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Another Insurance Question

huntington79huntington79
in 2nd Trimester

Mine is similar to a previous post, but I didn't want to be a post hog about my own issues on someone else's post. 

Anyway...

My husband switched jobs about 3 weeks ago and we lost our insurance. We considered going on Cobra, but it is quite expensive. It will be 90 days before he is eligible for insurance through his new job, so we just decided that we'll pay out of pocket for any doctor's appointments for the next 90 days, and then get on the new insurance in time for baby's arrival and the last 4 weeks of my pregnancy. Considering what we were paying for our insurance premiums and the amount that our insurance was not covering, I think we are actually going to end up paying less! It was awful insurance. Haven't had any issues so far, and I'm just praying that all else goes smoothly/normally while we don't have insurance.

Anyway, we got to our last Dr's appointment and told them the situation and they said that their policy is for those patients who are not on insurance to pay in-full, up front! So, that means that at our next appointment we will owe $2,750! That will cover the rest of our appointments, another ultrasound, delivery, and post-natal visit. But we don't have $2,750 to spend!!! I LOVE my doctor and she made it sound like they would totally work with us, but then when I talked to the finance lady, I got the hard-line. I asked her if we could make payments; said no. I asked her: well, we're getting insurance in 90 days, and will be covered for the rest of the pregnancy, delivery, and post-natal visits at that point. But, we'll have already paid cash for everything - so what happens to our money?" She said that after it was all said and done, they would evaluate what was covered by the new insurance and issue us a refund check. I've been so stressed/bummed about this and this is what I want to do (which my DH is not quite comfortable with): 

I want to go to my next appointment with about $600 and tell them that's all we can afford to pay at this time, and will try to bring the balance to the next appointment, and just see what they say. Basically, I want to make them have to literally turn me down and refuse care for a patient that they've had for 3 years - who is 24 weeks pregnant. If that fails, I want to lay the whole thing out to my Dr (didn't really want to have to get her involved in the finance thing) and see what she says. DH just wants to find another Dr or MW who is willing to take payments - and then deliver at a birthing center instead of the hospital (which is 45 minutes away as opposed to 5-10 minutes away). I'm not comfortable with that at all. Ugh! 

So what do y'all think? Any ideas?  

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Re: Another Insurance Question

  • ColieJColieJ
    While it was totally your decision I wouldn't have chanced having an emergency with no insurance. My bill for the first 3 days (everything not even posted to the bill yet) was $20k. I have now been in hospital for 21 days. While my situation is unique, I would have hedged my bets on cobra. All you can do is again state you don't have $3k and see what they say. 3 months is 12 weeks though so you will be 34 weeks. That is pushing it. Did you already verify with new insurance that your current OB is covered and that your pregnancy would be covered?
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  • eris1995eris1995 member

    I would have taken the cobra - especially being pg.  Is there anyway you can still do that?

    Complications can come up.  You can deliver early.  I would not be comfortable not having any insurance right now.  DH is self-employed and we pay an arm and a leg for our plan but it's better than "what if..."

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  • LCB34LCB34 member

    I don't think you are going to get out of the payment - policy it policy and you and your husband made the decision for him to switch jobs and be uninsured for 90 days.  I think that decision was not well thought out and you need to pay the consequences - it is not your OBs responsibility.

    I would totally see a clinic helping someone out that was forced into a non-insurance situation (i.e. getting laid off) but, you made this decision yourself (you DH changing jobs and not carrying Cobra until the new ins kicks in) - they should not have any obligation to help you.

     

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  • ColieJColieJ
    Also if you were currently under care and you switched even if they (hubby new INS company) considered it preexisting condition in most states they have to cover you. If you had a lapse, they don't. At my husbands job they don't have any preexisting clauses so pregnancy would be covered regardless.
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  • 618mom22boys618mom22boys member

    imageColieJ:
    Also if you were currently under care and you switched even if they (hubby new INS company) considered it preexisting condition in most states they have to cover you. If you had a lapse, they don't. At my husbands job they don't have any preexisting clauses so pregnancy would be covered regardless.

    This is what I was thinking.  Have you even talked to anyone from this new ins company to see if you will be covered?  

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  • huntington79huntington79

    State law dictates that insurance companies are not allowed to count pregnancy as a pre-existing condition on a group plan. I will be covered on the new insurance.

    I know my OB doesn't have any obligation to work with me. I didn't say that their rule was unfair, mean, or that we didn't take the risk. I'm simply saying that my Dr made it sound like it was totally fine when I talked to her, then I got the nitty-gritty from the finance administrator. I realize it is my responsibility and my risk, when we decided not to take the insurance for 90 days. I'm not really looking for opinions on what I should have done; kind of too late for that.   

    My question is more along the lines of, what have I got to loose by asking them to take the money I do have, and giving me more time to come up with the rest? Has anyone ever tried this sort of thing? What kind of success/non-success have you had? Any other ideas on how to deal with this? TIA! 

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  • christiecroffordchristiecrofford member
    imageLCB34:

    I don't think you are going to get out of the payment - policy it policy and you and your husband made the decision for him to switch jobs and be uninsured for 90 days.  I think that decision was not well thought out and you need to pay the consequences - it is not your OBs responsibility.

    I would totally see a clinic helping someone out that was forced into a non-insurance situation (i.e. getting laid off) but, you made this decision yourself (you DH changing jobs and not carrying Cobra until the new ins kicks in) - they should not have any obligation to help you.

     

    Some people need to make hasty decisions for their family. My husband just had to switch jobs a couple of weeks ago too for the betterment of our financial situation, although I have to wait a couple more weeks for insurance too. It was a sacrifice but in the long run, it is what is best.

    Anyways, I do not think you are going to get out of the bill either. It would probably just be better for you to get COBRA until the new insurance kicks in (if that option is still available.)

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  • girgirgirgirgirgir member
    Have you considered going to a different doctor or clinic for the next few appointments? Check your local Planned Parenthood to see which services they offer. Your state's department of health services may also be able to help or at least point you in the right direction. Then, when you have insurance again, you can visit your regular OB.
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  • mcwee1624mcwee1624

    It does not hurt to try. My suggestion would be to call back and ask before you actually go to your appointment. They may be more willing to work with you if they see that you have every intention of making payments, and $600 is almost 1/4 of the balance. The worst thing they can tell you is "No."

    Have you considered looking into some kind of state help in the mean time? As a tax payer, you should be able to seek some kind of temporary state assistance during a time of need. You can look into possibly applying for temporary medical assistance that might pay a portion of your bill while you cover the rest. I am not familiar with how these programs work but I know that many states provide assistance of some kind.

    Hope they are willing to work with you while the insurance coverage kicks in. GL

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