.)

This is so true!! It does not matter what you get in writing, if your insurance refuses the claim, then you will be up a creek. I also would switch OB's and stick with one that delivers in a hospital that is covered 100%. 


 BabyFruit Ticker 
01-11-2013 at 8:32 PM
shellyup
Not Ranked
Joined on 05-17-2008
180 Points
shellyup is not online. Last active: 04-23-2013, 4:25 AMNewbie

Thank you *all* so so much!

I feel a lot better because of your support!

Wow - it's unanimous, too, which gives me a ton more confidence to make this decision - and I'm really starting to agree, I think switching at this point is my best option.

I agree, too, that I need to focus this thing with my insurance company. 

Can't help but feel bad, though, for all of those other expectant mom's who are currently with my OB, and have the same insurance I do, and are going into this new fancy hospital without knowing all the facts...it will be MONTHS, maybe even years (it takes forever to actually GET the darn bills) before this issue will surface.  That is another reason I become so annoyed with my OB when they say "but we haven't had any problems with your insurance" - duh, because all of the circumstances haven't happened, and bills haven't gone out yet!  Tell me that in 5 years!

 To quote some of the email's I've received from the "new" facility so far, in response to me pushing to know how I can be assured that I won't have to stop everyone who breathes on me at their hospital and ask, "what is your tax id" they say:

"What (xxx) will do is make sure that we don’t expect more from you than what we would have been paid if we were a participating provider."

Haha - really?  that's convienent for you, but what you would have been paid could be THOUSANDS, and it would come out of my pocket!

and the newest promise (note "her group" refers to the un-covered tax id):

" I can assure you that both (xxx) and I will do our very best to make this as painless as possible for you financailly if you do get bills from her group or from the hospital for hospital services which are usually the largest bills that you would get."

Oh, painelss? Really? so just because hospital services is the largest bill, then I suppose the "other" bills will be mere pennies. Thanks! Sign me up! Seriously?

Just a final thought-

After feeling like I have a good handle on this now, and with all of your great feedback and support, and talking it over with DH - I'm now in a much better position for us to make a decision.

 However - now, I feel responsible for letting other mom's at my OB know what they could potentially be facing. Not even like a good semaratin kind of thing, but by not saying anything I feel irresponsible.  Best I've done so far is let my pediatrician know - hopefully it get at least a rumor-mill going in the medical community.  And, at the very least - to all of you, please make sure your hospital is FULLY COVERED and there are no hidden tax id's that can be billed under, which may not be covered.  Call your insurance co and get the approved tax id number(s).  Then, call the hospital, ask them to "put in writing that they will only bill for tax id xyz."  This is what started my whole investigation process.

Hopefully, you will not have any suprises like I did.

Thank you all, again!!! Really.

 
01-12-2013 at 10:21 AM
Lilopinto
Not Ranked
Joined on 06-27-2012
207 Points
Lilopinto is not online. Last active: 02-09-2013, 1:56 AMNewbie

Im sorry about your situation, I work for two different insurancecompanies in the past ten years 1. private ins 2. government fund programs (Medicaid/Medicare), so I want to assure you that contacting your insurance is the only way to go. First the hospital cant give anything in writing saying we are going to take care of you at no cost, they will bill your insurance who will after weeks will denied the claim and the hospital will then come for you. 

what state are you in? What state did the facility move to? most important who is your carrier?

 
01-14-2013 at 9:56 AM
shellyup
Not Ranked
Joined on 05-17-2008
180 Points
shellyup is not online. Last active: 04-23-2013, 4:25 AMNewbie
Lilopinto:

Im sorry about your situation, I work for two different insurancecompanies in the past ten years 1. private ins 2. government fund programs (Medicaid/Medicare), so I want to assure you that contacting your insurance is the only way to go. First the hospital cant give anything in writing saying we are going to take care of you at no cost, they will bill your insurance who will after weeks will denied the claim and the hospital will then come for you. 

what state are you in? What state did the facility move to? most important who is your carrier?

 UPDATE! :) 

You're absolutely correct, and thank you!  

I decided this morning that my Insurance Co would be my first contact.  TURNS OUT:  there is a stipulation called "RAPLE" in my insurance plan - which states that regardless of the tax id the hospital bills, the MAIN tax id (which is the covered tax id) will be what they use - so, ALL costs will be covered.  Also, it is extremely common (per insurance co) for hospitals to have multiple tax ids, but to use this term, along with "Universal Billing" and everyone goes back on the 'same page' in the event that the un-covered tax id is used by mistake.

OY

so, all of that for nothing - but, I'm lucky because my plan states that - one lesson learned: make sure my plan always contains this "RAPLE" clause and they participate in "Universal Billing" - other mom's at my OB still may not be as lucky

we're going to put this whole thing behind us now, and after all is said and done (and paid :)) I still will be switching.  I shouldn't have had to worry about all this in the first place IMO.

 

Thank you all again!!! :) xo

 
Hot Topics

New dad or dad-to-be? Chat with other dads here!
Visit the Dads & Dads-to-be board

Need baby shower inspiration? Get ideas here!
Visit the Baby Showers board

Chat with other crafty moms here!
Visit the Crafty Moms board

search boards

choose another board