Hospital / OB WWYD

[greycat]

I have BCBS insurance through MH (works for the Feds). Apparently BCBS recently redid their networks. As of next year the hospital I am planning to deliver at will become a Tier 2 provider which means I will have to pay a portion OOP (not sure how much more yet). My OB only delivers at the hospital I was planning to deliver at so if I switch hospitals I need to switch docs as well.

I don't love my OB but I am generally happy. I had a great experience at the hospital last time (nurses, docs, overall care). I picked the hospital because it has a level 3 NICU. My nephew had unexpected complications as a newborn (full term, normal delivery) so I feel strongly about having a good NICU where I am. I picked my OB because they delivered at this particular hospital.

Of course company's open enrollment is this month and MH isn't until next month. I'm hoping we can find out enough info about the new network to evaluate the costs / coverage.

Would you switch providers or consider paying more OOP? If you switched providers during your pregnancy did you have trouble finding an office willing to take you?

[spk926]

If you don't absolutely LOVE your OB then I would switch. There are tons of OBs out there that you can be "generally happy" about like your old one. What level NICU care does the hospital you would deliver at if you switched have?

Side note- I switched OBs because we moved. It was so hard and I even cried to DH about it because I LOVED my old OB. Probably an unhealthy amount. That being said, I asked around and got so many glowing recommendations for a new one and I'm almost halfway through my pregnancy and so far I love him and his practice. So there is definitely hope that you'll find another OB you like as much or more than your current one.

[londoncalling]

I switched providers before getting pregnant (by a month or so) because of insurance. I could either switch for 100% coverage or have 80% covered. 20% OOP of a standard delivery is $$, let alone if there were complications. I personally would try and find the least expensive option that I'm most comfortable with.

I think you need more info to find out what hospitals are covered as Tier 1 and what their NICU situation is and evaluate if that's OK and then find an OB practice and talk to them before making your decision.

I'm sorry that you're having to deal with this!

[greycat]

The other hospitals near me have Level 2 NICUs. The closest Tier 1 hospitals with a Level 3 NICU are 1+hrs away (more in traffic) which is further than I would like to go.

There is a hospital near me that has a Level 2 NICU but is affiliated with CHOP (regional children's hospital). This might be a good compromise. fS was hospitalized there when he was a baby and I had a bad expire eve with one of the NICU nurses which is probably coloring my view of the hospital.

Honestly the hospital is the priority to me over the doc. My main annoyance with my OB is that they always run late and aren't effiencient with paperwork, lab results, scripts, etc.

[Deleted]

With the girls I chose my OB based on the hospital. That was more important to me than the Dr. I switched to them when I was newly pregnant, maybe 5 weeks or so.

[Deleted]

Oct 5, 2015 8:13:44 GMT -5 spk926 said:

If you don't absolutely LOVE your OB then I would switch. There are tons of OBs out there that you can be "generally happy" about like your old one. What level NICU care does the hospital you would deliver at if you switched have?

I agree. There are so many OB's out there, especially if you're not in love with your current one. A Tier 2 hospital could be unexpectedly MONSTROUSLY expensive KWIM? I had DS at a fully covered hospital, and he had complications as a full-term newborn. My total bill was $30K, which is not *that high* really for a NICU stay. But still, if it had been a Tier 2 hospital for my insurance I would have had to pay 20% OOP. That's six THOUSAND dollars. We certainly don't have that kind of cash available. Now imagine if he/I needed $50K worth of care. Or $100K. Or more. That's not a risk I would be willing to take. I would find a fully covered OB and hospital.

[Deleted]

I switched OB's at 7 months PG because we moved. My new OB took me no problem.

[Ashley&Scott]

So the issue is that your hospital is Tier 2, it really has nothing to do with your OB right? Yes, I would pay more to be at a hospital with a level 3 NICU. 

[jessnpaul]

Yes, but if it's Tier 2 and your kid has to go to the NICU there, wouldn't you be responsible for some of that too? And that can get REALLY expensive!

My kid spent 8.5 weeks in the NICU (level 3) and the bills were ENORMOUS! Thankfully BCBS (I've since switched) covered the entire hospital bill but not the doctors, but that's a story for another day.

[greycat]

Oct 5, 2015 9:04:17 GMT -5 jessnpaul said:

Yes, but if it's Tier 2 and your kid has to go to the NICU there, wouldn't you be responsible for some of that too? And that can get REALLY expensive!
.

I have no idea how it would work. We are planning to call our insurance to get more information. I'm guessing either they would cover it because it's an emergency or they would transfer to a hospital further away.

[Deleted]

How many weeks are you? I switched at 11-12 weeks and I am so glad I did. THe process was a little nerve wracking just because i needed to get an NT scan and didnt have a doctor. I now feel great about my decision. Im at a much better hospital and have a doctor who is way better. My previous doctor was never on time for appointments and was just an overall pain in the behind to deal with.

[greycat]

Oct 5, 2015 8:58:19 GMT -5 @supergreen said:

Oct 5, 2015 8:13:44 GMT -5 spk926 said:

If you don't absolutely LOVE your OB then I would switch. There are tons of OBs out there that you can be "generally happy" about like your old one. What level NICU care does the hospital you would deliver at if you switched have?

I agree. There are so many OB's out there, especially if you're not in love with your current one. A Tier 2 hospital could be unexpectedly MONSTROUSLY expensive KWIM? I had DS at a fully covered hospital, and he had complications as a full-term newborn. My total bill was $30K, which is not *that high* really for a NICU stay. But still, if it had been a Tier 2 hospital for my insurance I would have had to pay 20% OOP. That's six THOUSAND dollars. We certainly don't have that kind of cash available. Now imagine if he/I needed $50K worth of care. Or $100K. Or more. That's not a risk I would be willing to take. I would find a fully covered OB and hospital.

