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I may have to switch OBs...just need to vent


Forum: 2013 Playroom

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  • 5 Post By lister

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  #1  
March 5th, 2013, 11:34 PM
Mega Super Mommy
Join Date: Aug 2006
Location: Nevada
Posts: 2,505
I'm 35.5 weeks, and I may have to switch providers because of an insurance issue. We've been trying to get an in-network exception for my out-of-network OB. My OB's billing people suggested we do this, and they were in charge of it. The billing people said it's pretty common when someone lives in such a rural area to get an exception because there aren't a lot of options. My current OB is 100 miles away; she is the closest OB to us. To go in-network, we have to drive 3.5 hours. We can't afford to pay out of network for my OB plus in-network for the hospital (we are talking at least an extra $3,000 on top of our $1,500 in network deductible).

Anyway, we started this process about 6 weeks ago and were told that it would take 2 weeks to find out if we would get the exception. Well, I kept calling and calling and not getting anywhere. Finally the billing services lady called me last week and gave me an authorization #, which we were led to believe was for the in-network exception (meaning my OB would essentially be considered in-network). We got the paperwork in the mail yesterday, and all it is is an authorization number telling us that the insurance company deems my delivery to be a medical necessity, and it's okay if I see my OB but we will still incur out-of network costs. Well duh, I can go to any doctor and incur out of network costs. We waited all this time for that!? DH called the insurance, and there is a lady working on it so it may still work out, but it will be a few days before we know anything.


So I may have to call around and find an OB/MW willing to take me on after 36 weeks. And I'll have to drive 3.5 hours one way. And I still have to pay for all those doctor visits to my OB. A homebirth is out of the question because we live so far from any medical facilities. I had one with DD2, but we had to drive 3.5 hours to our midwife's house to have our "home birth." If we have to switch providers, then we have to work on the logistics of getting a hotel, trying to decide when to go down there (my last labor was 4 hours, so if we wait until I'm in labor baby might be born in the middle of the desert).

My mom wants to book her tickets to fly out here, but at this point I don't even know what airport she should fly into.

Aaaah. I just need to hear back from the insurance so we can make plans.

Thanks for letting me vent!!!!

I am just so lost right now.
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  #2  
March 5th, 2013, 11:51 PM
*Anya*'s Avatar Platinum Supermommy
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wow how frustrating I'm so sorry that it turned into such a mess, will be thinking of you guys and hoping for the best possible outcome.
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  #3  
March 6th, 2013, 03:34 AM
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Oh wow yeah that's crap!! Did they just change to out of network this year? Why are they telling you guys this so late? That's really stressful!!
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  #4  
March 6th, 2013, 03:40 AM
ThaiSpice's Avatar Platinum Supermommy
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Oh man...very frustrating! I'm so sorry you have to deal with this now. Hoping it all works out for the best!
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  #5  
March 6th, 2013, 04:52 AM
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Oh man, that has got to be so very frustrating! I hope they can get it straightened out and soon!!
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  #6  
March 6th, 2013, 05:55 AM
plastikmom's Avatar Super Mommy
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So sorry you are dealing with this stress!! Hope they are able to work it out for you soon!
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  #7  
March 6th, 2013, 06:49 AM
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Yikes, that is very frustrating! I hate dealing with insurance!
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  #8  
March 6th, 2013, 08:01 AM
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Quote:
Originally Posted by kitt View Post
Oh wow yeah that's crap!! Did they just change to out of network this year? Why are they telling you guys this so late? That's really stressful!!
No, my OB has always been out of network. We were just going to pay out of network for my OB so we don't have to drive 3.5 hours. But then we found out that the out of network deductible is separate from the in network deductible. So I called my OB's office to find out exactly what my OB's global cost was. When I did that, the billing lady mentioned this exception that many people get when they live in a rural community...basically even though the OB is out of network, she could get the insurance to treat her as in-network. She told me it would take 2 weeks to get the paperwork, but it's been 6 weeks, and we totally got the wrong thing. At this point I just need to know if the exception is going to happen so I can find a new OB if needed!
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  #9  
March 6th, 2013, 08:21 AM
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Join Date: Feb 2012
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HI. I usually don't post but I used to work for an insurance company (it was the Mental Health side not medical but it shouldn't be so different) so this info might be helpful to you.
Call your insurance and ask for a Single Case Agreement. The Insurance will call your Dr. and they will make an arrangement where the Dr will considered in network just for you based on that there are no other Dr's in your area. If you have any issues ask right away to speak to a supervisor no matter what the representative says to you.
Good Luck!
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  #10  
March 6th, 2013, 08:33 AM
ThaiSpice's Avatar Platinum Supermommy
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^ Sounds like that would be worth a try!
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  #11  
March 6th, 2013, 09:34 AM
Mega Super Mommy
Join Date: Aug 2006
Location: Nevada
Posts: 2,505
Quote:
Originally Posted by lister View Post
HI. I usually don't post but I used to work for an insurance company (it was the Mental Health side not medical but it shouldn't be so different) so this info might be helpful to you.
Call your insurance and ask for a Single Case Agreement. The Insurance will call your Dr. and they will make an arrangement where the Dr will considered in network just for you based on that there are no other Dr's in your area. If you have any issues ask right away to speak to a supervisor no matter what the representative says to you.
Good Luck!
Thank you for posting!! That is very helpful; I'll give them a call.
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  #12  
March 6th, 2013, 09:49 AM
HalfDozen's Avatar Formerly Number5OnTheWay
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Posts: 3,596
Good luck!! I can't imagine how stressful it would be to look for a new OB/midwife at this point. I hope you can get it figured out, and soon!!
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  #13  
March 6th, 2013, 10:11 AM
Purple_cat's Avatar Mega Super Mommy
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How stressful! I hope that you can get it figured out soon!
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  #14  
March 6th, 2013, 03:41 PM
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Location: NJ
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good luck to you..I am sorry you have this stress right now !
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  #15  
March 6th, 2013, 05:32 PM
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How frustrating! I hope everything gets worked out quickly for you.
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  #16  
March 6th, 2013, 09:12 PM
kimberley's Avatar Mega Super Mommy
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Ugh that sounds confusing and frustrating.. Hope it turns out for you!
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