Help an HMO newb ??

erinh2005 · September 2016

Long story short: DHs new job effed us around and our healthcare doesn't start until Nov. 1st. (I'll be 12w on Nov. 3rd). Also we signed up for HMO due to cost and have no experience with this coverage. Here's my question: I understand we have to see a primary care physician for all dr visits before being referred to a specialist (i.e. Obgyn). So I'm wondering if you ladies think it's smart to wait until our coverage starts to get that ball rolling? Or should I pay (around $300) cash to get a prenatal visit with a random Obgyn in the next couple of weeks just to make sure all is well. My fear is that the HMO process of getting in with an Obgyn is going to take a few weeks or something once our coverage begins Nov 1. Anyone with experience/advice please!?

jatwal128 · September 2016

I don't have any experience with HMO insurance, and I understand you wanting to see someone before 12 weeks. Do you have a primary care physician chosen at this point? If so, could you call them and explain the situation and see if they could at least tell you who they would be referring you to when the time comes? That way maybe you could get in and see the same OB initially even if the first visit is out of pocket. It would give you some consistency that way.

pshaortao · September 2016

Is this by any chance through Kaiser?

erinh2005 · September 2016

@jatwal128 That's a good start! I will see if they can give me that info.. We tentatively chose a primary care dr just based on location since we weren't familiar with anyone on the list so I will give her a call!
@pshaortao I've heard good things about Kaiser but it was also too expensive so it's through blue cross blue shield HMO

pshaortao · September 2016

Just checking

only because based on my experience with kaiser, they assigned both a physician and an ob/gyno doctor. It definitely wouldn't hurt to call the physician you've been assigned and go from there. That way you can schedule something for the first week of November with an OB.

m3ganmc · September 2016

We just got an HMO too and when I called the insurance company they said OBGYN is the one specialist that does not need a referral from your PCP.

erinh2005 · September 2016

@m3ganmc Awesome hopefully that's the case for us! Sounds like I should start by checking with the PCP. Thanks!

kat81 · September 2016

@m3ganmc
Ditto. I talked to my HMO insurance and they swore I did not need a referral for obgyn / prenatal care. And it seems like usually the deal is that you pay your typical copay for the first appointment ($20, $40, or whatever it is) and then the rest are free.

With that in mind, I'd go ahead and pick an obgyn and make an initial appointment to occur after your insurance kicks in. A lot of practices don't really want to see you until about 12 weeks anyway, so I don't think it's that big of a deal to have your first appointment be after this time. The only tricky thing is that some screenings are around 12 weeks, so if you think you'll want those tests done, it would be good to get cracking on it as soon as you make that appointment.

catem07 · September 2016

Lurker. I have an HMO and don't need a referral for ob/gyn. If you decide to go now and pay out of pocket you can still probably find one in your network. It's not like you have to go to a specific ob/gyn that they assign, it just has to be in network.

SparkySunDevil · September 2016

For a pregnant woman, your OBGYN is your PCP. Most insurances don't classify them as a specialist. I was able to make my appointment without getting a referral.

erinh2005 · September 2016

Yay I made an appt! I'm just gonna pay around $250 for my initial OBGYN appt. since I want to go prior to 12weeks but oddly enough they said I do need a referral (unless I was talking to a dummy)! So Oct 7th it is... Can't wait! Thanks for all the advice ladies!! @pshaortao @m3ganmc @kat81 @catem07 @SparkySunDevil @jatwal128

mdlorenz · September 2016

Why can't you get a PCP who does OB? (Family Practice). Forgive me if you are high-risk or otherwise prefer OB over FP with OB.

erinh2005 · September 2016

@mdlorenz That sounds like another good possibility. I guess I will see if the current set-up works and then go from there. I guess I was delivered by a PCP who did OB but I'm from a one hospital town in Iowa so I figure here in LA they're too busy for such a thing? Probably a naive assumption lol.

mdlorenz · September 2016

@erinh2005 - Yes, on either coast FP with OB is less common, but worth a look since you have hoops to jump through.

NurseK2016 · October 2016

*Lurking* @erinh2005 where are you from in Iowa!? I was born, raised, and still live in Cedar Rapids

erinh2005 · October 2016

@NurseK2016 Hi! I'm from fort dodge originally!!

ALC0618 · October 2016

Some states don't require OBGYN referrals and some do.

erinh2005 · October 2016

@NurseK2016 Oh! But I also lived in Iowa city and worked at the coral ridge mall for two years!

blueberry312 · October 2016

Sounds like you figured this out, but I just wanted to mention that I'm on an HMO, and I did need to get a referral from my PCP. So to anyone else reading this, it's best to check. And probably good just to touch base with your PCP and let him/her know about your pregnancy anyway...

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