Question
MY WIFE AND I ARE HAVING A BABY AND HAD A QUESTION ABOUT HMO COVERAGE. OUR OBGYN HAS THREE PLACES THAT HE DELIVERS BUT OUR HMO ONLY COVERS ONE OF THEM. WE WENT TO TAKE A TOUR AND ITS THE WORST PLACE WE HAVE EVER SEEN. WE DEFINITELY DONT WANT TO HAVE THE BABY THERE. IS THERE ANYWAY TO TRANSFER TO ONE OF THE OTHER PLACES THAT HE DELIVERS AND STILL BE COVERED OR ANY OTHER PLACE OF OUR CHOICE?? WE CALLED THE INSURANCE AND THEY SAID THAT WE HAD TO GO THERE, OR ONLY THE HOSPITALS THAT ARE IN OUR PLAN BUT ALL THE OTHER PLACES ARE TO FAR. HOW CAN WE TRANSFER TO ANOTHER HOSPITAL AND STILL BE COVERED??
Answer
Hi
If the HMO does not authorize you using a provider that is not in their system and you go anyway, you have to pay. If you should be out of State, like on a vacation, and suddenly the Baby decided to arrive, it might be covered under the emergency clause of the HMO contract.
That is one of the problems with HMOs
John
