When we moved to New Jersey, I was already 24 weeks pregnant. Of course, I didn't know anyone who could give me a recommendation for a good obstetrician, so I just ended up going to one of the first places I called. Fortunately, I ended up loving my new doctor. Her office and the hospital she worked through both accepted our insurance, which was great.
Being the slacker that I am, I failed to look for pediatricians before Porgie was born. So, I just ended up taking her to the pediatrician that took care of her in the hospital. Being the naive girl that I am, I just assumed that they accepted my insurance.
Since Porgie's birth, we have been receiving numerous bills from the pediatrician's office. I honestly never analyzed the bills, I just paid them.
On Friday I received a bill for Porgie's nine month check-up. The bill was for $106.00. According to the bill, I was responsible for $85.00, the insurance company was responsible for $0.00, and there was an adjustment which subtracted $21.00 from the bill. Now, I might be a little dumb, but this bill obviously was incorrect. Why would I be responsible for 80% of the bill.
I called my insurance company to bitch, when the girl on the other end explained that they do not pay for out-of-network doctor visits. What? I explained that I went to an OB who worked for Cooper Hospital (who accepts my insurance), delivered my baby at Cooper hospital (who accepts my insurance), and took my daughter to the pediatrician who checked her out at Cooper Hospital. Obviously, the pediatrician had to be in-network too.
The lady on the other end proceeded to tell me that the office where I have been taking my baby is not in-network, nor are any of the doctor's from that office. I was stunned. How could no-one have told me?
Sure enough, I went back and looked at the bills we received after Porgie's birth. The OB and hospital expenses were covered (at least partially) by our insurance. However, our insurance company failed to pay any of the pediatrician charges - even for the initial newborn care in the hospital.
I am extremely confused. How can an insurance company accept charges from the OB and the hospital, but not the pediatrician? When you have a baby, there are several people who have to be present in the hospital - like the pediatrician. I just don't understand.
With a heavy heart, I decided that I had to change doctors and hospitals. The only other hospital close to our home accepts our insurance, but guess what? The OBs from that hospital do not accept our insurance. AHHHH!
I am so fucking frustrated. I want to rip all of my hair out. FUCK!
10 comments:
What the hell? That is so fucked up! I'm pissed right along with you.
Keep calling the insurance company and bugging the piss out of them until you get the answers you need.
HMO's in this country are beyond fixable. I would never want universal health care either because that would be even worse. You think you don't have control over anything now, having the government tell me when and who I can see is wrong. We need to be in control of our own health care and be able to see whoever the fuck we want.
Sorry for the rant. Anyway...I hope you figure this out because it's just way too expensive to be out of network or paying out of pocket and not using the insurance that gets taken out of paychecks every month.
aaaaahhhh! i am dealing with insurance issues of my own. being self-employed is a major issue when trying to get insurance...and rates...holy shit the rates! until december of last year, we were paying $1700 every two months for health insurance (with maternity coverage) from blue cross blue shield. can you believe that shit? we then switched over to a different company and opted for a high deductible HSA plan. problem is, we haven't been really disciplined about putting money into the HSA and of course, all the doctor's visits are paid by us at 100% until the deductible ($5200 for our family) is met. i am now looking into yet another plan that would work for our family. each of mikaela's doctor visits (with the immunizations) are costing us around $400!!!! i fucking hate insurance and the medical industry in general. they are in cohoots to keep medical expenses high so the insurance companies can justifiably have insanely high premiums. in many other countries, their is subsidized healthcare...but i've heard horror stories about that as well. i wish you the best of luck in finding a new pediatrician.
ooops...i meant "there"...not "their". can you tell i was writing in a frenzy??? damn typos...
That is so retarded. And frustrating! Why would the hospital even have an out-of-network dr check your baby in the hospital? Just to F with you?
I have to admit, this is why I'm a (little) glad I belong to a massive HMO. That way, the HMO pediatrician on call checked out Baby E in the hospital. And then they just assigned me to some dr. (Though I did just rant abt her on my own blog...) So actually I hate HMOs too. I just hate it all. Okay?
106 bucks for a well-baby check. Give me a frickin break.
thats all very confusing for me, we pay taxes and goverment pays for health care, so in effect its free, granted they take a 3rd of our wage in taxes. But even if that how things are still doenst seem fair
Ugh, I hate insurance! Something needs to get done in this country about insurance! I hope you find another doctor/pediatrician that you love!
Insurance companies suck. We had a similar problem with the ped that I chose for Claire too. His services were covered 100% in the hospital and for the first 2 weeks, but afterwards I would have to change to the NAVY's ped OR pay a big copay. I thought that the ped was considered "in-network" based on the insurance's website, but apparently that doesn't matter in this area. I had to switch her to the NAVY ped, but luckily that worked out well. I took Claire to that other doctor for about 1.5 months, so I'm waiting to see if the ins. will cover it or not.
Insurance companies and health care in this country suck.
i have zero clue how medical insurance works in the US, but it certainly sounds kinda like it doesn't...and i'm frustrated right there with ya as the situation sounds unreasonable.
however, i've been away and not reading for a coupla weeks...you're pregnant! that's wonderful, Christy! congrats to you, and i hope that goes smashingly.
How frustrating. And confusing. I'm sure you have a good plan and can sort it out. Changing doctors sucks, though.
I handle the medical bills at our house. I am constantly amazed by how stupidly it's all done. Here's my tip: call the insurance company directly to find out what you owe people. Your doctor's billing office is as likely as not to screw up.
Well written article.
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