Conference moira::parenting

	Thanks Lisa!

	I didn't even *think* that it would be reimbursed.  We paid
	ours out of pocket!  I'll have to see if I can put in a claim
	(I use Tufts, too)

	Another thing I noticed during open enrollment is that 
	obstetric visits are covered 100%.  After I'd been to
	my OB about 6 times, one of the receptionists asked me
	for $18 in co-payments.  I paid that, plus I made a copayment
	for several more of my visits.  I doubt that I'll try to get it
	back, but I'll know better next time around.  I assumed that since
	they asked for the money, I was supposed to pay it.  I'll be sure
	to call Tufts to confirm in the future (Especially with co-payments
	up to $5.00 now!)

	Karen

Hmmm.  I'm curious...I have Tufts also and I read that there is a co-payment
for OB visits.  Am I missing something?

    We use Tufts also.  In looking at the Benefits booklet, just handed
    out during open enrollment, it does state a co-payment for OB visits.
    I'm wondering if we only have to pay one co-payment for the entire
    pregnancy.
    
    I will call Tufts and find out...
    
    Will let you know.
    
    Peggy
    

    
    That's how it works for MTHP/Hitchcock, you pay 5$ at the first
    prenatal visit and all of the rest are covered under that co-payment.
    Makes having babies a rather inexpensive venture (yeah right ;-))
    
    			Wendy

    Ok, I just spoke to Tufts and here's the scoop.
    
    For each OB visit, there is a co-payment of $5.
    
    Childbirth classes ARE reimburseable.  You have to send in a
    certificate from the Lamaze class and they will reimburse you.
    It HAS to be Lamase based classes.
    
    The hospital charges are covered 100%, basic stay is two days AFTER
    the birth and semi-private rooms only are covered.
    
    Hope this helps!
    
    Peggy
    

    
    
    I have Healthsource New Hampshire.  I went to my Primary
    Care Physician for the pregnancy test and paid the $5.00
    copay.  When I went to the OB they told me as long as I
    am pregnant I don't have to pay them.  The OB then referred
    me to an Endocrinologist because I have a history of 
    Gestational Diabetes and I do not have to pay this doctor
    either.  
    
    Jeanne
    

I have TUFTS.  My OB asked for a single co-pay of $30 to cover all the 
visits for the entire pregnancy.  I'm not sure if that is a TUFTS policy, or
if that just the policy for this particular office.

    I didn't know that Tufts would reimburse you for Lamaze classes.  Do
    you think they would honor a Lamaze certificate from 3 years ago.  If
    so I am going to make them out a copy of mine and send it in to them.
    
    
    Liz

    
    	I never got a certificate.  Wouldn't a bill showing the fee
    	as paid suffice ?
    
    	Karen
    

    Are there any Fallon members out there?  I know that co-pay is $2 per
    visit except for ANY hospital services which are covered 100%.  The
    only additional cost to have a baby is if you request a private vs.
    semi-private room.  I found out yesterday that it will only cost me $5
    extra a day for a private room (I'll be at Leominster Hospital).  $5 to
    have a baby!  GREAT!  Can't beat it!
    
    I do have a question about the childbirth classes though.  I know that
    Fallon will reimburse for half (up to $25 I believe), but is anyone
    familiar with the logistics of the reimbursement?  I've sent my card
    into Leominster Hospital requesting to be signed up for classes
    (haven't heard anything yet), without sending payment.  Do they bill me
    and then I show that to Fallon and they then reimburse me?  I guess the
    same question would apply for Fallon's carseat program.  Anybody?
    
    Thanks in advance!
    
    Lynn
    

Lynn,

I'm a Fallon member.  Just last week I received a confirmation letter from
them indicating our schedule for childbirth classes.  Along with the letter
was a form that they asked us to fill out, and return with payment...at
least two weeks prior to the first class.  They ask for payment in full
before the first class. 

The Leominster Hospital fee for the classes is $50, but if you belong to
Fallon, they only require you to send in a check for $25...they will bill
Fallon for the other $25.  You'll need to put your Fallon MR# and ID# on
the form you return with your check.  So you won't have to worry about
getting "reimbursed" from Fallon.

