Insurance Challenge: Changing Obstetric Care after 6 Months of Pregnancy

My HMO will not allow me to change my obstetric care since I am beyond
my 6th month of pregnancy. It is due to their "global billing" process
that occurs with one bill that covers all prenatal care and delivery
sent by the ob/gyn to insurance after delivery. This is a money issue
and all I have been hearing are "contractual obligations."

I need to change to a new medical group by Sept. 1st in order to be
delivered by a midwife. I have 2 short days left to convince them or
find an "out of the box" solution that they would agree to do.

My medical coverage is currently an HMO. The medical group I need to
switch to will not accept me because they said they would lose money
taking me at such a late date (I'm due in 6 weeks)

I am trying to change the medical group so that I can be put under
midwife care. This is really important to me, and I am looking for a
loophole, or at least some convincing arguments but I feel helpless in
this matter and do not know if there is anything left I can do/plead
for.


Your help in this matter is greatly appreciated.

helari wrote:
My HMO will not allow me to change my obstetric care since I am beyond
my 6th month of pregnancy. It is due to their "global billing" process
that occurs with one bill that covers all prenatal care and delivery
sent by the ob/gyn to insurance after delivery. This is a money issue
and all I have been hearing are "contractual obligations."

I need to change to a new medical group by Sept. 1st in order to be
delivered by a midwife. I have 2 short days left to convince them or
find an "out of the box" solution that they would agree to do.

My medical coverage is currently an HMO. The medical group I need to
switch to will not accept me because they said they would lose money
taking me at such a late date (I'm due in 6 weeks)

I am trying to change the medical group so that I can be put under
midwife care. This is really important to me, and I am looking for a
loophole, or at least some convincing arguments but I feel helpless in
this matter and do not know if there is anything left I can do/plead
for.

Have you asked if the two practices are willing to work something
out between themselves? Have you asked the insurer what happens
if you just happen to be delivered by someone else (i.e., you went
into labor out of town, or your "on the record" caregiver wasn't able
to make it to the birth)? Have you tried to argue that providing
obstetric care is not equivalent to providing midwifery care and
that you're entitled to midwifery care if that's what you want?
Ultimately, you may not have a lot of recourse outside of
paying out of pocket.

Best wishes,
Ericka

helari wrote:
My HMO will not allow me to change my obstetric care since I am beyond
my 6th month of pregnancy. It is due to their "global billing" process
that occurs with one bill that covers all prenatal care and delivery
sent by the ob/gyn to insurance after delivery. This is a money issue
and all I have been hearing are "contractual obligations."

I need to change to a new medical group by Sept. 1st in order to be
delivered by a midwife. I have 2 short days left to convince them or
find an "out of the box" solution that they would agree to do.

From what I'm reading, you're 8 months pregnant, your HMO says you
can't change after the 6th month, and the new medical group won't take
you after the the first day of the 9th month. Is this correct?

Is your concern regarding prenatal care, or delivery? If it's delivery,
it seems like hiring a midwife out-of-pocket is the way to go.

It'd be worth it to figure out what the HMO's policy would be for
paying a facility outside of the 1st medical group's contracted
facility (unless it's a two-hospital town), like for an emergency
birth. But that's just splitting hairs and looking up
policies/contracts for the facility component of the birth, not the
provider component.

My medical coverage is currently an HMO. The medical group I need to
switch to will not accept me because they said they would lose money
taking me at such a late date (I'm due in 6 weeks).

I'm guessing that they *would* take you if you offered to pay for all
subsequent 8th-9th month visits and delivery out of pocket. Just
something to consider.

I am trying to change the medical group so that I can be put under
midwife care. This is really important to me, and I am looking for a
loophole, or at least some convincing arguments but I feel helpless in
this matter and do not know if there is anything left I can do/plead
for.

The closest thing I can think of, outside of you paying for your care
going forward out-of-pocket (so your existing medical group gets the
global, but you pay for all subsequent visits and delivery) would be to
hire a midwife and/or doula out-of-pocket for delivery. Is your issue
that you don't like the prenatal care you've been receiving from
Medical Group 1, and believe that the prenatal care for the next month
from Medical Group 2 would be better, or are your concerns about
delivery with an OB from Medical Group 1?

Sorry to be so pessimistic about this; if I were in your shoes I'd look
into hiring a midwife whom I'd be paying, pronto, given your preference
and due date.

Best of luck,
Caledonia