- 14,809
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.
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.