As for Fallon's carseat program (we're scheduled to go tomorrow night!), 
I think we sent in a check for $20 when we signed up for the class.  At
the time, we didn't know when the class would be scheduled.  Later on, 
we received a confirmation notice indicating that our payment was received,
and the date we were scheduled to attend the class at the Fallon facility.
When you attend the class, they will give you the carseat.

I hope this helps!

Jayne

P.S. - thanks for the info about private vs. semi-private room charges.  
       Since I haven't "toured" the hospital yet, I haven't seen what room
       choices are available.  I think one of the childbirth classes includes
       a tour of the maternity facilities.
    

    Thanks for the info Jayne!  I'm looking forward to starting classes!
    
    Lynn

	Jayne's right on both counts.  However, I seem to remember that
the additional charge for the private room was $10/day.  I could be wrong
though.  It may become academic; when my wife had a baby, there were no
private rooms available.  We ended up with a semi-private, but they left
the second bed unoccupied (no extra charge).  The only drawback: no recliner
for "Dad." :-(

	Brian W.

    
    
    The difference between private and semi-private is $10.00  I called the
    hospital today.  Semi-private is $320.00 and private is $330.00
    
    
    Lisa

    Lisa,
    
    That's odd about the difference in room costs.  The reason I say that
    is because I had met with a person from Fallon's patient relations on
    Monday, and she called Leominster for me as I sat there.  The person on
    the other end told her a $5 difference.  Oh well.  Like someone else
    said, it's academic I guess.  $5 or $10, it's definitely well worth it!
    
    Would anyone who's had a baby at Leominster want to comment on the
    staff, the dinner they give you before you leave, etc.?  I love the
    ward!  Getting off the elevator onto that floor is like walking into a
    hotel lobby!
    
    Lynn
    

    
    Lynn, 
    
    I LOVED the maternity ward at Leominster hospital!!!!  You should be
    very happy there. The staff was great, very friendly and attentive.
    I had a labor nurse (with a british accent) who was fabulous! 
    
    As you saw, the ward is BEAUTIFUL. Plenty of room, everything is new
    and the lobby area is large for waiting family and friends (my whole
    family was there waiting, and my younger sisters had already picked out
    which couchs they planned on sleeping on if I went thru the night!!)
    I liked the way the nursery was set up also, that anyone coming off the
    elevator didn't have to go searching to find the babies to look at,
    they were right there..
    
    The dinner was very nice, served down in the dining room (bring your
    doughnut tho, the chairs are wooden! OUCH!I sent hubby up for mine). 
    I forget the choice of meals, but we had a nice piece of steak, carafe
    of wine and dessert (cheesecake!), with linens, candles and all!
    
    Along with that, they had a McDonalds run everynight at 7pm (if they 
    still do this, I don't know)...they gave you a list of the menu and you
    got to get whatever you wanted...the tab picked up by the hospital!!!
    
    I was VERY VERY happy with everything about the hospital and the ward.
    I hope you are too!
    
    Chris (who delivered there 14 mos ago)
            

    I've been considering rooming-in this time.  Notice, I said
    "considering".
    
    I'm wondering how this is done.  Tufts will cover a semi-private
    room.  Do they allow rooming-in in a semi-private room?  or do
    they give you a private room at no extra charge because you're not
    using the nursery.
    
    Just curious...
    
    Thanks,
    peggy
    
    P.S.  I'll be using Emerson Hospital in Concord.

    
    Peggy,
    
    
    	From what I have heard you have to have a private room to room in.
    I'm also "considering" rooming in.    You should call Emerson and ask
    the price difference between priv vs semi, since it's most times 5 or
    10 dollars and pay the difference yourself, thats what I plan to do.  I
    just hope they have a private available so I can do this.
    
    
    Good luck Lisa

	Lisa & Peggy,

	By "rooming-in" do you mean baby stays with Mom in room?  
	If so, is it hospital policy (Emerson in particular) that
	does not allow rooming-in for semi-private?

