Need advice for insurance!! — The Bump
Minnesota Babies

Need advice for insurance!!

Em&Josh99Em&Josh99 member
edited March 2014 in Minnesota Babies
Okay, i'm going to try to explain this as BEST as I can. I am a complete moron when it comes to insurance and I just need a bit of friendly advice. When I got pregnant I started seeing this doctor through the Allina/United Hospital network that I REALLY really like. She makes me feel comfortable and is very fast to respond to every concern/question I have. Well..come to find out that United hospital isn't really in our "preferred network" Our insurance deductible is $700, and with United our services would be covered at 70% with a max OOP of 5000. I think if we switched to a different provider, it would be covered at 90% with max OOP of 2500. My only issue with my network is that it's strictly Fairview and I just have a very bad taste in my mouth about fairview hospitals. I'm currently 15 weeks pregnant. What should I do?? Should I switch at this point? Is it worth it to switch providers if i'm happy with where i'm at right now?? Please offer any advice you have! Thank you so much! 

Re: Need advice for insurance!!

  • JGYJGY member

    I've recently begun working in healthcare and it's opened my eyes to the ways in which a lot of things work.  You likely have already, but have you inquired as to whether your Dr. has admitting rights to any other hospitals?  MANY physicians work within more than 1 health system, since more often than not the physicans are not employees of the system itself but rather work under a service agreement.  There's a chance that this Dr. might also be able to deliver in a hospital that is within your network.

    Re: Fairview, if you don't mind sharing, I am also interested in where the bad taste stems from.  In my experience as a former Doula, Fairview is all over the map in terms of their culture around birth (granted that was 7 years ago, but I hear similar stories now).  Your experience at Southdale (just as an example) could be lightyears away from your experience at Riverside. What kind of experience are you looking for?  I'd love to help if I can.

    Full disclosure ... I delivered at Riverside last year in March and was quite happy with my experience there, even while being devastated with my actual birth.

     

    Married to my amazing wife 6/12/10 
    TTC since 6/11
    Unmedicated IUI #1 - 6/28/11 - BFN
    Unmedicated IUI #2 - 7/25/11 - BFN
    Robotic Myomectomy (Fibroid Surgery) - 11/15/11
    Unmedicated IUI #3 - 4/24/12 - BFN 
    Progesterone Supported Leuteal Phase IUI #4 - 6/21/12 - BFP!!
    Baby Boy G Born 3/24/13

    On to #2, are we crazy?
    IUI #1 - 11/28/14 - BFP!  Beta #1 (11DPO) 34, Beta #2 (13DPO) 101, Beta #3 (20DPO) 3043
    Ultrasound at 6w4d shows a single, fluttering heartbeat.  Say hello to Sticky Ricki!

     

    image

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  • Em&Josh99Em&Josh99 member
    edited March 2014
    JGY-
    I appreciate your feedback TREMENDOUSLY! It's funny that you mention that about the doctors potentially working through several hospitals, I actually just learned that tidbit TODAY just hours ago haha! But alas, my doctor is strictly Allina/United affiliated.

    I guess as far as my dislike for fairview goes, Most of it is just word of mouth and hearing people's very unfortunate stories. I know every facility has these, but fairview just seems much more prominent in my mind as far as these go. For myself, I had an off putting experience before I got pregnant where I made an appt to discuss some concerns I was having in regards to conceiving. My periods were getting few and far between and I wasn't conceiving after months of trying. The doctor basically laughed at me and said I shouldn't even START to worry until it's been a year. I mean, granted it may have been a silly concern to her but to me it wasn't and she shouldn't have made me feel that it was. It's not that I would ever be stubborn enough to REFUSE Fairview's care, but I'm just sort of bummed that it's being presented to me as my ONLY choice (unless I want to fork out $$$) especially when I was so happy with the doctor I found. I hope that makes sense.

    My next question for YOU and anyone else that would care to chime in is, out of all the fairview locations in the twin cities-would you recommend UMMC Riverside the most? As opposed to Ridges or Southdale? Is there anyone specifically you could point me to?? I need all the help I can get. Again, thank you so much for your help!!
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  • auroraloo- Which Fairview location did you deliver at? Could you recommend anyone specially to me?? Thank you!!
  • JGYJGY member

    @Em&Josh99 I really sorry that you had that negative experience (no I don't work for Fairview ;) ), and I'm also sorry that the provider that you DO like so much isn't in network for you.

