Health Insurance Question Re Prenatal

Dear T.,
Congratulations on your pregnancy!
I'm a licensed insurance agent and my advice is to definitely speak with Aetna Member Services. The number is on your ID card. Have a list of questions prepared ahead of time and document your conversation. I would definitely let them know that you are pregnant and that you need to clarify your maternity benefits, if there are any restrictions on providers you can see such as in-network as opposed to out-of-network, and if you need referrals, etc. It's best to find all of that out now.
As for the blood work, I don't see why it would be necessary to repeat the same tests. You can have your results forwarded to your new physician. Keep in mind that insurance policies pay for benefits covered and for things that are deemed "medically necessary". Unless the lab botched the tests or something, it wouldn't be necessary to repeat the blood work due to switching doctors. Doctors are pretty savvy about these things. They know they need to submit diagnosis codes and procedure codes in order to request tests and submit to insurance. Start with your insurance company first. If you don't have an Evidence of Coverage booklet that outlines your benefits, rights and responsibilities, request one.

Best of wishes to you!

1 mom found this helpful

I went to one Dr. when I found out I was pregnant and she did all my bloodwork. After I realized that she did not deliver at the hospital I wanted to give birth at so I signed a release and had them transfer all my bloodwork results to my new Dr.! I did not have to have the tests done twice and the insurance didnt have to approve them twice. Problem was solved. You should be able to do this too. Good luck!

As long as your only switching doctors and not adding a visit it should be fine. You can always call your insurance company to double check.

I have Aetna POS & all of my prenatal visits were of no cost or co-pay to me, including blood work. However, your company's Aetna POS plan may not cover the same things as mine, or another company for that matter. You should probably call the member services number on your Aetna I.D. card & they will be able to tell you whether your plan will cover blood work from a 2nd prenatal doc. But actually, if the 1st doc already did blood work, you or the 2nd doc can request for that info to be sent to the 2nd doc.

This being my first prenatal experience in California, I was quite surprised by a couple things. First of all, when I changed OBs, I had to pay $15 for a copy of my medical records! They told me the only reason it wasn't more was because I didn't have many records.

The second thing I was really surprised about was the $30 bill I got from my previous OB. Evidently in CA, when you change OBs, you have to pay the copay to your previous OB for every appointment you had with them. Thank goodness I only had ONE appointment with them! I don't know if this is specifically an HMO thing, but you should call your insurance company just to make sure.

As far as bloodwork goes, your new OB should accept whatever has already been drawn, etc. Just make sure you take copies of your medical records with you, but your new OB shouldn't make you repeat bloodwork. When I moved from Florida to Delaware, my DE OB accepted whatever was already done in FL, the only difference being that each state draws blood for different tests.

Part of me is glad that I'm planning a homebirth and won't have to deal with all the insurance stuff come birth-time!

Probably need to talk with your insurance about it. However, I would go see the new doc and ask them to hold off on the blood work for now until you see if you like the new one. If not, nothing lost. If you find out your insurance will pay for the blood work again, have it done with the new doc.

If the insurace will not pay for it, ask the first doc to forward it to the new doc for you. Those are YOUR records and you have the right to choose a doctor that you are comfortable with. I know that it is hard to tell a doctor that you just aren't comfortable with him/her. However, chances are that you will speak to a receptionist or nurse about forwarding the blood work, they will fax you a release of medical information form to sign and once you fax it back you will not need to contact the first doctor again.

I don't know specifically about Aetna, but you might call the toll free number on the back of your card and speak to a customer service person. They can pull up your plan and let you know what would be covered, and the sequence of events that should be followed to ensure coverage.

Good Luck, and Congratulations!!

You can take your records with you to a new doc. If you think the blood work at the previous doc was faulty I would doubt that you could have it done all over again.

Hi! There is no "general" with health insurance plans. Every group has their own policy. There are different types of plans like PPO's HMO's, POS's, etc. What is covered in one company's PPO has no bearing on another. It would probably only take one quick 2 minute call to the 1-800 number on the back of your insurance card to find out the answer. Be sure to find out yes or no from the folks who you are actually relying on to pay the bill! You don't want any surprises. : )

Hello T.: With things changing so fast in the job market and companies changing their policies you need to check with your company and get it in writting as to what you can do.
Congradulations on the new baby. My 5 children are the greatest experiance of my life and the greatest adventure that I am ever going to have. Honestly I thought that parenthood was great but being a grandparent is the best!! I am smart again and the little ones think I am a hero when my children think I am " oh Mom". Nana Glenda

I don't know why the second doc would need to re-do the bloodwork.

I did it with an HMO during my first pregnancy 15 years ago. Saw one doc for my initial visit, we didn't "click" and then switched to a totally new practice for my pregnancy and delivery. My new doc simply requested all test results and records be transferred to his office. No problem at all and no need to redo any tests. First visit was the week or two post missed period, second visit was a month or so later. I had no issues with switching docs on my insurance, apparently it's done all the time.

You are entitled to anything at all in your medical records. I would simply submit a request for copies of the test results from the Dr's office and take them with you to the next Dr you see. Not sure how your insurance works but if you have a primary care Dr outside of your OB/GYN have them request the records for you. It's not unusual for a primary care Dr to want to be kept in the loop when their patient is seeing another Dr for one reason or another. It's not an unusual request and chances are the Dr's ofc you saw wont even blink an eye at it. They may however charge you a copying fee. It may be a per page fee or a flat rate but its usually a minimal amount

T.,

What about just asking the first doctor to forward your test results and other information to the next doctor. Usually it takes a quick form that you fill out to release your health record and then your results can be sent wherever you want. As far as paying for extra tests, I would just call your insurance and tell them your situation--see what they say. Make sure you get the name, time of the phone call and what they say down on paper. Make sure you repeat what they say and ask them to verify it. That way if there are any discrepences, you will have the proof to dispute your charge. Most insurance companies record all phone calls--- so that would be in your favor in this instance. Good luck!

M.

T., why don't you just have the new doctor request your medical records from the first one? Or you could probably just pick them up and take them with you to your second appt. You might have to pay a copy fee, but I don't think it would be much. I think your records actually belong to you.