preeclampsia and hospitalization charges (obgyn, insurance, home)

[avarmaavarma]

Just a week prior to delivery, my wife was diagnosed with pre-eclampsia (a high risk condition for pregnant women).

She was admitted a week early - and kept under observation - as a high risk patient. This was done on an urgent basis - and my understanding was that urgent care was 100% covered by our plan.

It seems the insurance provider (Aetna), is not treating this as urgent care - and as a routine hospitalization - where we are liable for the co-pay as well as a daily rate for the hospital.

Does anyone have past experience with something like this?

Thanks
AV

[Threestep2]

Originally Posted by avarmaavarma

Just a week prior to delivery, my wife was diagnosed with pre-eclampsia (a high risk condition for pregnant women).

She was admitted a week early - and kept under observation - as a high risk patient. This was done on an urgent basis - and my understanding was that urgent care was 100% covered by our plan.

It seems the insurance provider (Aetna), is not treating this as urgent care - and as a routine hospitalization - where we are liable for the co-pay as well as a daily rate for the hospital.

Does anyone have past experience with something like this?

Thanks
AV

Discuss this with the medical provider who submitted her to the hospital and the hospital. Are the billing codes correct?

[Trainwreck20]

Originally Posted by avarmaavarma

Just a week prior to delivery, my wife was diagnosed with pre-eclampsia (a high risk condition for pregnant women).

She was admitted a week early - and kept under observation - as a high risk patient. This was done on an urgent basis - and my understanding was that urgent care was 100% covered by our plan.

It seems the insurance provider (Aetna), is not treating this as urgent care - and as a routine hospitalization - where we are liable for the co-pay as well as a daily rate for the hospital.

Does anyone have past experience with something like this?

Thanks
AV

Interesting approach - my wife had high blood pressure near the end of her term - maybe last six weeks? - and they put her on modified bed rest at home. Basically, lay down all day except for bathroom and her every-other-day Dr visits. She took her blood pressure multiple times a day and had to send it to the doctors office at the end of the day, as well, iirc. In any case, about 2 weeks prior to delivery, she went in for an appointment and they decided it was too high and induced that afternoon. All expenses were covered, but there were none prior to her being admitted for inducing.

It does seem a bit odd that it was 'bad enough' to not stay at home on bed rest, but not bad enough to induce. Although I will admit I am far from a medical doctor and that has been 15 years or so. But two weeks from due date is considered well within full-term. Has she delivered already, I assume? Did they have to induce? Did they give her magnesium sulfate (or similar) to abate the PE during/after delivery?

[avarmaavarma]

yes - it was exactly that - bad enough to check into a hospital, with the understanding that they could induce at any time!

Multiple tests per day, close monitoring - they stretched it out for a week, and finally induced. Not sure what to make of it.

She never had severe symptoms - until towards day 7 - where she had really really high BP - and they induced right away.

[Trainwreck20]

Originally Posted by avarmaavarma

yes - it was exactly that - bad enough to check into a hospital, with the understanding that they could induce at any time!

Multiple tests per day, close monitoring - they stretched it out for a week, and finally induced. Not sure what to make of it.

She never had severe symptoms - until towards day 7 - where she had really really high BP - and they induced right away.

I suspect that the insurance is claiming that she 'should have been monitored at home'. I don't know if that is right or wrong, but it is what happened to us. I am not a fan of insurance companies, but I don't really trust hospital decisions especially, either - had a close friend rack up 10s of thousands in 'uncovered' charges that could have been avoided but they were treated as if 'normal'. You might have to pressure the hospital into explaining (to you and the insurance) why they deemed it necessary to come in but apparently too early to induce.

[ashbeeigh]

It has to do with the doctor’s orders. There’s two different types of hospitalization, as you mentioned “inpatient” or “observation.” The doctor will have to put in an order to change her hospitalization to “inpatient” for it to flip over to the other hospital stay. There’s usually a team of case managers looking at these things pushing the doctors to switch over to the inpatient status if a patient has been there more than two nights. But, this could be different in thr OBGYN world. I’m more experienced in the med/surg world.

Even with that said, I’m a bit confused though, are you suggesting that because it was an emergency that you should only be paying the ER visit?

And asking online is like the dullest thing. Call Aetna in the morning to understand the charges.

[creepy]

Often insurance companies try and get out of paying OR it takes time to re-process and get the charges to a correct level. I always wait a couple months to see if on their own-the charges are adjusted.



If they are not, you can call the doctor office and the insurance company and start a convo about the situation.


I also had pre-eclampsia, mine was severe. You and your wife and very lucky to have gotten thru that. Each situation with it is different. In my case we had to do a C-section, I think me trying labor, might have given me a stroke. It is a very stressful things to go thru. I normally have low blood pressure. Some women can lie on one side and get thru it, mine did not respond to this at all. Some women die from this-lucky that your wife and I made it thru.


Side note, your wife now has a 50/50 chance if she has a child with you again of having a recurrence, if for some reason she were to have a child with another man, that chance goes back to 100%. My info is old though and perhaps in the 20 or so years since I had my son, the rates of pre-eclampsia - they have found a way to prevent or treat.


I had PPD depression/anxiety after this-don't know if it was related or not but now I am an advocate for other women who have PPD, so if your wife ever needs someone to talk to, contact me.