Here's what I've learned recently:
- Aetna, and probably any insurance agency, makes their policies so confusing and convoluted that even their representatives can't agree on anything. Guess that makes sense. If a procedure is confusing, people are probably inclined to just pay the bill and move on. Well, I'm 100% certain that I'll be making additional phone calls and claims after baby boy makes his grand entrance. Somehow, I'm convinced that this is going to blow up in January no matter what I've discovered the past week.
- One thing is for certain: when the old practice files for their money, I'm am going to be responsible for a copay for every doctor visit that I went to with them. What's so great about this is that I can predict to the dollar what I will owe out-of-pocket for that care. Finally, something that is black and white.
- The new practice will bill Aetna globally. What I don't know is if Aetna is going to split up care in 2011 and 2012. In the 6-7 calls I've made to Aetna the past week, there is seriously a 50/50 response rate to this inquiry. And since my new practice is a specialist (I use that very loosely since I will never see the doctor), I will have to meet a deductible before insurance will kick in. Lucky for them if they split things between 2011 and 2012 since that means I'll be paying 100% for the prenatal care because their cost is actually less than my two deductibles combined since I'm transferring late in the game. The new twist to this is that I finally got the figures for office visits. There is a $300 difference between 1-6 visits, and 7+ visits. I have one visit under my belt and could have three more before the end of the year. It's possible I'll have three more in the new year, but if I didn't start seeing them until the new year, I would be in the same bracket as I might land anyway, so I'd be charged the same amount. Now, would insurance have tolerated my potential 2 visits being charged the same as a possible 6? I don't know. I can't get a straight answer, but since OB care is standard and is billed globally (remember, that means the OB doesn't file until the baby is born, so all care is captured in one giant bill), I won't find out until the very end anyway. Also, will insurance split the office visits up in calendar years, thus lowering the overall cost of each visit? I don't know. Can you see that there are a lot of I don't knows?
- And speaking of deductibles, if this bill settles and I am charged the full deductible for both 2011 and 2012, then we'll be responsible for 80% of prenatal, doctor delivery and postnatal care. I ran the numbers and there's a chance that insurance will only pick up....wait for it...approximately $550. I'm so not kidding. Now, that figure doesn't include the actual hospital stay (yet another call I am going to make so we can predict what we will owe and make best use of our FSA allocation since Craig found out we can still make changes), but we will be paying way more than insurance if it pans out this way. What's ironic is that we pay more than $8000 a year just to have this lovely Aetna insurance (seriously...do some quick math and realize that that is more than the $550 they could be fronting for this care!). They are making their money off of us whether or not I meet the deductible in both years. It's basically way cheaper to pay completely out of pocket for the birth and not have insurance. I have all the numbers written down, but I won't put it here. Suffice it to say that a traditional labor and delivery costs less than $8000, including all the prenatal and postnatal care and the hospital stay.
- I did find out that the fees at the new place, despite being a specialist practice, are actually less than the old place, and the Aetna care calculator thingy also says that the overall hospital stay is cheaper at the hospital the new practice is affiliated with. So, that's good news.
ANYWAY...
Since my hours and hours and hours on the phone have literally left me with no resolution.
And I can't get straight answers from difference Aetna representatives.
Which leads me to the impossibility of actually predicting anything.
I'm going to make the decision based off of what I want, versus let ambiguity dictate something that we won't truly know the answer to until after this baby is born.
The new practice it is.
I needed to go through this exercise for a couple of reasons. Primarily because I didn't feel comfortable with how the whole transfer went down. It didn't feel right to be told that I needed to pay 20% of their fixed prenatal care costs when I was only going to be seeing them for 12 weeks. I can now change practices knowing I have exhausted all my resources and literally reached the end of the road (no matter that the road was a complete dead end...). And I'll say that we have the money. But I firmly believe just because you have, doesn't mean you should. I want to be a good steward of what's been given to us, and that means researching the fiscal repercussions of changing practices.
And I promise this is my last post about insurance. I will return to my regular, surface, and all-about-my-family-to-include-cute-pictures-of-Madeline blogging in the next post. :-)
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