	I had my first at Emerson and requested and got a private 
	room (it was extra under John Hancock).  Emerson gives 
	privates on a first-come, first-served basis.
	I roomed-in with my baby but I think it was all by chance.
	No one asked and I was not aware I needed to request it.
	I was nursing and just kept her with me.  This worked out
	fine for me.

	I'm due with my second at the end of May and will be going
	to Emerson, again.  I'm interested in this policy 
	especially from the standpoint that, if there are no privates
	available and one wants to room-in, what can she do?

	Deanna

    Hi, 
    
    As for "rooming-in":  I highly recommend it!!  When I had my son Alex
    I was so incredibly captivated by the little person that I couldn't
    have imagined letting him out of my sight.  The nurses offered to take
    him away, but I was emphatic about him staying with me (my husband 
    stayed with us, also).  I, too, was nursing and I wanted to make sure
    that he wasn't given any sugar-water or pacifier.  
    
    Remember, "mother knows best".  My $.02 says follow your heart....
    Those memories of our first days together are precious to me!!!!!
    
    Good luck and wishing you all safe deliveries,
    
    Linette 
    

On the other hand...we chose not to room in. Birth is a very tiring experience
for both mother and husband. My wife needed a lot of rest to recover from the
cesarian. By not rooming in, we could have the baby in the room as much as we
wanted...plenty of time to experience everything...and if we wanted to rest the
nurse just wheeled him down the hall. The only time they took him out of the 
room were for baths and cotor checkups, and I was present for both.

Chris

There is another consideration that I came across in choosing a semi-private
vs. private room at Emerson hospital for my hospital stay after having my
second child.

If you want an older sibling to be able to visit at other than regular
visiting hours, you have to have a private room.  This was essential for
us since we wanted older brother to be able to come visit mom and meet
his new little brother.  Regular visiting hours at Emerson are 2-3 (in the
middle of nap time for most toddlers) and 6-8 (dinner, bedtime).  If I hadn't
had a private room, Ben (my older son) wouldn't have been able to come and
some very special time would have been missed.

    I just delivered at Leominster 5 months ago and yes they still have
    McDonald's runs (thank god) and all. I had a private room and I have
    real problems sleeping after I deliver children so I had my son in with 
    me all but at night and Pedi check-ups. 
    
    As far as the OB co-payment, I have central mass health care and the 
    whole total bill with both for me to deliver and my kids to stay in
    the nursery, room, etc...was 3,000. I payed out a 3$ check for the 
    global co-payment. (this is what they called it when I asked if they 
    need a payment). 
    
    Hi Peggy!
    
    Charlene

    The difference in price between a private and semi-private room t
    Emerson was $30 as of last May.  I remember, because I was billed
    incorrectly for a private room.  Looking back, I should have 
    probably opted for a private room (roomate was noisy and had a bad
    cough at night), oh well.  This was through Harvard Community HP.  I 
    also don't remember them having a policy about siblings not visiting
    with a semi-private room.  My son and husband were there at off-hours
    both days.  The nurses were very accomodating.

    I'm curious....
    
    How do most hospitals define "semi-private"?, ie how many beds
    to a room?

I would guess two, with a sliding curtain between them.

Dave

    Back to the "What's covered" topic.  Emerson Hospital was paid 100%
    percent by Harvard Community for my hospital stay and the birth of my
    daughter Lindsey.  Harvard also paid 100% for all pre-delivery office 
    visits and for the care for Lindsey when she was born.  It did cost me
    $3.00 for the post-partum visit though.
    
    As for Emerson and room set up, semi-private is two beds in one room,
    two TV's and one bathroom.  Rooming in was not allowed for semi-private
    rooms, but was for private rooms.  (This was in September)
    
    Lisa Cozzens

    
    
    I am surprized no one has commented about the new time limitations (is
    that the right way to express this?) for hopsital stays?
    
    Harvard Community started this new procedure July 1st, 1993.  Hold on
    to your seats.
    
    Regular deliveries are out in 24 hours. 
    C-Sections are out in 72 hours.
    
