When faced with open enrollment or finding a new health insurance plan, it’s important to make sure you can continue to see the providers you’ve developed trust with. With that in mind, it’s important to make sure your current doctors and local hospitals accept the plan you’re thinking of choosing. Reading the fine print in your health insurance policy is not exactly light weekend reading, but when you are trying to conceive or have just found out you are expecting a child, it may be more important than you think.
Medical coverage can vary widely depending on your policy so as you are considering your new insurance coverage, consider these key factors.
Know Your Network Provider
It seems counterintuitive that a doctor and a hospital aren’t always on the same insurance network, but it’s sometimes the reality of healthcare in the United States.
Not only do you need to be sure that your physician is covered in your network of providers, but also you need to confirm that the hospital your doctor has privileges at is also in your network.
This is especially crucial for OB patients who would like their provider present at the birth of their child. It’s also relevant for all surgery. No one wants to find out in their third trimester that they can’t give birth with their doctor because the hospital is out-of-network.
When you choose an in-network ob/gyn and hospital, it’s much more likely that all medical professionals who may treat you, including nurses and the anesthesiologist, are in your network.
The difference between in-network and out-of-network care can mean thousands of dollars of out-of-pocket expenses.
How Much of your Medical Care is Covered by Insurance?
Under the Affordable Care Act, maternity care, including pregnancy, labor, delivery and newborn care, are considered among of the 10 essential health benefits that must be covered by all health insurance plans.
However, coverage is usually not as straightforward as you’d expect and some plans only cover a percentage of costs.
You can find the percentage covered under the maternity section of your policy but you need to read the fine print – not all insurance companies define maternity and childbirth the same way. You can speak to your OB and ask them for a list of all procedures and tests that are expected during your pregnancy and then bring your list to your insurance policy for review of exactly what and what percentage is covered. You want to avoid surprises!
You may also want to consider a different plan if you find that your policy is not covering what you and your provider expect you’ll need.
How Can I Make Sure My Doctor Has Admitting Privileges?
Insurance networks were designed to include doctors with admitting privileges to hospital in the network, but that’s not always the case.
There are times that a hospital may choose not to work with an insurance provider, or contract negotiations between the parties leads to a temporary lack of coverage. A mismatch between your doctor and local hospital is an unfortunate a reality of narrow networks.
The most critical time to do your research on insurance networks is before you buy the plan.
If it’s too late and you have already committed to your insurance policy, now it’s time to verify your coverage. Confirm that your doctor and the hospital are both in-network and if you need help finding out, please contact our office so we can help you. Don’t be worried about checking this with multiple sources, including your doctor and insurer.
Your healthcare provider is a great resource and often knows a lot about local insurance plans, as they have to work with them every day.
Ideally, from your perspective, it’s preferable to find the right plan in order to continue care with your current provider. The relationship built between a doctor and a patient is important and no one wants to have to consider switching doctors, especially when pregnant.