No Immediate Danger of Our Health Plan

During our last visit for a scheduled checkup, we were informed that our help plan, Aetna HMO (we didn’t choose PPO or POS plan mainly because we are still young, in good health, and only use our doctor for annual physical), will no longer be accepted by the hospital. The reason, as we heard from our doctor, was that Aetna wants to put a ceiling on the cost of each delivery and the hospital rejected the proposal as the amount wasn’t enough to cover the whole bill.

Since then, we have contacted Aetna, the hospital, and our doctor, and found we still some breathing room. Actually, only Aetna PPO and POS will be terminated by September 19th. For HMO plan, the hospital’s contract with Aetna will expire next January , and by then we should have a new health plan that is in the hospital’s network (the annual renew starts next month). The hospital also told us that since my wife is already in the second trimester and did all her first trimester tests with the hospital, her scheduled Amnio, which is late this month, will not be affected anyway. This gave us some relief as we were really worried when we first got the news. It won’t be too much trouble to change hospital, but finding a good OB/GYN (yes, a good doctor) isn’t an easy job, not to mention rescheduling the test, which has to be performed during certain period of time. Glad we don’t have to go through this at least for now.

As for the future, the hospital proposed an alternative to us: we switch to Aetna PPO or POS plan next year and continue to use the hospital till delivery. Aetna will pay the hospital at the out-of-network rate which covers about 70% of the cost and the other 30% will be our responsibility. However, since even at 70% what the hospital will receive is still higher than what Aetna plans to pay under the new proposal, the hospital can waive the 30%.

The proposal is interesting, but I am afraid we don’t want to go this route as it’s kind of risky. Even if there is a written agreement from the hospital, the potential trouble outweighs any benefit the plan (PPO or POS) has to offer. The simplest solution may be just getting an in-network plan.

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