Many expectant parents are pretty savvy these days aboout making sure that their obstetrician and the hospital where they plan to have their baby are in their health insurance network. Using an out-of-network provider would almost certainly mean higher out-of-pocket costs: The plan might pay just 60 percent of charges, for example, instead of 80 percent or more.
However, fewer parents-to-be realize that they may be in for a nasty surprise if their baby is premature, or for some other reason needs special care immediately after birth: The neonatal intensive care unit (NICU) personnel at their in-network hospital may be out of network.
“Some hospitals do contract with other clinical provider groups to run their NICUs,” says Marie Watteau, director of media relations at the American Hospital Association.
The companies that staff the NICUs may accept the same insurance carriers as the hospital, or they may not.
“When selecting a hospital, pregnant women should verify that all hospital care, including NICU care and physician services, are in network,” Watteau said.
At Owensboro Medical Health System, the NICU unit isn’t leased to another company.
“Since the physician group is from Louisville most of the insurers are the same ones we encounter,” said OMHS spokesman Gordon Wilkerson. “We also worked with the group prior to (NICU) implementation to make sure they knew what insurers we see at OMHS, so they could contract and become in-network.”
The OMHS NICU has been open for a year.
In Englewood, Colo., Nathan and Sonji Wilkes thought they had covered all the insurance bases before the birth of their son, Thomas, seven years ago.
Their obstetrician and hospital home were all in-network. They checked with the health insurer that provided their coverage to estimate their out-of-pocket costs. The expected total: $400.
Thomas’s birth was uneventful. But when hospital personnel circumcised him, he wouldn’t stop bleeding. He was given a diagnosis of hemophilia, treated and placed in the hospital’s NICU, where he received treatment to stop the bleeding and remained under observation for a day.
A few weeks later, the Wilkeses got a $50,000 bill for Thomas’s NICU stay. They learned that the unit, located on the same floor as the regular nursery and delivery rooms, was staffed by a company under contract to the hospital, and the company didn’t accept the family’s insurance plan.
“We just thought it was part of the hospital,” says Nathan Wilkes. “We had no idea that it was even an option that the NICU could be in a different network.”