Health Insurance Tied to Hospital - What Do You Do?

[Craigy]

My wife is about to start at a new employer, and, like her current employer, offers health insurance which really only provides coverage for services rendered by their health system.  I could find the exact percentages but it's essentially a we-don't-cover-anything-outside-of-our-very-small-network setup.  This would require that she change her OB, have her coworkers deliver any children, etc. (feels like a HIPAA violation but I'm sure there's some exclusion for this), and also have us switch our child's pediatrician from a long time family friend to someone new.

I told her we should consider just staying with current doctors and just paying cash, but it's an arduous process actually getting a cash price out of any of these places for various services to really shop it.  And based on the total bill for our last child's normal delivery with one night's stay being about $40,000, I don't know if using out of network services for everything would really work.  Alternatively, I could switch her and our child to my employer's insurance which is not tied to a specific hospital network, but it's completely unsubsidized and the entire cost of insurance with my employer would come out of my check, and further the coverage is pretty poor, so that option is not very enticing.

I'm sure many of y'all are with hospitals that offer similar only-within-our-system type coverage, what do you do in your situations?  Simply use your own facility's services?  Pay cash and go elsewhere?  Something else?

Thanks!!!    

[VagabondMD]

Are you sure that it is not simply considered out of network and more expensive to use other hospitals, systems, and docs? That is how it is for our hospitals' employees, except that services that are not provided at our hospital (i.e. Transplant, trauma, niche surgical procedures, etc.) are reimbursed at in-network levels.

[wideopenspaces]

Our hospital and clinics are the largest providers of health care in our state so it's not exactly the same thing. But I'd switch to the employer insurance if I was your wife, especially for big things like a delivery or surgery. For the pediatrician, well checks are pretty cheap so if it's important to keep the doctor I'd just pay out of pocket for that.

[Craigy]

Vagabond MD wrote:

Are you sure that it is not simply considered out of network and more expensive to use other hospitals, systems, and docs? That is how it is for our hospitals’ employees, except that services that are not provided at our hospital (i.e. Transplant, trauma, niche surgical procedures, etc.) are reimbursed at in-network levels.

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Out-of-network is more expensive in that it is simply not covered except for emergency transportation and emergency room services.  Like yours, only exceptions to this are services not offered by the hospital (ie, a few niche services) and if you live out of the area (a pretty large distance away).

 

[Craigy]

wideopenspaces wrote:

Our hospital and clinics are the largest providers of health care in our state so it’s not exactly the same thing. But I’d switch to the employer insurance if I was your wife, especially for big things like a delivery or surgery. For the pediatrician, well checks are pretty cheap so if it’s important to keep the doctor I’d just pay out of pocket for that.

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This is probably what we'll do.

She's not too enthused about having her coworkers (mostly men) deliver her children, but it's not the end of the world.  I offered to learn how to do a tub birth at home, but she didn't think that was funny.   :lol:

I can't imagine pediatrician visits cost a lot.  I suggested we just visit our friend outside of work and just pay her cash, but then we'd have to deal with getting immunizations etc. elsewhere or ordering them from a distributor.

[wideopenspaces]

Yeah I don't blame her for that but surely she has one colleague in ob or family medicine that is female that does deliveries? I just think it would be too weird to have a male colleague doing it. I would perhaps go so far as to be induced the day my female doc was on call. And actually that's what I did with both of my babies!

[Hatton]

Odd that no female obs are on the new insurance plan.  Female obs make up >50% of residency now.

[pulmdoc]

It's not a HIPPA violation if her co workers actually have a valid reason to access her medical records like providing her medical care. Just want to clear that up. My health insurance is closely tied to the health system I work for as well. I have found it not to be a big deal and even advantageous-my PCP was not accepting new patients but took me on as a personal favor because I asked and she knew me. My wife delivered our kids at the hospital I work at with no issues. If your wife is an OB (implied) I can understand the squeamishness, but at least she knows who she would trust and who she wouldn't.

[MrsIMDoc]

My insurance is tied completely to our hospital.  I am even on the committee for approving meds to our HMO's formulary (lucky me).  It is the major health care provider in our community so it may be different from your situation. Overall I was happy with my care at my hospital and I have the perk/option to read all of my medical record in our EMR.

 

[Craigy]

pulmdoc wrote:

It’s not a HIPPA violation if her co workers actually have a valid reason to access her medical records like providing her medical care. Just want to clear that up. My health insurance is closely tied to the health system I work for as well. I have found it not to be a big deal and even advantageous-my PCP was not accepting new patients but took me on as a personal favor because I asked and she knew me. My wife delivered our kids at the hospital I work at with no issues. If your wife is an OB (implied) I can understand the squeamishness, but at least she knows who she would trust and who she wouldn’t.

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Right.  It just seems strange, like it should be some inherent conflict, that your health insurance could force you to have your coworkers provide your medical care.  The whole point of the HIPAA privacy rule is privacy, especially from family, friends and coworkers.

Again, it's not the end of the world.  Was curious though to see if anyone chooses alternative care and how they go about it.

[Craigy]

wideopenspaces wrote:

Yeah I don’t blame her for that but surely she has one colleague in ob or family medicine that is female that does deliveries? I just think it would be too weird to have a male colleague doing it. I would perhaps go so far as to be induced the day my female doc was on call. And actually that’s what I did with both of my babies!

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That's what she was thinking, perhaps a scheduled induction.  But of course these kids don't care about your schedule.      We'll cross that bridge when we come to it.

[SwanSong]

And what happens if you are on vacation and you have a medical emergency?  That seems to be a gaping hole in this health insurance plan.

[wideopenspaces]

I was lucky enough to have very considerate babies, at least when it came to the timing of delivery ?