    I think that it's important to remember that much of the time any given Dr's approach/bedside manner/etc. is really mostly about THEM and not so much about the health system that they may work in.  And when it comes down to getting the kind of care you want, finding a provider that is supportive of your feelings and desires and treats you well is really the ticket to having the birth experience that you want.  I'm a really good example of that, in that the actual birth that I had was NOTHING that I wanted.  However because of the care team that I chose, the experience was still wonderful.  I know 100% that my care team did everything that they could safely do to help me have the birth that I wanted and, in absence of that, to respect my birth experience while still maintaining the safety and health of both me and my child (and my partner).

    I think that the best Fairview hospital for you to birth in really depends on what kind of experience you are looking for.  I can say that I chose UMMC Riverside because I wanted to labor naturally, have the ability to choose water birth if that's what I was feeling at the time, be in a culture that valued minimized interventions, and be in the best possible place for breastfeeding support.

    But that doesn't mean that I couldn't  have had that at a different facility if, say, Ridges was closer to me geographically.  So much depends on the relationship that you have with your Dr/MW and the care team that supports them.  But if you want anectodal information, I will say that it has been my experience that UMMC Riverside is more consistently supportive of the type of birth that I wanted.

    Was all of that politically correct enough??  ;)

    Feel free to PM me if you have any other questions.

     

    Married to my amazing wife 6/12/10 
    TTC since 6/11
    Unmedicated IUI #1 - 6/28/11 - BFN
    Unmedicated IUI #2 - 7/25/11 - BFN
    Robotic Myomectomy (Fibroid Surgery) - 11/15/11
    Unmedicated IUI #3 - 4/24/12 - BFN 
    Progesterone Supported Leuteal Phase IUI #4 - 6/21/12 - BFP!!
    Baby Boy G Born 3/24/13

    On to #2, are we crazy?
    IUI #1 - 11/28/14 - BFP!  Beta #1 (11DPO) 34, Beta #2 (13DPO) 101, Beta #3 (20DPO) 3043
    Ultrasound at 6w4d shows a single, fluttering heartbeat.  Say hello to Sticky Ricki!

     

    image

  • IMO, I'd keep the doc you have and risk the added cost.  I always opt for the better doctor because it's in the end more efficient than being stuck with one who isn't...

    I should also add that I'm NOT a fan of the Fairview system.  I had a WONDERFUL doc who moved her practice there, only to get "reigned in" to their lower standard of care making her hands tied which was frustrating because I'd been with her so long as a patient I could tell it was because of the Fairview policies that she wasn't allowed to treat me as she had for years previous...  I've also got other issues but I don't discuss them in a forum like this.. 

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  • I am with ya on the Fairview System, I am not a fan either. I am a social worker for the county and haven't been impressed with the quality of care.

    When chatting with a few coworkers we all are in agreement that the new maternity center at Southdale has been decent. Law suit wise they are at acceptable rating. (St Joes is pretty high if you are using that network of providers)

    I know this is more of an insurance option. But, when we trying to conceive our daughter, my husbands insurance didn't have that great of coverage for infertility treatments. And my job offered a plan that had my OB to be out of network too.

    We opted to just buy private insurance for me & then after our daughter was born we both went back on my husbands insurance through his work. (You can switch as birth is considered a qualified life event)

    For us it made sense financially to pay a few bucks more monthly to see who I wanted to see and remain in network then fork out more cash for being out of network with another insurance carrier. (Stress wise I wasn't willing to switch doctors either) I personally used BlueCross / BlueShield.

    Good Luck! :-)
  • I am with ya on the Fairview System, I am not a fan either. I am a social worker for the county and haven't been impressed with the quality of care.

    When chatting with a few coworkers we all are in agreement that the new maternity center at Southdale has been decent. Law suit wise they are at acceptable rating. (St Joes is pretty high if you are using that network of providers)

    I know this is more of an insurance option. But, when we trying to conceive our daughter, my husbands insurance didn't have that great of coverage for infertility treatments. And my job offered a plan that had my OB to be out of network too.

    We opted to just buy private insurance for me & then after our daughter was born we both went back on my husbands insurance through his work. (You can switch as birth is considered a qualified life event)

    For us it made sense financially to pay a few bucks more monthly to see who I wanted to see and remain in network then fork out more cash for being out of network with another insurance carrier. (Stress wise I wasn't willing to switch doctors either) I personally used BlueCross / BlueShield.

    Good Luck! :-)
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