Insurance question

REOM

I feel sick. I just received an email that effective Jan 1, the hospital where my daughter's team of specialists are will no longer be in our network. If the hospital isn't in our network, does that mean that the providers will not be either? Our geneticist also works out of another hospital, could we possibly see her there, or not because her main address is this other hospital?

Another option is to put my DD on my husband's insurance (which is super expensive, but covers that hospital). Can you cover one child, but not the other?

I will call and ask, but I thought I would ask if anyone here had an insight.

Thanks

ToastieSimons

1) you can always call your insurance company and request a caseworker.  They may be able to fight to have your specialists covered because they're who you've always used.

2) Yes, if your insurance covers the specialist at another hopsital you may use them.  We had that issue with a GI dr.  He works at a children's hospital that is not in our insurance.  However, 1 day a week they did a clinic at another hospital on the other side of the city.  We could see him there.

3) I have no idea about covering 1 child and not the other.  Besides for us there is a 1 person/2 people/family rate.  Once you cover 1 child the rate doesn't go up to cover additional children so it would probably be cheaper to add both of them to your DH's insurance if you choose to go that route.  Also you have to know when open enrollment is.  You can't just add them at any time.

REOM

Thanks so much Toastie. I am still in shock  that it was our hospital that we listed. We finally found a team that we love and I'm going to do whatever I need to for my daughter to continue there.

My husband's insurance open enrollment is Nov, so that is actually rather convenient if we have to go that route. But I'm going to call Blue Cross (mine) tomorrow.

Thanks again! Insurance, ugh.

thefuturemrskudla

the providers may still be in network.

REOM

thefuturemrskudla:

the providers may still be in network.

But her office is physically in the hospital that is going out of network. You don't think that automatically causes her to go out of network too (I sure hope not!) ??

thefuturemrskudla

No, it doesn't. 

 

BUmama

Call the providers individually, but generally it refers only to the hospital itself.

That said, it's probably a scare tactic by the insurance. They want you to call the hospital and ask questions to force the hospital to play by their rules and therefore stay in network.

We get these letters on a pretty regular basis from our insurance company and a month later we'll get another one retracting the earlier statement.

REOM

BUmama:

Call the providers individually, but generally it refers only to the hospital itself.

That said, it's probably a scare tactic by the insurance. They want you to call the hospital and ask questions to force the hospital to play by their rules and therefore stay in network.

We get these letters on a pretty regular basis from our insurance company and a month later we'll get another one retracting the earlier statement.

Yes, the language they used was definitely bad-mouthing the hospital. I'm glad to know that it's common. Hopefully they will retract...

LandoWedding

Just dittoing to ask for a caseworker!

Justinlove

Your individual providers are the ones who accept/deny insurances so you might be ok.  However, if their office is located inside the hospital, then chances are good that they fall under the hospital's insurance umbrella.

Ask for a caseworker, but I'll be honest with you.  If the hospital actually gets dropped by the insurance company, it is because the hospital refused to pay the rates the insurance is requiring and you will have a HARD time getting the insurance to accept services from their providers.  If it gets to that point, things did not go well with negotiations and they will probably not want to work with you to help you individual situation.

I would not lose hope yet, but I certainly would look into covering your children under your husband's plan.  In my experience, it doesn't matter how many children you have, they are all covered under one plan price so seperating your kids onto different plans would not necessarily be in your best financial interest.