Tuesday, May 10, 2011

Our own version of the NFL lock-out??

Beware - RANT ahead.
Photobucket
I just love this girl to pieces:)
During our last visit to Addie's pediatrician we were greeted with -"here's a letter you need to read about potential changes to your health insurance."  Hhhmmmm....ok, I thought - this ought to be interesting.  I read the letter which basically stated that Anthem, whom our health insurance is through, was at odds with CHKD (the primary network of pediatricians in our area) and negotiations to renew the contract between the two parties had stalled.  The primary reason...they couldn't agree on pay rates.  HA!  Seriously...millionaires can't get along with billionaires....boy, this surely sounds familiar.  I have spent the last several months listening to all of the hoop-la about the failed NFL negotiations and I too am a disappointed NFL fan but THIS....seriously, this was different.  Here's my deal...the NFL deal (or lack thereof) is bad - no football - BOO:(  But, asking me to switch pediatricians simply because the the two parties can't get along is a whole different story - now you are involving my family...and I just can't get down with that.  I am all for fair pay rates and people should be compensated for the services they provide but my daughter shouldn't have to suffer because these two can't find middle ground. Because...unfortunately, at the end of the day the only ones that suffer from all of this are the kids...and that's just not fair.  So...at the bottom of letter it listed a phone number I could call - which of course directs you to an automated message about the negotiations - blah, blah, blah.  Not anything I didn't already know - next step - call CHKD and this time....a live voice!!  A nice, friendly, understanding and sympathetic voice that listened to my concerns and said as much as she could.  Her message was not significantly different from that of any other correspondence I had received but she seemed genuinely concerned about my situation and assured me that should negotiations completely fail and Anthem and CHKD part ways, they would do everything they could to transition their current patients to their new pediatricians that are considered in-network.  She passed along a web address (www.chkd.org/anthem) that would provide updates as they were available and also encouraged me to call back should I have any additional questions.  Ok - I appreciated that but at the end of the day the bottom line is this - if they can't reach an agreement we will be forced to either pay "out of network" costs (only 70% of our visits will be covered - leaving us to pay approximately $200 per visit - ouch) or to change pediatricians to an "in-network" physician where we will pay $0 for Addie's well-baby care visits.  Frustrating on several different fronts - the first being that we pay ALOT of money a month for health insurance and to add on to that because someone thinks they aren't getting a large enough cut is disheartening and also we went through a fairly laborious process of talking to friends and meeting with pediatricians prior to Addie's arrival to find a pediatrician that we thought would provide Addie with the best care.  We LOVE Addie's pediatrician - we are comfortable with him - we trust him - and we DONT want to change.  And honestly, we likely won't - we'll suck it up and pay the 30% and it will pain me everytime I hand over my check card because this should be FREE!!! Whew...ok, I must admit - I feel slightly better having that off my chest.  Anyone else had this happen??  If so, were they able to resolve it before you had to make a change or pay out of pocket??    

J

15 comments:

Natalie said...

I did have a similar problem...but it was between the hospital and my insurance when I was about to give birth! Basically if Nolan hadn't been 1 day early...and been born a day late we would have been out of network for the whole labor process! I mean how crazy is that...not like I could just change everything last minute. So I will just say I was relieved he came early b/c their contract did end the Saturday after he was born. I feel your pain!

Megan said...

This affects us too- but not just the pediatrcian. About half of Charlie's specialists are also affected (the other half- also CHKD- are in a different contract that isn't ending). We are confident that it will be worked out in time. Anthem can't shut out the only children's hospital in the area.
I see you've called CHKD- but have you called anthem? Have you talked to your HR department? Perhaps they need to pick a new insurance carrier (or at least put pressure on Anthem from that end).

In the meantime, get the appointments in before June 15! (The deadline was extended if you didn't see that). I think at worst- we'll have about a week or so of out-of-network coverage and then they'll work it out.

KVH said...

Ugh! I am in the same exact boat with CHKD.

We moved to the area in September and had to find a new pediatrician for my daughter after loving the heck out of her last one. Everybody I talked to recommended the practice we are in now and I JUST started getting comfortable with them and liking the doctor. I really hope they come to an agreement because I don't think I am ready for another change.

Cara S. said...

Girl...I wish I had some afvice for you. That totally SUCKS! I would be pissed too, I like to be abkle to chose my doctor and then when someone tells you you can't go there. BLAH that just urks me, especially for a pediatrician. I am so with you, that is the one doctor I pick that I would hate to be told I can't go to. You trust them and put your baby in their hands you know as it relates to medical stuff and you trust them and for someone to tell you you have to change just SUCKS. Hopefully this all gets resolved and you don't have to apy out of picket the 30%!!

Melissa at Tall Blonde said...

So frustrating!!!! I couldn't believe it after Mia was born how much out of pocket we had to pay. Normal delivery, no complications, nothing. How is that not all covered??
Glad you feel better! Sometimes it just helps to let it all out there!

Cheryl E. said...

OMG that is totally ridic! You have every right to be upset and you are completely right about it affecting the children. So sad. The sad part is this healthcare thing is only going to get worse.

Megan said...

UGH!! I haven't had this specific problem, but health insurance REALLY bothers me! We pay $850 a month premiums through my hub's work and we still end up with bills on top of that!! $850 a month for healthy people with no health conditions is RIDIC!!!

I hope your mess gets straightened out. I totally understand wanting to stay with the ped you have now.

Our Happy Married Life... said...

aw, sorry you are dealing with this. That's crazy. But thanks for the reminder...we need to figure out who our ped will be. :)

Mrs EyeCanSee said...

Insurance sucks. Sorry you're having to jump through so many hoops!

Melissa: Write it in Lipstick said...

Ugh that stinks, I hope everything works out paying that much for a visit should be a crime.

Samantha said...

That really sucks, and I am so sorry. Fingers crossed for you. And BTW, blogging is for venting... so do it as often as you can!

Raven said...

oh man, reading that first bold sentence about changes to your insurance rattled my nerves right away! We had the same thing happen to us. WHAT IS IT WITH INSURANCE? People pay them BILLIONS and when we really need them, they try to loop hole us to death. Hoping things work out the right way, the way they should.

good news? Your little girl is PRECIOUS.

Happiness Is... said...

That is ridiculous.

Kelli Kegley said...

Yuck! I'm sorry you are having to deal with this! Insurance can be soooo frustrating!

Beach Bum & Baby said...

I'm so sorry J! This is so ridiculous!! I can't believe how many people are suffering because of this, well like you said, the kids are the ones suffering. Addie likes going there (she told me, duh) and she shouldn't have to change. :( I think it's sad that so far they haven't been able to come to an agreement. My fingers are crossed that they are able to figure something out soon!!!