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Switch to $$ Insurance or keep HMO...

564 Views 3 Replies 4 Participants Last post by  mamaverdi
and pay MW cash??? How did you handle it if you kept your HMO?

The insurance plans available to us are all either HMOs or one really expensive PPO. (I mean, like four times the car payment expensive!!) And there are few opportunities to switch so if we do jump, we are stuck with it for a while.

So, ok, we can save up to pay cash for the midwife and keep the HMO as usual for the rest of the family's health care.

But if we go that route, do I do concurrent care with my OB, go to some prenatals, have a few "flat tires" and miss most of them, & smile and nod & keep my mouth shut, lol

or, do I stay the heck out of there and go only to the MW for prenatals etc.

Cuz I'm curious... not anticipating trouble but DH is concerned...

If I blow off my OB/GYN and don't even go in for a pg test, nothing, then if I need to transfer during or after the birth and they have no record even that I was pg... are they gonna make it an issue?? Other than being rude to us, lol.

Your experience/thoughts appreciated!
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Well, our insurance is through my DH and to switch mine I'd have to switch it for all of us. I didn't want to do that since our HMO has got just about everything covered and I haven't seen a PPO plan that I was comfortable with in case someone did need some emergency medical care. I also was afraid that in case I needed a hospital transfer (not anticipating this though!) I'd have more to cover with with a PPO, whereas last time my HMO covered it all. I had money saved up and just paid the midwives out of my own pocket. For me it was a simpler choice and I wouldn't have to worry about how well the PPO would cover us.

In the case of concurrent care, I went and talked with my OB and told her I was thinking about a HB, though I had pretty much decided on it. She was very cool about it but told me that her group could not provide concurrent care at all if I had made my decision to go ahead with a HB. I went to her office for a few prenatals and was generally really irritated with the care (longer waits in the waiting room with DS, incorrect info given to me by the RN, pushing the doppler thing for insurance purposes, little to no mention of nutrition or health) I was totally spoiled by my wonderful midwives and their comprehensive check-ins with me. My OB did thank me for being honest with her when I told her I was pretty sure I wanted to HB and I wouldn't have had it any other way. She is very sweet and if I would have been doing concurrent care I don't think it would have been a healthy dr./patient relationship if I had omitted telling her something so obviously crucial.

I did get my initial labwork done first though so that was covered by HMO and I could have had an ultrasound done as well since she gave me the referral but I finally decided against it. You could always just be open and say you are thinking about it if you want to get some testing done and want it to be covered by your HMO. Where I am, my midwives couldn't do most of that unless I had a PPO-oh well.

Good luck with figuring it all out
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when i was PG last time, we had the opportunity to switch from an HMO to a PPO (that would cover the homebirth) but we decided against it. we crunched the numbers... basically with the added monthly premiums, the large deductible (because it was out-of-network), and the fact that after the deductible they would only pay 75% (i think) we decided it wasn't worth it. it only would have saved us a couple hundred dollars. so we payed out of pocket.
the other thing that persuaded us was that *if* we did have to transfer to the hospital, the insurance company would only pay for the hospital delivery (and the charges related to it). they wouldn't also pay the HB midwives their fee, which means we would have to pay them out of pocket *on top of* now paying the bigger premiums.

i didn't see an OB at all last time, didn't line anyone up as "back-up", and i don't expect i will this time either. last time i had a family practice doc oder my pregnancy bloodwork so that it was covered. this time i'm not even getting bloodwork done at all, so it's not an issue. i know what hospitals around me are more "homebirth friendly", so in a non-emergent transfer we'll go there. if it's an emergency we'll just go to the closest one.
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It really depends on what you need your insurance for....

And as for concurrent care, most OBs won't do it. And lying about it isn't very healthy.

And why? The midwife either will or won't have a back up OB. Have you spoken to her about this?

If I had an OB/Gyn that I really knew well and liked and their hospital was closest, I might consider speaking with them about it. Or maybe not.

There are so many personal factors. But personally, I don't see the point.

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