Pittsburgh Nesties
Dear Community,

Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.

If you have questions about this, please email help@theknot.com.

Thank you.

Note: This only affects The Nest's community members and will not affect members on The Bump or The Knot.

WWYD - UPMC/Highmark Insurance Question

Hi, I barely post and lurk quite a bit on here.  I have been married for a year and 4 months now and live in the North Hills. 

Question:
So I have a really great insurance plan through work with Highmark. I am pregnant and see the Midwives at Magee - due December 30th. As most of you know, come January 1, the Midwives will no longer take my insurance since they are UPMC. This is how it will be unless a deal is reached and who knows if that will ever happen.  If I stay with the Midwives and a deal is not reached, out-of-network, my insurance covers 80% so I would pay 20%. 
Would you switch doctors now? or wait it out? I'd really hate to switch and then a deal be reached.

Re: WWYD - UPMC/Highmark Insurance Question

  • kris356kris356 member
    Ancient Membership 500 Comments 100 Love Its Name Dropper
    Personally, I would switch but I have issues with Magee in general so I may not be the best person to ask. Plus, I am cheap and wouldn't want to pay when I could be covered 100% and deliver at West Penn or St. Clair.
    image

    "He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be worthy of such devotion." - Unknown 

  • lishielishie member
    Eighth Anniversary 5000 Comments 25 Love Its
    Ditto Kris. I'm pretty risk averse and would want to find someone I know would be covered under my insurance. I'm an odd one and since I didn't have high risk pregnancies I didn't want to deliver at Magee.

    I had both my boys at Forbes, and I loved the doctors and nurses there.
    imageimage
  • denaleadenalea member
    Ancient Membership 1000 Comments 100 Love Its Combo Breaker
    I, too, would hate to have to pay because of a late baby...and a lot of them are!  If the choice was between full coverage and paying 20%, I would change.  20% of baby delivery will add up quickly and easily be thousands.  (Not to mention, new year, new deductibles, etc.)

    But, before I switched, I would check with the mid-wives and your insurance to be sure you understand correctly.  What would their policy be, given that you are a current patient, if you were to go past your due date?  Would you be grandfathered into coverarge?  Is there any kind of allowance made for that kind of thing?  I can't hurt to ask.

    If the answer is no, there is no allowance for that kind of thing (or the 80%/20% is the allowance), I would go ahead and switch now.  You are still early in your pregnancy, and you have enough time to switch around until you find someone else you're comfortable with.

    Sorry you're going through this.  It stinks that the insurance wars are being played out like this.
  • I agree with Dena - I'd check and see if there were any policy for existing patients. If not - I'd go ahead and switch now just for peace of mind (when you're that far along - the last thing you'd want is a bunch of stress). Good luck in your decision! 
  • Ditto Dena!  I would confirm first that there wasn't an exception for your situation.  If there is not, then I would switch.  20% of delivery would be thousands of dollars (not sure if you have an OOP max).  Hopefully they will strike a deal soon and you won't have to worry about it.  (Also, if you stay at Magee, I had an awesome experience there with both of my c-sections, and wouldn't hesitate to recommend the hospital.)
  • Ditto everyone else! And, another positive experience (x3) for me at Magee.

     

    What I loved the best was the honesty of the nurses there. When I had #2, the night before I went home I had a nurse urge me to let them take my son to the nursery for the night bc I needed the rest. They brought him to me when he was hungry, but knowing there wasn't the pressure to keep him with me, was a nice break for me.

    image
    My three sons!

  • mc0113mc0113 member
    10 Comments First Anniversary
    Thanks so much, ladies! All of the positive experiences at Magee are why I don't want to give that up if I don't have to. No one seems to know what will happen. The lady I spoke with at the Midwives office said that they haven't told them anything and that she would suspect they would grandfather me in since I have a 2014 due date - but of course, no one can confirm anything yet. I think I'll wait a bit longer then make a decision. Thanks again!
  • I had two good experiences at Magee, but I'm not sure that I would risk paying 20% of the cost just to give birth there with other good hospitals available.

    With my second, I wanted a VBAC, which Magee will allow but not all hospitals will. I would have payed 20% of the costs for that benefit, but otherwise I would switch.