    I can't imagine being home with a little one, never mind your first
    when you need advise or if you have others to care for in 24 hours.  I
    don't agree with this at all!!!!  I am not going to want my mother to
    stay with me but feel as though I will not have enough experience to
    get through the first couple of days without some kind of help.  Am I
    worrying too much?
    
    I had an ovary removed in October and spent five days in the hospital
    and then 6 weeks home recooperating.  How can someone with a C-Section
    be home and moving around in 72 hours is beyond me!
    
    
    
    Comments?
    
    cj

My wife delivered our second daughter in February, and was out in 24 hours.  At
least Fallon gives you the option.  If you choose the one day and out they give
you a $100 give certificate to Toys-R-Us or Spags.

I had a double hernia operation in May, and it was done under full anethsia, and
outpatient....cut at 9:00, out by 5:00!

This is where our health care system is headed, so get used to it!

/mtb

Matthew Thornton Health Plan has had these hospital stay limits for over a year.
And I think you're right to worry.  By all means, plan ahead!  Consider having
help on hand after you get home.  If you can't arrange to have help, let your
doctor know your personal situation.  

I had a C-section at 11 pm on a Friday, and was home the following Tuesday.
(I should admit that I was covered by John Hancock, not Matthew Thornton,
but since I have HMO/Elect I was aware of the Matthew Thornton rules.  And
I don't think Matthew Thornton would have forced me to go home at 11 pm on
Monday evening :-)

My husband took 4 weeks vacation, and my mom visited for 10 days.  And yes,
this was my first.

My mom was *wonderful*.  She did all the cooking and cleaning, and when Dan
or I got frustrated because we couldn't seem to console Noelle, she'd take
over baby duty.  She offered advice only when asked and was full of 
supportive comments.  This is the kind of help every mother should receive!
When Mom left, Dan took over dinners until I was more fully on my feet.

The thing I missed most from the hospital was the adjustable bed.  And, because
I needed my hands to lower myself from standing into a chair, I needed someone
around to hand me the baby, and to take the baby from me so that I could rise.

BTW, the hospital nursery staff said to call them if it was 2 am and you
were desperate for advice of some sort -- they're up anyway!

Best wishes for a speedy delivery and a baby who quickly learns to sleep through
the night!

- Deb

re: Carla (Harvard).

I had heard that one too.  I didn't know that they had already instituted
it though!  I also heard that you will be visited by a nurse for the first
couple of days you are home.  

I'm in the same boat as you and my mom lives in Florida (I'm in MA)!  
I could ask my MIL but she smokes continuously so I don't want her 
staying with me.  I guess I'll be on my own, except for my husband. 

Karen

    I had a c-section and was out in 3 days.  At the time I couldn't
    believe they were sending me home.  It was very emotional, to go home
    but that's the day your milk comes in & double duty emotions with it.
    Anyway, my husband stayed home with me a whole week when I got home and
    when he was ready to go back to work that Monday (or as ready as he
    could have been) I was able to get around & handle the baby by myself. 
    
    I've had many ovarian cyst operations which were wickedly painful & a
    c-section was a walk in the park after that.
    
    I didn't get any sleep in the hospital, I felt like every time I was
    just getting to sleep they were checking my vidal or attaching this
    very hungry stranger to my breast.  When I got home I got
    sleep......

A friend who's an OB nurse told me that most new mothers have no idea how to
handle a baby.  When mothers were kept in the hospital for a while, they at
least had the opportunity to ask questions and get instructions.  Imagine
having never driven a car, being handed the keys to an expensive new car,
and being told to drive it home alone.

Especially when the car has a mind of it's own!  ;-)

    I was in for 72 hours and was given super instruction from St.
    Vincent's in Worcester.  They had someone talk with me for hours on
    every subject - I felt like they really listen!  After they gave me
    morning instruction, they came back every couple of hours to chat and
    see if I had more questions.  I really felt like they knew I was there
    only for a short time, but in that time they'd do everything they could
    to help me feel comfortable with my new little person.  The day I left
    several folks said to call if I thought of anything else I needed
    answers too.  
    
    I was very very lucky.  I'll never ever forget those very special
    people.

