Saturday, August 15, 2009

Yikes!!

I already decided to go with a different doctors than the one* I met with, one of the several reasons being that the wife-half of the team no longer accepts any insurance, and so she would have been covered at 30%, and since she's half the appointments and possibly delivery, this would have amounted to a LOT of money.

Well, I decided to double-check how much out-of-network is covered, and I was thinking about the wrong Apple plan (Apple has its own "special" plans through United, and it's large enough that it has its own customer service department, though this doesn't really mean jack). Our plan covers 0% for out-of-network, completely negating the point of having insurance when it comes to her. If she were to deliver, we'd be responsible for 100%!! What the hell is insurance for if it covers nada?!

* I met with the husband-half of the duo, which is why it's plural, then suddenly a one.

4 comments:

  1. Stumbled upon your journal. It's called you are supposed to use a doctor in their network. It is not the insurance companies fault either. So do not blame them. It's your responsibility to check before you obtain services and you can easily do so on the web site for the insurance or even asking the doctor's office themselves. They don't have time to go through and check for you unless you ask. That is not their jobs and is not as pressing as medical attention required to other patients or yourself. It is up to "buyer beware" basically. Everyone has responsibilities for health care, including the patient. That is why they ask you to choose a doctor as well, so that you are required to check if they are in network. The only time an out of network provider is considered in network (as it does happen) is in emergency situations as it is hardly likely at the time you can choose where you go for service. If you have a problem with the plan it is time to speak to your group administrator at Apple - they chose a plan like that (obviously an HMO vs PPO) to keep their costs down on the premiums they have to pay as well as they are required to pay 50% of the employee only premium rates. That's why United and other insurance carriers have such weak plans available as well - because employers want cheap plans but can say they offer insurance for employees. Aflac is a good option if you're worried about it. I've heard they offer supplemental plans that pay you cash money for gaps in coverage by major medical or even if you have no insurance. I think that's the Duck product.

    Also if you know they are doctors for "high end" clients, why are you so surprised at the costs?????????????????? That would tell me straight up that well if I'm struggling and unable to hardly make it right now, I think I should go elsewhere. There are plenty of great physicians and health care providers available for those with a budget.

    Also 15 pounds in a pregnancy is the recommended weight gain by all levels of income. Think of it like this, a baby weighs what 8 or 9 pounds - maybe 10 at birth. Any health care field that is up to date on research will tell you that 15 pounds is the recommended. Some exceed that as I know family has for my case, but I don't see him being out of line thinking 4 pounds so far is ok.

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  2. Too bad our insurance lists them as covered right now. So when their receptionists said they are covered, and our insurance lists them, what reason would I have for thinking they're not? The wife-half not accepting insurance is new. I'm not sure if she just hasn't informed out company, or if our company just hasn't updated their patient website. But there was NOTHING to indicate to us that one of them wouldn't be covered.

    If our insurance isn't changing, and these people "accept" our insurance, why go elsewhere instead of trying to find the best doctors in our network? Or who we were led to believe were in our network, anyway. If you've got insurance and money's tight, are you really saying this should mean looking for the budget-doctors? Why not look for the best of who's covered? If you're new to my blog, it might benefit you to know I'm very high risk, especially the delivery. Both vaginal and c-section carry a very real, high risk of death for me. We don't want to go to the cheapest budget doctor in our network if we don't have to, not when that would elevate my risk even more. Getting in to see a doctor at all can easily take several weeks until the first appointment. I'm almost 25 weeks, so that doesn't leave several weeks for me to wait, especially since one of my risks is early delivery, and there are three separate risk factors for that as it is.

    Everything I've read in books and online and my other doctors all recommend gaining in the area of 25 pounds if you're a normal weight, more if you tend to be very thin or underweight. My weight for my height (non-pregnancy) is on the cusp between normal and underweight. When underweight, 35 pounds or more is recommended. Baby may weight 8 pounds or so, but the amniotic fluid has weight, the enlargement of the uterus has weight, the extra blood, the placenta, enlarged breast tissue... There are more areas to gain weight than just the baby's body. 15 pounds is about what's recommended for obese woman. My pre-pregnancy weight is usually 121-122 and I'm 5'7, and it took a good bit of work gaining another ten before pregnancy, cutting out ballet. I trust Stanford to be a bit more up to date.

    My baby's hitting all her milestones, so my Stanford doctors weren't concerned yet. They did want to see me gain more in the third trimester. I'm overall not too concerned anymore myself (I'm also up to six pounds gained as of this morning), as she's active and seems healthy by all tests that have been done, and I'm taking tons of vitamins, so hopefully that's making up for anything I may be lacking in the weight department.

    I've got to say I like your username. One of our dogs was named after an Austen character.

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  3. Personally, I think telling you they are covered then billing you is quite shady. Assuming you had continuous coverage over the job change, you could talk to the insurance company and try to get reimbursement. It would be a hassle, but it might be worth a shot for $400.

    I would definitely not see these doctors again.

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  4. As a "courtesy" they were willing to "let" us pay at the next appointment. There isn't going to be a next appointment, so we aren't paying. That was ridiculous. I don't appreciate being told both are covered and not told about a very high fee for walking in the door, a "deposit," they call it. I don't know if it was bad training for the receptionists or what, but we can't afford to not be told about fees beforehand.

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