Feb 23, 2008

Just a Little Health Insurance Freakout

Ok, I am seriously freaking out here.

I got a letter today from the hospital where we're scheduled to have the baby in early May. It seems they've been unable to reach a contract with our health insurer despite twice extending the deadline (the hospital is a nonprofit, the insurer is not) and, if they don't reach one in the meantime, as of April 1, we won't be covered if we have the baby there - it will be an out-of-network hospital.

I can't afford the OON fees (which, in our case, according to my insurance paperwork, would be just about the whole cost of having the baby - 2 years ago, it was about $13,000) and I sure as heck don't want to give up my OB at this point in the game (I'm 29 weeks tomorrow) - even assuming I could find another one.

I am hoping that one of the following happens:

(1) Best of all: they reach agreement and we continue as if nothing happened.

(2) I believe my OB has admitting privileges at the local medical school hospital *but* it looks from their website that he doesn't deliver there. I'd have to have one of their on-staff doctors do it and I'm not comfortable with that.

(3) I already have a letter from my health insurer (from the fall) approving me to deliver by c-section at my hospital - maybe because they sent me the letter already, I'll be ok?? Unfortunately, it also says that the approval is subject to the in-network/out-of-network benefits of our policy, so I rather doubt it.

I've emailed the negotiating VP for the health insurance company and plan to call his office on Monday. I'm also planning to call the customer service people at the health insurance company on Monday to find out if that letter will keep me from having to foot the bill or if there is some sort of exception for women about to have babies when this sort of thing happens. I'm *also* planning on calling my boss, who is also a state legislator, to see if she can hook me up with someone in the State Office of Health Care Advocate. Not that they can do anything really for me specifically but they could apply pressure to the health insurer to resolve the contract negotiation quickly and positively for subscribers.

Part of what's so damn stressful is that there's only about 10 weeks before I deliver (God willing) and, by the time the deadline passes, there will be only about 4 1/2 weeks remaining - that's very little time to get any other alternative plans in place, even if I knew for sure, today, what the end result of the negotiation was going to be.

This just sucks. I know, I know - there are so many more people with so many more urgent issues than this, but I'm freaking out all the same - this hospital and my OB have been really good and the idea of having to change is really frightening, particularly given the reputation of the "big" hospital (not the medical school hospital) in the area (currently on probation for a number of issues, including a fetal death from lack of monitoring).

6 Comments:

Blogger Brightdreamer said...

So, 2008 got to your health insurance. Bummer. Hope you can get things hammered out. I don't suppose your OB has any suggestions? (Sometimes, kids take matters in their own hands and pick their own delivery dates, too... and if any year would pull a surprise like that on ya, it would be this one.)

1:50 AM  
Blogger LauraJ said...

No wonder you a big ball of stress!! Wanna move to Canada??

11:58 AM  
Blogger smileymamaT said...

yes, that is an urgent matter. Glad you are contacting the right people. I'd be freaking out too. Let us know if it gets sorted out?

Take care-
T

8:29 AM  
Blogger Betty897X said...

My insurance company and local hospital went through this same thing in late 2006. They sent out letters to everyone, scaring the crap out of everyone who lives in my town. The next closest hospitals are both 20+ miles away. The good news is that they DID reach a deal. I think the letter was a scare tactic. Everyone got all freaked out and p*ssed off and I think the insurance company hoped they (the public) would pressure the hospital to comply. I don't know why/how is was resolved, but it was. I'm relatively sure the same will happen for you. You're just stuck in the middle of the corporate p*ssing match in the meantime. Now, granted, I wasn't about to have a baby, so I wasn't as freaked as you understandably are. I certainly hope it all works out for you.

12:38 PM  
Blogger Jade said...

That just sucks major... I hope it all works out. I would highly recommend talking to your OB to see if he has any advice or inside information maybe - possibly something to calm your fear?

2:34 AM  
Blogger Greta said...

it does suck rocks but umm sista...20+ thousand for a baby out of network or just a few thousand network i'd have to go with another doctor...i mean you will be in pain so it won't matter if another doctor is looking at your vajayjay....LMAO {snort}

10:27 PM  

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