When no one knows what they're talking about

Jan 14, 2008

  1. Crabcake Johnny
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    Crabcake Johnny Guru

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    I have a current client who's been with me almost three years - just got pregnant, unplanned, and doesn't have maternity. No biggie - right into MHIP and she's covered.

    She calls me back and it turns out she's living part of the time in Reston VA with her "on again off again" boyfriend.

    So she throws this scenario about me: "John, what happens if I'm in Reston and go into early labor? Will I still be covered if I have to go to the local hospital?"

    Well, that's out of the Carefirst Blue Cross network that only covers MD, DC and northern VA. So now we're into the Anthem network.

    I called MHIP and they had no clue. They cover "emergencies" out of network as if they're in network. Duh - I knew that. But is early labor considered a medical emergency? They don't know - call Carefirst.

    I called Carefirst - 1st rep told me as long as she's at a Blue Cross hospital in VA she's covered but she'd check and call back. She never called back. I called again - different answer. If she's out of the Carefirst network she's subject to balance billing since Carefirst has no contact with Anthem. Oh, but medical emergencies are ok.

    I said "I thought with Blue Cross you could see any Blue Cross doctor or go to any Blue Cross hospital. His reply? "Where'd you hear that?" I said, "actually, when I called you over 2 years ago and asked." Great.

    So is early labor a medical emergency? He couldn't tell me and his gut instinct is yes since she'd "have" to seek medical treatment.

    So I called my client back and she wasn't thrilled. Now she wants something in writing stating if she goes into early labor in VA she'd be covered. I told her such a letter would never be written by Carefirst.

    So where are we? No where.
     
  2. taterpeeler
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    taterpeeler Guru

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    john.... does she really have any options... no, she is prego, not your fault.... so it's kinda the old... she's up against a brick wall with no way out.
     
  3. moonlightandmargaritas
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    moonlightandmargaritas Guru

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  4. Crabcake Johnny
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    Crabcake Johnny Guru

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    That's what I was told once - by a Carefirst rep; that as long as they're in the Blue network clients are fine.
     
  5. salpro22
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    salpro22 Guru

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    HaHa, leave it to Carefirst to not be informed about their own plans....
     
    salpro22, Jan 14, 2008
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  6. somarco
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    somarco GA Medicare Expert

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    Nope.

    You catch a break if you are covered under a group plan and part of their national network, otherwise you are limited to your "home state" network. Buy in GA and go to Disney World. Covered for emergency situations, otherwise . . .

    Each Blue plan operates mostly independent of the others, even among "sister" plans like the Anthem/Wellpoint conglomerate.
     
    somarco, Jan 14, 2008
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  7. TXINSURANCE
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    TXINSURANCE Guru

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    Why didn't she look all of this up before getting pregnant?

    I hate to state the obvious.

    Its like looking up your flood coverage after the hurricane.
     
  8. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    What about Universal? Or Busch Gardens here in Tampa?

    Thanks Bob, I learned something.
     
  9. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    Throes of passion perhaps?
     
  10. Dave020
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    Dave020 Super Moderator Moderator

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    I'm not sure about this, in California you get access to Blue Card PPO as long as you are enrolled in a Blue Cross CA or Blue Shield CA individual PPO plan.

    If she is in an HMO, then yes there is no Blue Card, however PPO is a different animal.
     
    Dave020, Jan 14, 2008
    #10
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