CareFirst and the NICU

mek10976

Has anyone here had experience with CareFirst insurance and coverage for a NICU bill?

I have the Blue Preferred PPO, which is normally really good and covers just about everything.  However, I have received a very scary bill from the hospital for the month that DS was in the NICU.

Just wondering if I need to pick up a few more jobs to pay for this, or if this is likely to be a billing mistake.

NowDNAtoo

I don't have specific experience with the NICU, but I have received a 'bill' from the hospital stating what everything cost before it was completely processed by CareFirst.  Once I received the CareFirst coverage sheet I then received an official bill from the hospital with what I owed.  I would call CareFirst and see if they have processed it and if this is the final bill.

fairfaxMomToBe

I have the same insurance and also got a weird bill from the hospital. It was followed up by a check from the insurance company for the exact amount. It's possible that for some reason they will pay you and not the hospital. I have not found anything that Carefirst PPO hasn't covered. I bet it's a mistake.

manciibride

I dont have carefirst but my insurance is a ppo.. If I choose a dr. within the network they pay 100% if the doctor is out of network they pay 70% and I am responsible for 30%.  My daughter was in the PICU after surgery for 16 days and so some drs that treated her in the PICU were in network -some weren't. I got a pretty hefty bill afterwards to pay the 30% for the doctors that were not in network.

I called the insurance company and told the rep that it wasn't fair because I could not choose whom was going to treat her at the PICU, obviously if it were up to me they would all be in network, but since she was in the hospital I had no control over that decision. The rep agreed and said I should file an appeal because they should cover as if it were in network when there is a hospitalization.  I received a letter 3 weeks later saying I had won the appeal and the bill would be paid at 100% instead of 70%. I would call customer service and ask if there is anything you can do about this balance...

Ana0927

I have the same insurance and the same thing happened to us when both my DD and DH were at the hospital and they were no small bills. 

 Apparently the attending dr. was not covered by my insurance but after reading the last post I am going to call and make an appeal.

Geb

we had the PPO in 2003 when #1 was born. The INOVA Fairfax NICU docs were considered out of network because they wouldn't contract with BC/BS PPO. There was a lot of written back and forth and the end result...we ate the balance. I appealed and everything. Now this was over 5 years ago, but I was royally pissed, because the last thing on my mind when our baby went to the NICU was in and out of network crap. Plus what was I going to do? Say "Oh no, let's not send him to the NICU for the hole in his lung?"

JenGK

Ditto on calling the insurance company.  We had an issue with a doctor who attended my emergency c-section being out of network, as well as some of the neonatologists who later treated Zach.  I called the insurance company, explained the situation, and they reprocessed the claim and paid everything.  I was able to resolve in one phone call what the billing office at the doctor couldn't for months.