Allow me to share the harrowing ordeal we endured immediately after our son’s birth. The story involves health care coverage for my son right after his birth. Hopefully, our experience can serve as a guide to help others sidestep the stress and confusion that overshadowed what should have been a time of pure joy and happiness. Just so you know, the problems we had were not attribuable to my health insurer.
In 2018, shortly after our son’s arrival and just prior to our discharge from the hospital, we found ourselves inundated with documents to sign and decisions to make. As first-time parents, it was exciting and a bit overwhelming. One issue that did not cross my mind was my son’s healthcare coverage. I was lucky to have great insurance through work, and my wife was insured under my plan.
Plus, in California, health care insurance for a new born child falls under the mother’s health insurance policy for 30 days after birth. This ensures that the newborn receives necessary medical attention during the initial period after birth without requiring separate insurance arrangements.
Nothing to worry about, right?
Before being discharged from the hospital, my wife and I were asked to select a pediatrician for our newborn son. In the lead-up to my wife’s delivery, we compiled a shortlist of pediatricians affiliated with the hospital where she had prenatal care and gave birth. When the time came, we were fortunate to have a compassionate nurse pay a visit to our post-delivery room. She graciously laid out our options and we decided upon a pediatrician who was on our list. Our nurse took the initiative to schedule our son’s very first pediatrician appointment, which was slotted for 48 hours following our discharge.
This initial appointment was crucial, as our son was born with jaundice.
On the morning of my son’s highly anticipated pediatrician appointment, my phone rang, and I assumed it was the doctor’s office confirming our meeting later that day. Little did I know; the call was not going to be pleasant. The receptionist on the other end informed me that we couldn’t proceed with the scheduled appointment because the doctor did not accept our insurance. Initially, I suspected some error or misunderstanding, and I tried to maintain my composure, but panic was setting in.
I attempted to explain that our choice of pediatrician had been based on the options presented to us by the hospital, based on our insurance. This didn’t make any sense.
Unfortunately, the response from the receptionist was far from empathetic. He was inattentive and dismissive. In fact, he started mentioning random hospital names for me to explore, which only angered me. As my agitation grew, I started yelling and reiterating that the doctor appointment had been arranged through the hospital based on our insurance coverage. I was told to “calm down.” You can imagine that his request only had the opposite effect, making me angrier. At one point I recall stating I would pay out of pocket for the appointment. The receptionist responded, “it is too expensive, try another place. It is a good thing this interaction took place over the phone and not at the doctor’s office.
Frustrated, I insisted on speaking with the individual responsible for billing and insurance matters within the department.
Health insurance is a blessing to have. I am well aware there are a lot of people who are under insured, can’t obtain insurance or have other issues with medical bills. However, for the most part, if an issue does not directly affect you, you don’t really take it into account or think about it too much. This reminds me of the issue I had with my wife’s ambulance bill and the issue people have with surprise bills.
While waiting on the phone I truly felt sympathy and empathized with people who do not have or are not able to get health insurance. I literally felt dread. My mouth was completely dry and I was shaking. My son needed to be seen by a doctor and now I was being told he could not be seen. The good news was we had insurance and I could have eventually reviewed our options and selected another pediatrician. But there was no time for that. When someone you care about is in immediate need of care it is hard to think straight.
Following a transfer, I found myself conversing with the department’s billing manager. I laid out our predicament, emphasizing that the hospital nurse had recommended the pediatrician based on our insurance coverage. After a protracted exchange, I pleaded with her to contact my insurance provider and explore possible solutions. I did not trust her, so I decided to simultaneously contact my insurance carrier. As the saying goes, “God helps those who help themselves.”
My first attempt to connect with a customer service representative proved futile. The representative was clueless and I did not get the vibe she wanted to work to assist me. I promptly ended the call and redialed the insurance carrier. Luck was on my side this time as I connected with a helpful customer service representative. She quickly reassured me, urging me not to worry, and promised to help.
In a significant turn of events, she informed me of a 30-day authorization she would provide, granting us approval to consult any doctor of our choosing for my son. The relief was immediate, and she issued an authorization code to be relayed to the doctor’s office. To ensure I had no further problems, I requested she remain on the line as I called back the billing manager. Just an FYI, my health insurer no longer provides that 30-day authorization.
While speaking with the health insurer’s customer service representative, I tried to figure out why this situation had occurred. I already knew that during the first 30 days following childbirth, a baby’s coverage and deductible were linked to their mother’s policy. The pediatrician we had selected was part of a practice group comprising several doctors. Though I can’t recall the exact numbers, nearly all the doctors within the group, except for two, accepted my wife’s insurance. It was odd that despite sharing the same office space, nearly every doctor, save for those two exceptions, accepted our insurance. I confirmed this when I cross-referenced an online search of the health insurer’s approved doctors’ list. All the doctors at the office were approved under my wife’s plan, except for two. We chose the one doctor not on the list.
Here is the kicker. According to the customer service representative, we could have simply designated one of the doctors who accepted my wife’s insurance as the primary pediatrician and then went ahead and scheduled appointments with our preferred physician in the office. That is exactly what we ended up doing and my son still has the same pediatrician.
I am well aware that the incident was not my health insurer’s fault. If I was more knowledgeable about health insurance at the time, I could have avoided this mess. Looking back at the issue, one can see this was a result of many miscommunications. I wonder how often this lack of communication and knowledge cause problems for people.
I wish the story was done.
Eager to resolve the issue, I reached out to the billing manager at the hospital once more. When we first spoke, she informed me that she had contacted my insurance carrier and was unable to assist. I remember remarking, “That’s weird, I have a representative from the insurance company on the phone, and she has granted me a 30-day authorization to ensure my son’s coverage anywhere for the next month.” Awkward silence ensued. Then the insurance representative interjected with a courteous “hello.”
Later that day, we got to our scheduled appointment. The billing manager came out to greet us and apologized for the “misunderstanding.” I begrudgingly accepted the apology and told her that other people may not have made inquiries like I did and the hospital may be providing incorrect information to families with new born babies. I highly doubt anything will change, but at least I learned a lot about from the experience.