Well, changing practices hasn't been so cut and dry.
Things I've learned in my hours and hours and hours on the phone with our FSA, Aetna and the new practice.
- The new practice's supervising physician is a perinatologist. Midwives cannot practice without a supervising physician in the state of Georgia. Because he is a perinatologist, insurance won't kick in until I've met my $750 deductible and then I'm subject to 20% of all visits. Even though the doctor is also an OB/GYN, insurance views him as a specialist, so my coverage is different. No matter that I will never see him and the only thing he is going to do towards my prenatal care and delivery (should I be successful at a VBAC, which is the whole point of changing anyway), is to review my surgical records to say I'm a VBAC candidate. There honestly shouldn't be a reason that I'm NOT a candidate.
- My particular insurance doesn't have carry over deductible for conditions that span two calendar years, like pregnancy. Since this baby is due in January, we're obviously going to cross over calendar years.
- The old physician that was overseeing the midwives at that practice was part of the Excel community and therefore insurance picked up the majority of my prenatal care. However, we have NO idea how much we are left with because prenatal/maternity/delivery care is billed globally, which means the OB practice will not file with insurance until AFTER the baby is born. At that point, Aetna will thrash out what belongs in what calendar year. Will I meet my 2011 deductible? I have no idea and neither does Aetna. If I am close to the deductible, then changing practices wouldn't be a huge cost, however, if I'm far from my deductible then I not only have to meet our $750 deductible in 2011 (plus 20% of all office visits), but I will also have to turn around and meet a $750 deductible in 2012 for the delivery. Baby boy will also have a $750 deductible and all our prenatal/hospital care will be subject to 20%.
- In addition, we've had a healthy year and before my new practice office visit last week, we had in excess of $900 in our FSA account. I had originally thought we needed to spend it before the end of the calendar year. Turns out, our FSA has a "plan year", which extends until March 15. Any medical services rendered before March 15, 2012 can be paid for out of the 2011 FSA account. Finally, some good news! If I am FAR from my deductible, it's not even a stretch to believe that my deductible would be fully covered with 2011 FSA funds.
Other interesting tidbits I learned the past week:
- Aetna views midwives as specialists and specialists are not eligible to be part of the Excel community and all billed the same. Not that that really matters in any situation, but I found it interesting that a midwife is considered the same as say, a plastic surgeon or other highly specialized physician. They are billed how their supervising physician is billed, whether he/she is an OB/GYN or a perinatologist. The former case would mean I only have a $30 copay and insurance picks up the majority of my care. The latter case would mean I have a $60 copay, plus I have to meet my $750 deductible and then 20% of all care.
- The OB/GYN has 90 days to file with the insurance company and then the insurance company figures out the bill in 2-4 weeks. Thus, there's a HIGH probability that I won't even know what we owe our old practice until the baby is a couple months old.
- A group practice isn't eligible to be part of the Excel community. Physicians are either part of it or not. Good to know going forward. For example, if Madeline's pediatrician's office has two physicians and one is part of the Excel community and the other isn't, then depending on who we see will mean the difference between having to meet Madeline's $750 deductible before insurance will kick in and cover the cost of her visit.
Talk about a mess.
Bottom line...I honestly don't know how I'm going to proceed going forward. I'm still trying to see if I can get a preliminary guess of how much we'll owe for our 2011 deductible. If I'm teetering towards meeting it, then we'll switch to the new practice immediately. If I'm far off, then I'll probably stick with the old practice for the remainder of 2011 and switch to the new practice in January. The second option will also mean we won't have to find the money for my deductible for 2012, because FSA from 2011 will cover the cost. The good news to all this is that FSA should cover either the 2011 deductible (of which I have NO idea how close we are) OR we will be able to use it in 2012.
And honestly, if you understand what I typed out and made it to the end -- Congratulations!
And I should say that I'm not bickering about insurance here. I'm grateful, no matter how poor our insurance actually is (we pay A LOT out of pocket each month...so much that honestly if we didn't have any other medical expenses in a year, paying for a birth without insurance would be cheaper...). But insurance is exactly that - to cover the unexpected. If we had an emergency in our family, it would definitely come in handy.
But where do I go from here...........time will tell. Just please pray. The way it's looking right now, I'm going to switch to the new practice 20 days before my due date. Y-I-K-E-S!
2 comments:
When pregnant with Katie, the doctor's fee was $4,000 prior to delivery. Plus $1,500 for the amnio he told me was required of all women over the age of 38. I was 39. Switched to midwives. Total cost: $995 whether I delivered at their facility or at home. Met my deductible prior to leaving doctor at 14 weeks which was $750. and had paid 30% for all subsequent visits. When she was born, insurance said they covered midwives, and I filed. Company said I had now met $60 of my deductible and would not pay me for anything else. We paid 100% for Katie. I truly do not like insurance, especially with all the i's dotted and t's crossed, but it is a blessing to have it despite the headaches you are going through. I feel for you. Enough to give you a migraine.
Every time you come to mind (more and more the closer we get to January) I say a prayer for you and your family and the upcoming arrival of the newest Baby K. I will add this concern to those prayers. :)
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