Tuesday, May 8, 2012

The Insurance Issue

I mentioned yesterday that Bossy's GI doctor no longer takes our insurance.  It is absolutely crazy.

It started a few months ago when the Children's Hospital (where GI is, and where all of Bossy's records of everything....NICU, GI, Neuro, etc...all reside), sent out a letter stating that they were in negotiations with the insurance company (Blue Cross/Blue Shield!), and if they couldn't reach an agreement, the contract would expire April 15.

Now, this has happened before, and it has never been an issue. Both sides puff up their chests to show how big and bad they are....but in the end they reach an agreement.  This time....not so much.

Believe it or not....the contract expired.  The hospital is the only dedicated Children's hospital in the state, and they no longer accept one of the largest insurance plans in the country.  The hospital wanted to be reimbursed at a higher rate than the insurance company was willing to do, even though the rate was lower than what all the other insurance companies were paying.  I really think that everyone figured at the 11th hour it would work out.  Not so much.

So, for 90 days (mid July), the hospital will work with the insurance company to get things covered, but after that, no.  They will be out of network, and the patient is responsible for the balance. 

The problem for us...Bossy's feeding tube.  We HAVE to have a GI doctor.  And to find a pediatric GI....ugh.  Never mind that he has been going to this office for 10 years.  But we can't pay for everything out of pocket.  He needs an endoscopy next summer....that is $2000.  No way we can pay that out of pocket.

I will talk to the GI office when we go in June, and see what the deal is.  But I have a feeling we are going to have to start over with a new doctor.  UGH.


  1. I totally get your pain. We have to start over with a new pediatric neurologist and getting an appt with the old one was bad enough (3 months) but this new one hasn't called me back once in the 2 weeks I have been leaving messages. Unfortunately this is the only dr that takes this insurance (UHC). I hate being so limited when it comes to good healthcare for my kids. Heres hoping we get thru these hurdles and our kids get the proper care they deserve!

  2. What a pain! We had that issue with Blue Cross/Blue Shield and the doctors group at the hospital in my town. They couldn't agree on a contract, so if one of us had to go to the hospital we'd have to be taken at least 20 miles away. Maybe your current doctor can give you a recommendation for a pediatric GI - and if it takes awhile to get into them you could at least get the ball rolling now with setting up first appt and transferring records, etc. Hopefully it will all work out.

  3. That definitely sounds extremely complicated... hope you can get a good solution by talking to them and figuring out a new arrangement that works for the both of you without all the extra expenses.

  4. Hey Mysti...I am back:) I have a lot of catching up to do on your blog and I have missed you. My hubby did get laid off...on March 16th...and he is still out of work. I have kinda been in a depressed tail spin since then. The whole try to get out of debt idea just flew out the window and I haven't even had the motivation to think about it. I have just been working as much as I can while he is home...too bad I still don't make enough to keep us a float. I can't wait to read and see what you have been up to and how you are doing. I hope you are doing well:) And sorry about the insurance!

    1. Welcome back....I am so sorry about the work situation. Sending you positive energy that you make it through this rough patch.

  5. This happened here also, eventually they will quit peeing on each others trees and agree to something.

  6. Oh wow. Hopefully they will come to some sort of agreement soon. But I agree --- talk to the current doctor--- there may be someone that can be recommended -- and talk to the doctor now. The sooner you can get the ball running, the less lag time you will have.

  7. I tried to post on this yesterday, but it didn't go through. That is all a major headache...I don't know what to say, but I just feel for you. I hope it is resolved one way or another soon! - Fiona