Agreed. I'm sure what our responsibility would be yet - still trying to figure that out. I had an induction & epi with DS and the bills were quite high so I'm sensitive to the cost.

[greycat]

Oct 5, 2015 9:13:47 GMT -5 mr+ms said:

I would think you need to know the OOP limits for the plans in question before comparing. If similar and not sky high, then there may not be much of a $$ difference at the end of the day.

Agreed unfortunately MH's annual enrollment isn't until next month. I'm hoping we can get info sooner.

[mlt]

Unless you have some serious complication that requires a specialist I would switch providers so you can pay less out of pocket.

[Deleted]

Not exactly on-topic, but I'll need to switch OBs at about 20 weeks pregnant given our move. When should I start looking for an OB in our new community?

[gerberdaisy]

I think the level 2 with the affiliation with CHOP sounds like a great compromise. I have Fed BCBS and have always been really happy with it, therefore would probably not change insurers, but would find a new OB with the level 2 hospital.

This is assuming there is no known reason you would be more likely to need the NICU.

[greycat]

Oct 5, 2015 9:26:15 GMT -5 @cookiemonster03 said:

Oct 5, 2015 9:11:25 GMT -5 greycat said:

I have no idea how it would work. We are planning to call our insurance to get more information. I'm guessing either they would cover it because it's an emergency or they would transfer to a hospital further away.

This is typically very complicated.  I had a similar experience  (at a different facility) as jessnpaul with the NICU coverage and doctor coverage not being the same. From what I gather, this isn't all that unusual.

Good to know. My only experience has been with an anesthesiologist being out of network when the rest of the docs and hospital were in network. It was covered since I didn't have a choice in provider.

[Cicero]

How did you find out they were redoing their network? We have BCBS too and am now wondering if we'll have issues as well.

[greycat]

Oct 5, 2015 9:27:35 GMT -5 @cookiemonster03 said:

In theory, a level 2 with a CHOP affiliation sounds fine, but...I'm honestly way too risk adverse and would prefer the drive for piece of mind.

Me too normally. However I would probably have a drive for the OB not just the hospital and that's not practical for me. Also I'm not considered high risk so I'm not sure I can justify it to myself even if it is my preference.

[jessnpaul]

Oct 5, 2015 9:30:29 GMT -5 greycat said:

Oct 5, 2015 9:26:15 GMT -5 @cookiemonster03 said:

This is typically very complicated.  I had a similar experience  (at a different facility) as jessnpaul with the NICU coverage and doctor coverage not being the same. From what I gather, this isn't all that unusual.

Good to know. My only experience has been with an anesthesiologist being out of network when the rest of the docs and hospital were in network. It was covered since I didn't have a choice in provider.

After fighting tooth and nail with BCBS over so many charges, I leared that those are the magical words when it comes to insurance! That's the only way I got the NICU doctors covered at the in-network rate as well as various other OON providers that saw him while he was in the NICU! We still owed the balance (which we didn't have to pay since my son qualified for Medicare due to only being 2 pounds at birth) which was ridiculously $$$! 

[greycat]

Oct 5, 2015 9:33:32 GMT -5 Cicero said:

How did you find out they were redoing their network? We have BCBS too and am now wondering if we'll have issues as well.

I saw an article this morning. I would check into it before you panic. It is pretty impactful where I am (NJ) but may not be where you are.

[kershnic]

Do as I say, not as I did. I picked the doctor rather than the hospital. I changed doctors at 30 weeks in a high risk twin pregnancy (with no problem, btw, I talked to several and no one rejected me). My hospital had a confusing arrangement with my insurance that at one point I thought was going to mean paying the out of network deductible.

Choose the hospital that is covered the best that has a NICU you believe in. I wouldn't deliver at less than a level 3 NICU either. Then find a doctor who delivers there.

[CloudBee]

Oct 5, 2015 9:17:52 GMT -5 @idaholakelady said:

Not exactly on-topic, but I'll need to switch OBs at about 20 weeks pregnant given our move. When should I start looking for an OB in our new community?

I would start calling around now so you are on their radar. You can at least get paperwork filled out and mailed or faxed back to them.

[thatgirl2478]

First - double check that the changes are in fact happening. Second - find out what happens if you need to use that hospital. Sometimes BCBS can bill hospital services as covered if the OB/Pediatrician is covered (it happened to us - we have FEP BCBS PPO). Finally, worry about IF your baby needs the NICU at the higher level of care hospital once your baby is here. I would deliver at whatever hospital is covered and IF the baby needs to be transferred then either you can be transferred with him or you will already be released and therefore not staying at the hospital anyway.

But it boils down to a financial issue - can you afford possibly 20% of whatever NICU bill there is? 30k, 50k, 100k, more?

Here's what happened to us:

Our town had 3 different hospitals. 2 'merged' or at least that's the story they told the public. In reality, they just share the same 'brand' name - nothing else. When I went to verify that my preferred hospital was covered, I found listings for the DOCTORS and certain satellite groups which I assumed meant the hospital was covered. It wasn't. One month after delivery (c section) I received a bill for $3600 for my baby. When I called the insurance company to find out why it wasn't covered, they said the doctors services were covered but the HOSPITAL wasn't. And that's when I found out that the 2 hospitals with the same name weren't the same (one is covered one isn't). A few weeks later I got the bill for my hospital stay - $17k - so $20k total. Luckily they were able to bill it as if I went to a covered hospital because my OB and our Pediatrician were all covered (not sure why they couldn't do that in the first place).