    What about the Midwife Center in the strip district?
    Heather Margaret --- Feb '07 and Todd Eldon --- April '09

    image
  • mc0113mc0113 member
    10 Comments First Anniversary
    MrsAmers said:
    I had two good experiences at Magee, but I'm not sure that I would risk paying 20% of the cost just to give birth there with other good hospitals available. With my second, I wanted a VBAC, which Magee will allow but not all hospitals will. I would have payed 20% of the costs for that benefit, but otherwise I would switch. What about the Midwife Center in the strip district?
    Very true. This is our first and I plan to go natural which is why I'm interested in the Midwives at Magee.  We looked at the Midwife Center in the Strip but we like the idea of being in a hospital in case there are complications. And if there are, their back up hospital is UPMC Mercy - which would put us in the same situation with paying 20%. 

    If I do end up switching, can anyone recommend a Highmark doctor that would deliver at West Penn? At this point, that would be my second choice. 
  • I recently switched from a UPMC dr to Highmark (we switched insurance). I saw Dr Sword at West Penn OBGYN (they have several locations: http://www.westpennobgyn.com/) and really, really liked him.
  • I recently switched from a UPMC dr to Highmark (we switched insurance). I saw Dr Sword at West Penn OBGYN (they have several locations: http://www.westpennobgyn.com/) and really, really liked him.
    I used to see this practice before my insurance changed.  I love Dr. Sword.  Dr. McNulty delivered my first son and I love him as well.  There are several women in the practice as well, that are great, too.  Good luck!  
  • lala5507lala5507 member
    Ninth Anniversary 2500 Comments 100 Love Its Combo Breaker
    edited May 2014
    Seems like I am in the minority here. I didn't love my Magee experience.  I mean it was ok.  If I had to deliver there again, I would.  but when my ob/gyns switched from upmc to highmark, I didn't hesitate to follow them.  I LOVE my doctors! If I ever have another baby it will be delivered at West Penn. 
     
  • I had 1 great, unmedicated birth at Magee and another OK, unmedicated birth at Magee (not with the midwives, just my docs).  But with that said, I wouldn't hesitate to deliver there again if there was a number 3 in the cards, and it was covered by my insurance. 

    Also to note, with number 2, I didn't have maternity coverage as part of my insurance so we had to pay for it out of pocket.  So IF you are able to go natural (which is an IF because there are so many unseen variables) 20% of costs wouldn't be too terrible (I think our hospital charges were around $6,000).

    With that said, I'd likely go with the sure thing and switch to a doctor's office where you're delivery will be covered at 100%. Even if they don't have midwives, it is completely possible to have a great med free birth experience without them. 
    imageBaby Birthday Ticker Ticker Baby Birthday Ticker Tickera>
  • Double check with Mercy...i believe the contract at Magee extends beyond 12/31
    ourblackandgoldworld.blogspot.com
  • Another plug for West Penn OB- Gyn - Dr. Roperti is great as are all the docs there.
    Isn't there a mid-wife practice associated with West Penn anymore?  I thought there was ?
    photo 332252f4-f278-4d48-99f9-c275d87c3339.jpg
    How time flies! Caileigh (9), Keira (6) & Eamon (3)







  • kris356kris356 member
    Ancient Membership 500 Comments 100 Love Its Name Dropper
    Double check with Mercy...i believe the contract at Magee extends beyond 12/31
    Magee might, but would her midwives still be covered? I think that may need the most clarification.
    image

    "He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be worthy of such devotion." - Unknown 

  • i delivered 2 babies via the midwives. first birth i did not deliver naturally and i don't think there was any real value/difference in being with a midwife or not.

    second baby i did deliver naturally- not out of choice- i was begging for an epidural towards the end but get this- Magee was so busy that night that i actually labored in the waiting room for 45 mins. by the time i was checked i was at 8 centimeters begging for an epi and they said they were so backed up they wouldn't make it in time! and they didn't.  it worked out for the best- i got the natural delivery i always hoped for... but that's not what you want to hear when you are at your pain maximum and your midwife is so busy she was only with me for the actual delivery (water broke and he was born 3 mins later...).... so yeah. i still like having my ob care through the midwives but i don't think they are worth paying 20% for. i bet you get better one on one care at a less busy hospital.
  • kris356kris356 member
    Ancient Membership 500 Comments 100 Love Its Name Dropper
    edited May 2014
    image

    "He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be worthy of such devotion." - Unknown 

Sign In or Register to comment.
Choose Another Board
Search Boards