Insurance Question

[MB22]

Hi all! I am a little over 6 months pregnant and changing jobs (and therefore insurance). In any case, I have two selections available for me upon my hire: a PPO and an HMO. Does anyone have any idea which would be easier for out of pocket cost to continue my prenatal care? My doctor is covered under both. Thanks for your help!

[Skylynns_mom]

i was told that pregnancy can not be consider a preexisting condition.  I looked into it b/c i will be switching insurances a month before i am due

[swade]

Yes, they do cover you if you are just switching insurances, but she is switching jobs.. that is a big difference, and in most cases they do not cover you.  My girlfriend, just got a new job and she found out she was pg, just a week after she started and because she was 9 weeks, they are not covering her.  She had a pre-exsisitng condition.  But I agree with the person who mentioned medicaid.  I looked into many insurances, and make sure you dont have any charges to you, some insurances dont cover all of your hospital stay, you have to cover 5% and that is like 200 a day.  I opted to try for medicaid and they gave it to just me while I am pg, and I dont have to pay for anything except for the circumsion.   Good luck

[loismwallace]

Someone mentioned Pre-existing conditions not being covered, but MOST ins. co. will cover you if you already had coverage before switching. In your case, you have ins, your just switcing. You should be fine. It's the same thing I'm going trough. We are switching from Aetna to Blue Cross Blue Shield. BCBS will be picking up my coverage because I was already being see.

[sweetangel7]

I have HMO Blue Cross and I have found it to be excellent...my mother has it too...she had brain surgery in October and paid nothing...not even a copay!  When I was prego all of my prenatal care was without a copay...I have gone to the ER a number of times and indeed paid a copay ($25) but never had to get a referral for them to foot the bill.  I have gone to the eye doctor without a referral...I have gone to a psychologist without a referral...Maybe I have been lucky but I wouldn't trade my HMO Blue for any other plan!  Best bet would be to have your hr dept. compare the plans and if you have any questions you should call a representative...also do beware of the 'pre existing condition clause'...I have heard others getting slammed with it and end up without coverage.

[JoyRenee]

loismwallace made an excellent point. You should also check into getting Medicaid as well. I had that, but only during my pregnancies. That program is called MC+ and you apply at your local Department of Family and Social Services. They paid for almost everything.

[honey1982]

i suggest a ppo i have ppo and i get to go to any doctor that i choose but i have picked my steady doctors and like the other poster sdaid with an hmo you have to call and see if the doctors accept hmo and then you will have to get a referral to see a specialist, it might be cheapier to pick hmo but i say spend the extra money and go with ppo if you plan on going to the doctor like i have medical conditions in which i have to see an endcrinologist , my pcp  vewry often and have to get labs drawn every few months thats why i choose a ppo. less hassle but good luck sweetie with whatever you choose.

[swade]

I would suggest contacting the HR department anyway.. BECAUSE BEING PREGANT IS A "PRE-EXSISTING CONDITION" and they may not cover you until you have the baby.. I actually just saw this on a documentary show, and I couldnt get insurance at all because I was pg already.. Be sure to check out before you switch jobs, good luck.. I know you wouldnt need that stress..

[Shannon125]

I would suggest contacting the HR Department. My company offers a PPO and an HMO as well. I know that each week in my paycheck I pay a little more for the PPO service than I would for the HMO service but the difference in money is worth it for me. At my company with an HMO you generally have to choose a Primary Care Physician and anytime you need to see a specialist (i.e. Allergist, Eye Doctor, Ob) or if you need to go to an Urgent Care facility or ER you would need a specific referral from your Primary Care Doctor. I find that rather inconvenient if you have an emergency on a Sunday afternoon. While you can get the referral after the fact (there's a grace period), you potentially run the risk of not getting it in time and can therefore be charged the out of pocket cost for the visit to the particular specialist rather than the copay. This happened to me at my last job when I needed to see the Eye Doctor urgently and could not get a referral from my PCP in enough time. I ended up getting a bill for 85 dollars. So that is why I don't bother with HMOs and prefer my PPO plan because I don't need any referrals and don't even have to choose a PCP if I don't want to. I am not sure if this is the same where you will be working but that is how it is at my company.

[loismwallace]

You should contact your HR department. I'm going through a very similar situation, ONLY I'll be 36w4d when my employer is changing our insurance. Aetna went up on them about $80 per employee......So now they are switching. I can't complain too much because my empoyer pays our health ins. Meantime our HR dept. has been keepingme informed so I will know if I am going to have pay anymore towards a deductable. I already paid $2000 so far. Something I did look into a month ago was Medicaid as a secondary ins. As it turns out, they will bill my ins. co. first and then Medicaid. If Medicaid pays the balance, my Dr. office will refund the $2000 after the baby is born. I wasn't counting on that, but that sure would be nice. I just wanted to cusion the blow with Medicaid incase the new ins. has a higher deductable.

All in all, I would be sure to talk to your HR. They should have all the answers you need or atleast know where to find them. Good luck!

[JoyRenee]

I have a PPO but I'm not entirely sure if the out-of-pocket costs are different. Your best bet is to call the new insurance company and ask them which would be more cost effective for you. HMO may have a higher deductible, therefore you'll pay more. But again, I'm not entirely sure.