    With my HMO if you are out in less than 36 hours, a nurse comes to
    visit you at home.  The home visit is both to check on the baby and do
    a "quick" physical check of mom (which was great since I wasn't prepared
    for the physical stuff that happens after the baby).  At our request
    the nurse checked the baby's room for any potential hazards.  As
    careful as we were she made some good suggestions.
    
    My baby also had jaundice and they sent a device (called a "wallaby")
    home with us so we actually had a home nurse come every morning for 6
    days.  She would draw blood and the hospital would call with the
    results.  My husband and I preferred this to the "light treatment"
    traditionally used at the hospital.
    
    My preference was to be home so the scenario the HMO outlined worked
    great.  You might check if your HMO has a hotline, ours has one can
    call 24 hours a day, 7 days a week.  And as a new mom, these nurses
    were essential.  They even called back to follow-up on the baby.
    
    So hopefully your hospital offers other services to make the shortened
    hospital stay manageable.  I also assume any complications would
    automatically lengthen the stay.
                                       

Our youngest daughter was born 10 weeks ago, and my wife came home 24 hours
after the delivery.  Our HMO (Healthsource) had told us that their policy is
24 hours, but that she could have stayed another day if she really felt that
she needed to (because they changed their policy while she was still pregnant).
Fortunately, Lisa was doing very well and came home early.

What bugged me was that Healthsource never came out and told us about this 
change when they made it last April!  We found out about it through friends who
had happened to call them.  We did get notification of the change in the most
recent newsletter that they sent out, and I got a real kick at the "spin" that
they did with it:  something like "to serve you better" and "since most people
heal faster at home" etc.  

Greg B.

    
    	We use MTHP and this past March I delivered Griffin (10.2 lbs) and
    was out of the hospital in less than 24 hours.
    
    	I was very worried before hand as my first delivery was very
    difficult and I was in the hospital from Monday to Thursday with him. I
    couldn't even conceive of leaving the hospital 24 hours after my second
    delivery!
    
    	But the second delivery was (ultimately) easier. With Spencer being
    at home, me being in the hospital with Griffin and receiving only pills
    for pain every few hours, I felt I wanted to be home more than stay in
    the hospital.
    
    	I ended up having a few complications and needed to be seen by the
    midwives a few days later, but overall, I would have much rather been
    at home than away. They also sent me home with medications and a nurse
    called me the next day to see how things were going (they tend to be
    alittle more relaxed aorund second and more times moms).
    
    	Every delivery is different, if you are not ready to go home for
    physical reasons, they won't let you, if you are not ready to go home
    for emotional reasons, then being in the hospital is not the answer but
    a support system is.
    
    				Wendy

    RE: 37 (HealthSource)
    
    Greg,
    
    I am surprised at the 24 hour hospital stay that you mentioned. We have
    had HealthSource as our HMO for over 5 years. Both my children (ages 
    4 yrs and 14 months) were born "on the HealthSource plan". Both times I
    was in the hospital for 2 days after birth. I know that HealthSource
    pays you some money if you return home in 24 hours.
    
    Shaila

    I just talked with my girlfriend's husband - I've been trying to call
    as yesterday was her due date with her first.  Sure enough, she had her
    baby last night at 5:00pm.  John said he was taking a shower and
    picking up a few things and he's off to bring them home.  I don't know
    what kind of insurance they have, but this is in New Mexico, so I guess
    it's not a regional thing.
    
    -sandy
    

    24 hours seems awfully quick - especially if you don't have a support
    network to go home to.
    
    When my first was born, there wsa NO WAY I could have gone home ni 24
    hours.... I was EXHAUSTED.   #2 was a much easier delivery, but I was
    still more than ready to get pampered for an extra night, and stock up
    on some sleep.  (FWIW, we don't have any family we can call on, so our
    only option would be to HIRE a nurse or mother's helper)
    
    The hospital I was in uses the time for lots of training - help in
    nursing, how to bathe the child, general operating instructions( 8-} )
    and the like. 
    
    Has there been any studies on the long term effects of incresed
    activity very soon after birth?  I know that pioneer women gave birth in the
    fields, etc,....But they also died at a younger age, and a prolapsed
    uterus isn't any fun.         
    
