Hopkins is dropping CareFirst

[Anonymous]

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

[Anonymous]

Anonymous wrote:A. Single payer health care systems do not pay doctors the big bucks
B. Carefirst is a nonprofit organization while Johns Hopkins made $200 million in profit last year

What that means for this discussion is up for debate but I think this is a complex issue.

Johns Hopkins Health System is also a not-for-profit organization. They both "made money" last year--they're not in the business of posting losses--but if we're talking about tax status, they and Carefirst have the same tax status.

[Anonymous]

Anonymous wrote:

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

Yes, I'd be furious. What will your employers do to accommodate this?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

Yes, I'd be furious. What will your employers do to accommodate this?

NP. Your bill will be huge!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

Yes, I'd be furious. What will your employers do to accommodate this?

DP here. If the situation is not resolved, she will have to change providers before she delivers unless she wants to pay $8-10k for her delivery.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

Yes, I'd be furious. What will your employers do to accommodate this?

Literally nothing. She’ll have to get a new OB.

Good luck, PP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This may not stick. Brinksmanship is common in the negotiations between powerful provider networks and insurers. They are probably contractually required to provide notice, but sending this sort of notice also gives JH significant leverage, as complaints will start pouring into CF. Even if JH actually goes out of network, it may only be for a short time, as the complaints often bring the parties back to the negotiating table. Still, absolutely sucks for patients.

Have Care First / BCBS, due in early 2023, and my OB only has privileges at Sibley. Both of our employers only offer BCBS.

Yes, I'd be furious. What will your employers do to accommodate this?

Literally nothing. She’ll have to get a new OB.

Good luck, PP.

Correct. This is PP. I will have to change OBs in the third trimester.

[Anonymous]

PP again. For the benefit of other folks on here who may be in a similar boat, I just spoke with Hopkins. This is what they told me: Until March 2023, all hospital charges will remain covered. So anything billed to "facility" will be covered, but anything billed to the "doctor" will not. (I don't know exactly how that line is drawn). So for those whose OBs are already out of network, there may not be a substantial increase, at least between December and March. But if no deal is reached, then as of March 2023, hospital charges would not be covered either.

[Anonymous]

Though I realize that out of network doctor charges alone can be very expensive.

[Anonymous]

Anonymous wrote:Though I realize that out of network doctor charges alone can be very expensive.

You have to be really rich to knowingly have a baby "out of network."

[Anonymous]

Anonymous wrote:PP again. For the benefit of other folks on here who may be in a similar boat, I just spoke with Hopkins. This is what they told me: Until March 2023, all hospital charges will remain covered. So anything billed to "facility" will be covered, but anything billed to the "doctor" will not. (I don't know exactly how that line is drawn). So for those whose OBs are already out of network, there may not be a substantial increase, at least between December and March. But if no deal is reached, then as of March 2023, hospital charges would not be covered either.

They should be able to break it down along averages comparing a csection to vaginal delivery. Facility is everything but the doctor(s). You also need to know if your anesthesiologist is IN or OON should you have a epidural or csection, and whether it is covered and how much. Usually facility covers everything. You may also be billed by the hospital ped and any physician who checks on your and your baby during your labor, delivery, and PP stay. The lactation consultant if they are not directly paid by the hospital. An assistants to the OB or Anesthesiologists. Etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:PP again. For the benefit of other folks on here who may be in a similar boat, I just spoke with Hopkins. This is what they told me: Until March 2023, all hospital charges will remain covered. So anything billed to "facility" will be covered, but anything billed to the "doctor" will not. (I don't know exactly how that line is drawn). So for those whose OBs are already out of network, there may not be a substantial increase, at least between December and March. But if no deal is reached, then as of March 2023, hospital charges would not be covered either.

They should be able to break it down along averages comparing a csection to vaginal delivery. Facility is everything but the doctor(s). You also need to know if your anesthesiologist is IN or OON should you have a epidural or csection, and whether it is covered and how much. Usually facility covers everything. You may also be billed by the hospital ped and any physician who checks on your and your baby during your labor, delivery, and PP stay. The lactation consultant if they are not directly paid by the hospital. An assistants to the OB or Anesthesiologists. Etc.

Unless I was loaded I would never ever risk this. I'd find an in-network provider AND hospital.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PP again. For the benefit of other folks on here who may be in a similar boat, I just spoke with Hopkins. This is what they told me: Until March 2023, all hospital charges will remain covered. So anything billed to "facility" will be covered, but anything billed to the "doctor" will not. (I don't know exactly how that line is drawn). So for those whose OBs are already out of network, there may not be a substantial increase, at least between December and March. But if no deal is reached, then as of March 2023, hospital charges would not be covered either.

They should be able to break it down along averages comparing a csection to vaginal delivery. Facility is everything but the doctor(s). You also need to know if your anesthesiologist is IN or OON should you have a epidural or csection, and whether it is covered and how much. Usually facility covers everything. You may also be billed by the hospital ped and any physician who checks on your and your baby during your labor, delivery, and PP stay. The lactation consultant if they are not directly paid by the hospital. An assistants to the OB or Anesthesiologists. Etc.

Unless I was loaded I would never ever risk this. I'd find an in-network provider AND hospital.

Thanks for this helpful breakdown. Obviously the best option is that a deal is reached before December 1. It is one thing when your cable provider threatens to drop a TV channel and tells you to "call your cable company" for bargaining pressure. It is quite another when it is your hospital and medical insurer, and you don't have any control as to the timing of your medical treatment.

[Anonymous]

Delivering at Inova Fairfax in December. Does anyone know if Inova is Hopkins?

[Anonymous]

Anonymous wrote:Delivering at Inova Fairfax in December. Does anyone know if Inova is Hopkins?

https://www.hopkinsmedicine.org/about/johnshopkins-health-system-corp.html

it's not. the hopkins hospitals are without hopkins in the name are: howard general, suburban, and sibley