Getting with insurance co. before getting pregnant

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Getting with insurance co. before getting pregnant

Postby megs4413 » Jun 16, 2006 10:55 am

Did anyone try to do this? I want to go over the last pregnancy and see what will be covered with this next pregnancy as our insurance has changed. I want to push for home health as opposed to admission though I'm sure they'll fight me on this. What do you think? Can you communicate with the insurance co. before you're even pg?
megs4413
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Postby mammaclare » Jun 16, 2006 12:05 pm

I did. I called customer service and had them walk me through all of the co-insurance I would have to pay, what my out of pocket maximums would be, deductibles, how many u/s they cover, my cost for home health, everything.

They had no problem answering all my questions and walking me through the coverage...and I have to say that the woman even put up wiht me when I kept comparing to my last PG and insurance (company changed carriers as of Jan 1 this year...Cigna to Aetna) and even complained a bit about the terms that my employer had negotiated. This pregnancy will run us about $2500 all said and done. Last one was $20 at the 1st pre-natal visit, and then $10 copay on Zofran every 5 or so days. And $70 to the hospital for the surcharge for a private room. (And I found out they only HAVE singles, so I can't believe they took my money...sleazebags).

I made a list of questions and wrote all the answers down, which helped me feel like I totally understood all the ins and outs of maternity coverage...so I say go ahead and call. I needed to get the information before I was too sick to think clearly.
Clare
Mommy to Rory Benjamin 8-28-03
And Kieran Alexander 12-15-06
HG Babies-Week 5 to The Bitter End!
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Postby mrsbigdog » Jun 19, 2006 10:06 pm

You should be able to find out anything you need to know from the customer service reps.

We switched insurance twice during my last HG pregnancy last year. The first switch was from Blue Cross/Blue Shield through my employer to Aetna PPO through my husband's work and I called them as soon as I knew we'd be changing and they had everything all set up to go on day one. I verified that they worked with the same home health co and everything. They were very helpful and everything went smoothly.

One month before delivery we changed from Aetna's PPO to their HMO. I called prior to the change to verify everything would be covered and what the differences would be. I was assured of no problems BUT when I needed to fill my Zofran script the HMO refused until I had tried several other things. We didn't have enough time before delivery to "test" new drugs and the dr ended up inducing me early just because I was out of Zofran, sick and losing weight again!

My point is that you can get alot of good information from them but remember that unless it is guaranteed in writing they might not cover it.

Donna
3x HG survivor: Theresa - 11/88, Katie - 1/95, Emily - 1/06
(one HG baby in each of the last three decades! - yes, just call me crazy)

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Postby megs4413 » Jun 19, 2006 10:26 pm

next question...does anyone know if you can ask for a written transcript or summary of the conversation...i want to say all the time to customer service reps...ok...can I get that in writing? I know they warn you they will be recording the call and I think the next time I need to...I'm going to tell them the same thing! there's a record feature on my cell phone and honestly...sometimes i think it would come in handy when dealing with this people!

I'm really wanting to know about getting the drugs precertified before I even get pg...we'll be starting the zofran from the BFP...i have some at home now left over from the mc in april, but it won't even be enough to get me through 3 days.....I also want to get a IV therapy site set up that I can use before I have to go to home health (if it comes to that). I have a lot of questions but I guess the point is I need to call!
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