    My first take on this new policy is not good.  Seems to be another
    example of saving money at one point, so that someone else can spend
    even MORE at another point in the process. 
    
    
    
    Jamd

I used the MT midwives (in NH), but actually have John
Hancock.  JH will pay for 48 hours, but the MT policy
is 24, for all patients.

However, I gave birth at 6:30AM, and the following
morning the midwife asked if I wanted to go home that
day or stay another night.  Apparently, it is much more
the medical provider discretion than a rigid policy.
She said she would keep me another night if I wanted it,
and that my insurance coverage had nothing to do with it.

(I was already packed, BTW.  I wanted out.  My mother
was waiting at home to pamper me and the baby).

Pat

    When AJ was born in Jan'87 I managed to somehow get real special
    "privileges" I went home on the SEVENTH day after delivery!  By the
    fifth evening I was hearing comments from the staff of "what are you
    still doing here?"  My OB had somehow "fudged" the paperwork since my
    sone was in NICU, and I had made it clear I wasn't going too far from
    my newborn.  He wrote some gobbledygook about me having a UTI and it
    was medically necessary to stay.  Who cares, it worked!  I had him on
    Friday evening, went home Thursday morning, was back in to visit him in
    NICU at suppertime that night, and even though I'd been told NOT to
    drive, I drove myself to the hospital the next morning, and was there
    by 6:30 a.m.!  Spent most of the morning there, was back up that
    evening with my inlaws and my husband, went up Saturday morning and
    evening (despite a major blizzard) and was overjoyed to bring him home
    on Sunday morning!  It was also convienient that while at the hospital
    I had the chance to use their electric breast pump, until the rented
    one had arrived at home.
    
    As AJ had to have subsequent surgeries and as I approached John Hancock
    for addmission dates, they had to send a doctor's request to their
    "medical review" team to justify ANY preop days, and he ligitimately
    needed several days of preparation for his operations.  
    
    Personally I resent that on a day as stressful as surgery, you are
    required to haul yourself out of bed before sunup to get to the
    hospital for 6 or 6:30 a.m.  I personally would prefer a good (well how
    good is it in a hospital?) night's sleep and just go straight to the
    surgery.  (Just MHO)
    
    Lyn

	Does anyone know if Tufts has changed it's policy regarding
	length of stay post-partum ?

	I believe at the beginning of the year it was 48 hours for
	a vaginal delivery....

	Karen

    I have Tufts and questioned them, I believe in April what
    is covered.  They said "basic stay".  I then asked for a
    definition of "basic stay" and they said 2 days.  
    
    I am due in 2 weeks, I certainly hope they didn't change
    it!
    
    If you find out differently, please let me know.
    
    Peggy
    
    P.S.  Tufts also covers child birth classes.  You have to
    send in a receipt and your certificate.  Plan on waiting
    about 4 weeks for reimbursement however!

    Peggy
    
    Tufts pays for Child birth classes?  Thats great!  How did you find out
    about this? 
    
    I am not due until January, but it never hurts to think
    ahead...espically if I can get reimbursed for something
    
    Also, where did you send the reciept for reimbursement?
    
    Thanks
    Anne Marie
    
    

    Anne Marie,
    
    The Lamaze instructor said to check our insurance, that
    some of them cover it.  So I called Tufts.
    
    You have to send the paperwork into the Waltham Claims
    office...  the address is listed on the back of your card.
    I put our policy # on the top of the paperwork in BIG
    numbers, so they couldn't miss it.
    
    Beware, it takes awhile for the reimbursement.  It took
    2 weeks just to make it into the "system".  Then it takes
    another 2-3 weeks for a check to be cut.  We sent ours in
    a month ago and I'm still waiting.
    
    It's nice to be reimbursed, especially when the class cost
    $70!
    
    Good luck with the rest of your pregnancy!
    
    Peggy
    

re: Child care classes.

Does anybody know if Harvard pays for Child Care classes?  I have to pay
$70 to the medical group which I use.  They serve Harvard Community Health 
Plan patients primarily, but also other patients.

