I never thought American insurance was perfect. I have been the 'pro bono' case of a specialist in NYC for four years now because my comprehensive insurance (by A.e.tna, one of the largest insurers in the U.S.) does not cover the care I need. And of course, they don't cover infertility at all. But I thought that at least my insurance would cover basic care for an infant ...
Here's the basic problem: PKU testing is mandated by NY State. If you refuse it, child protection services will come to your apartment and try to take your child (I know you can refuse it in other states but you can't here). Fine. I'm all pro-testing. But PKU testing -cannot- be done within 24 hours of birth because the child's temperature is not yet sufficiently regulated. And I will be released from the hospital before my infant is 24 hours old. Which means that I need this testing done at my pediatrician's. Which is -not- covered by my insurance. My insurance covers injury/illness/conjenital defects which are treated in-patient during the first 31 days. I.e. they will only cover procedures done in the hospital.
First of all, I cannot find an estimate of the cost on google. Nobody seems to pay out of pocket for this. Second, I'm pretty sure it's going to be a lot if they run the full genetic panel, which is recommended. Because of the paperwork mess my infant will not have her own insurance (with full benefits) until at least 10 days after birth. Which leaves me wondering what everyone else does ... I really just hope this is some awful misinformation provided by either my hospital, insurance or pediatrician. But thus far all three are sticking to their guns on trying to pass responsibility off on the other.
oh, and A.et.na didn't exactly give me the warm fuzzies when they kindly recommended I try to have a C-section so I could have a longer hospital stay and thus have all the necessary procedures done to my poor baby inpatient ... one more fine argument for the scheduled c-section here in NYC.
Subscribe to:
Post Comments (Atom)
12 comments:
Maybe this is a dumb suggestion, but could you bring the kid back to the hospital for testing?
Only if the hospital planned to readmit the baby for an ankle prick ...
Is it standard to stay less than 24 hours after birth? That doesn't seem like enough time.
PKU testing actually needs to be done about 24 to 48 hours after birth in order for the baby to have ingested enough food to check for the presence of Phenylalanine, it has nothing to do with the baby's body temp. It also needs to be redone at 2 weeks as a fail safe to catch any levels that may have been to low to register at 24 hours. This is especially important for breastfed babies who may register lower levels, even if affected. Hospitals routinely collect theses tests as a outpatient in their labs (although they are send outs), and it may be that the pedi's office does not have access to these forms or to the lab that does these or the people trained to do these specialized collections. In my particular state, they all go to the same lab, results are reported to the state, with follow up, and collection is specialized in training. ( All state mandated)
Collection involves a heel stick of the baby's foot and collecting blood for eight nickel sized cardboard spaces. Techs need to be certified in collection on a regular basis so you can see why you don't want someone messing it up and having to repeat this on a days old baby.
Hope this answers any questions. I can't see why your insurance would not be required by law to pay for this test. I would check with your Pedi's office, as most don't do them, instead referring patients back to the hospital lab for the baby, or if they are already home, as an outpatient.
I found a massively large manual that details the laws and am attaching the link here, but will also highlight the most important bit as well. First the link http://www.wadsworth.org/newborn/phyguidelines.pdf . This manual was published in 2003 and it look as if the applicable laws were passed in 2003 and the entire thing is about newborn screening in New York State. Anyway what you really need is on page 6, where it mentions that the hospital is required to do the newborn screening before the baby leaves the hospital, regardless of age and then again between days 3 and 5. It also states that according to the Am. Ped. Ass. this first date is not optimal but they recognize that not every baby stays in the hospital for more than 48 hours.
Hope it helps.
Thanks for the information Melissia, but my hospital explicitly warns that they -will not- test babies who stay for less than 48 hours in the hospital, and they will not readmit babies for testing. My pediatrician will absolutely do the testing, but then I have to pay out of pocket. The real question is how much this will cost - any ideas?
And yes Rachel, 24 hours (or less) is a short stay but given that partners can only visit during 'visiting hours' I would far rather be home at my apartment with JD and my mother around then alone in the hospital with a newborn who I am single-handedly supposed to care for (nobody uses the nursery - it's very frowned upon if you want to breastfeed and the nurse to patient ratio can be more than 10:1 so it's not like they have time to help you with the little stuff). Oh, and sharing a hospital room with another mother and newborn also sucks because it makes it even harder to sleep when someone else's baby is crying a few feet away from you.
Ok, I'll admit. I'm deeply puzzled. The law does suggest the hospital should offer us the test. But they explicitly state that they don't. I'm going to call them Monday and ask about it, or maybe wait until my next NST next week.
Two thoughts . . . do you have any friends who recently had a baby? If so, ask if they can look at what the cost was for the test on their E.O.B. (explanation of benefits).
Second, in my state, the baby is covered under the mother's policy for up to 30 days (including adopted children). Thus, if a woman gives birth on the 3rd day of the month, then baby is on her policy until the 1st day of the following month, at which time baby needs their own policy. I gotta think it's similar in NY?
A third thought . . . can't baby be on hubby's policy? I know plenty of people who contact their husband's HR office ahead of the birth and this is arranged so that baby is on Dad's policy at moment of birth. Or the first of the following month.
Here is the scoop. Like many state mandated programs, the actual cost of the test is paid for by the state, it is done only at one lab. I am talking about the entire newborn screening, of which the PKU is just a part, perhaps that is where the confusion comes in. I don't know of your hospital actually charges to collect the blood via heel stick, you will need to call the business office of the hospital or the doctor's office. If you go to the above reference manual and read the questions and answers it says that the costs are absorbed by the state, I thought so, it is also addressed in the law which is also listed.
Why will you be discharged before 24 hours?
Suggest you contact the New York State Newborn Screening program for guidance. They may need to talk to your birth hospital about the rrule that every newborn must be tested.
They may have ideas on hiow best to get the test paid for if hyou have to do it on your own or you want a repeat done at two weeks of age of your baby as a doublecheck.
There are out of state commercial and non-commercial labs which will do the test and the cost is $100 or less.
It is very important that these newborn screenings test be done. I am a PKU dad and until my son was born and detected I like most had no idea what this was about.
Your insurance sounds like a nightmare. We had 30 days to get the birth certification (basically a note from the hospital, since it takes the county at least 60 days to record the birth) to the insurance company, but coverage was retroactive to the date of birth (otherwise, testing in hospital wouldn't have been covered). Anyway, if the state mandates the testing, they ought to have some referrals as to where to get it for free/cheap. Not sure how much time you have, but you can continue to harass your insurance company until they agree to cover it. I wish you had better options for hospital stays. My hospital had unlimited visiting hours for parents, private rooms for all new moms (although you had to argue with the insurance about charging for that), and the nursery would come and take the baby any time you wanted or leave him/her as long as you wanted.
Post a Comment