TLDR at the bottom.
Moved to NYS, used to have BCBS from the previous state through COBRA. Wife got pregnant while on COBRA, found OB/GYN & Hospital in-network (Mt. Sinai West in NYC). Two months ago we changed insurances to an individual Empire BCBS plan through the NYS Marketplace because our COBRA expired, thinking it would also be in-network for all the baby delivery stuff. Called new insurance, said no issues, they called the doctor to make sure she’s in network (another rep told me that’s not the way it’s done). We kept going to the same doctor because the original rep told us we were good.
When I search for my wife’s OB/GYN on my new plan (VFG), she doesn’t show up, but everyone on her office (Mt. Sinai too) does. If I search for her using another BCBS prefix (for group plans like YXC) she does show up on the search. From the Dr’s office they have told me several times that they have checked with the Dr’s BCBS rep and said we’re fine, that the lists probably haven’t been updated properly.
All claims for prenatal stuff (ultrasounds, vaccines, lab work) have been covered but all of them say “Mt Sinai Obgyn”, none of them have the Dr’s name and we don’t have any claims for the Dr’s followups.
We have been asking them since June and they have always said that they’ve checked and there’s no issues, we’ll be covered.
Only written answer I have from the Dr’s is: “As per our provider profile database Dr. XXX is in network with Empire BCBS Commercial networks.”
The hospital is another story. Mt. Sinai West doesn’t show up on any BCBS database, it always shows as St. Luke’s Roosevelt Hospital. Roosevelt was the old name from a few years ago. We went to this hospital with our previous BCBS plan and it shows with that name, so I’m guessing we’re safe with that. All other Mt. Sinai hospitals in the NYC area do show up on all BCBS plans we have checked (including ours).
Given that we have paid $170 for one Ultrasound that was out of network when we switched insurances (going to a different in-network one since then) but the original charge to the insurance was $600, and that a denied genomics $3k bill went down to $149, I’m guessing that paying out of pocket would be less, but I don’t know about the Dr or the Hospital.
If our insurance doesn’t want to pay for the Dr’s or the Hospital, how much do you think we could be on the hook for for the prenatal visits and birth? Tens of thousands of dollars? We don’t qualify for any assistance. Our max OOP for my wife is $6900 and we have that money saved, but a $30k bill will break us. Not sure what else we could do at this point, other than just showing up at a different hospital for the delivery and handling the Dr’s bill separately somehow.
Every person we have talked (insurance, Dr’s office and Hospital) to has told us something different. It’s so frustrating.
We cannot change insurances at this point, my wife is due in a few days.
Thank you all!
TLDR: if my insurance doesn’t cover the OBGYN followups & hospital baby delivery bill, how much could we potentially have to pay out of pocket in the NYC area using Mount Sinai? Tens of thousands of dollars? Is there any way to negotiate this down after the fact if we don’t qualify for financial assistance (which we don’t)?
submitted by /u/codingManu
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TLDR at the bottom. Moved to NYS, used to have BCBS from the previous state through COBRA. Wife got pregnant while on COBRA, found OB/GYN & Hospital in-network (Mt. Sinai West in NYC). Two months ago we changed insurances to an individual Empire BCBS plan through the NYS Marketplace because our COBRA expired, thinking it would also be in-network for all the baby delivery stuff. Called new insurance, said no issues, they called the doctor to make sure she’s in network (another rep told me that’s not the way it’s done). We kept going to the same doctor because the original rep told us we were good. When I search for my wife’s OB/GYN on my new plan (VFG), she doesn’t show up, but everyone on her office (Mt. Sinai too) does. If I search for her using another BCBS prefix (for group plans like YXC) she does show up on the search. From the Dr’s office they have told me several times that they have checked with the Dr’s BCBS rep and said we’re fine, that the lists probably haven’t been updated properly. All claims for prenatal stuff (ultrasounds, vaccines, lab work) have been covered but all of them say “Mt Sinai Obgyn”, none of them have the Dr’s name and we don’t have any claims for the Dr’s followups. We have been asking them since June and they have always said that they’ve checked and there’s no issues, we’ll be covered. Only written answer I have from the Dr’s is: “As per our provider profile database Dr. XXX is in network with Empire BCBS Commercial networks.” The hospital is another story. Mt. Sinai West doesn’t show up on any BCBS database, it always shows as St. Luke’s Roosevelt Hospital. Roosevelt was the old name from a few years ago. We went to this hospital with our previous BCBS plan and it shows with that name, so I’m guessing we’re safe with that. All other Mt. Sinai hospitals in the NYC area do show up on all BCBS plans we have checked (including ours). Given that we have paid $170 for one Ultrasound that was out of network when we switched insurances (going to a different in-network one since then) but the original charge to the insurance was $600, and that a denied genomics $3k bill went down to $149, I’m guessing that paying out of pocket would be less, but I don’t know about the Dr or the Hospital. If our insurance doesn’t want to pay for the Dr’s or the Hospital, how much do you think we could be on the hook for for the prenatal visits and birth? Tens of thousands of dollars? We don’t qualify for any assistance. Our max OOP for my wife is $6900 and we have that money saved, but a $30k bill will break us. Not sure what else we could do at this point, other than just showing up at a different hospital for the delivery and handling the Dr’s bill separately somehow. Every person we have talked (insurance, Dr’s office and Hospital) to has told us something different. It’s so frustrating. We cannot change insurances at this point, my wife is due in a few days. Thank you all! TLDR: if my insurance doesn’t cover the OBGYN followups & hospital baby delivery bill, how much could we potentially have to pay out of pocket in the NYC area using Mount Sinai? Tens of thousands of dollars? Is there any way to negotiate this down after the fact if we don’t qualify for financial assistance (which we don’t)?
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