Karen

    Ouch!  $70 for someone to teach me how to relax and breath?
    Well, I guess I have no choice :-)....I hope I get my $70 worth, then
    again, from the stories I have heard, maybe I would rather a C-section, 
    but, then again, I have no choice in the matter....Mother nature will
    run her course... :-)
    
    Thanks for the info, I will keep in in mind when the time comes
    
    Anne Marie
    

    I had to pay $70 too.  It was worth every penny!!!!!  I not only
    enjoyed the classes, but enjoyed sharing in the joy of everyone in the
    same "prego" state.

	Perhaps you can shop around for classes.  Ours was $45 last
	year...

	Karen

    
    The one I just enrolled in is $50.00, at Nashua Memorial Hospital.  And
    after we "pass" the class and get the certificate, Matthew Thornton
    will reimburse 100%.
    
    I was told to go through Member Services for the details of all of
    this.
    
    There is also an interesting class offered at the Clarion Somerset
    Hotel in Nashua.  It's all day Sat, Sat. night and all day Sunday. 
    They do the childbirth classes plus a few other little "tips".  The
    cost includes the overnight stay and lunch Sat and Brunch (lunch?)
    Sunday.  And then you're done with it.  It's a w/end with lots of
    pregnant couples.  It's offered after your 6th month, and is run
    quarterly, according to the brochure I received.
    
    I believe the cost was $170.00 for the weekend, for BOTH people. 
    Matthew Thornton will reimburse $50.00 of that ....
    
    Sounded like a good time .... 
    
    Patty

    Patty,
    
    With a deal like that I only regret not being prego!!
    
    I wonder if they do "gift certificates", for my Sister Inlaw who is due
    in February?
    
    Lyn
    

    A plug for Nashu Memorial:  I had surgery there a couple of years ago
    and I was treated with the utmost concern for my comfort and safety.
    They went above the call to duty to treat me well.  

    re.53  Lynn,  I will try to remember to bring in the brochure - I don't
    see why they WOULDN'T let you do it as a "gift" - the only question
    would be getting reimbursed, if you wanted that $50.00 back - your SIL
    would probably have to do that part.
    
    As for Nashua Memorial - Jason was born there 5.5 years ago, and aside
    from one nurse who I'd have liked to have killed at the time, the whole
    experience was really wonderful and QUITE a lot different than when
    Chris was born at Framingham Union Hospital.  I still remember at
    F.U.H., the nurse came in and *FREAKED* out because I had him laying in
    my lap, instead of holding him, while I was watching TV.  Once I was
    done feeding him, they wanted him back in the nursery.  Of course that
    was 8 years ago, so maybe things have changed.  With Jason, he was in
    my room the WHOLE time except the very last night, when they were
    pretty adamant that they'd rather just let me get some sleep.  
    
    #3 is supposed to be born at Nashua Memorial as well - providing he
    doesn't have any suddenly different ideas!  (-:

The following is being posted for a member of the PARENTING notesfile
community who prefers to remain anonymous at this time.   If you wish
to contact the author by mail, please send your message to me and I will
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Carol Stolicny, PARENTING co-mod
-----------------------------------------------------------------------

I am 8 - 11 weeks pregnant (the due date is in question due to spotting
which might have been a period) so I had my first prenatal doctor's
appointment.  Because I am not familiar with any of the physicians in my plan,
the first appointment was with a nurse practitioner.

I have the HMO Elect with Hardvard Community Health and I go to the
Southboro Medical center.  I am looking for answers and recommendations to
several concerns listed below.

BTW - I am 40, had cancer of the cervix several years ago and I have
uterine fibroids.  This is my first pregnancy.  (And I am absolutely THRILLED!)


1.  The affiliated hospital is Framingham Union.  I live over an hour away
    from this hospital and I am wondering if I should be concerned.
    St Vincent's Hospital in Worcester is an easy commute and my gynecologist
    is there (I pay through the John Hancock portion of the plan)
    HCHP is not affiliated with this hospital, would I have any luck
    having HCHP pay the bills if it is outside of their plan?
    Am I stuck w/ Framingham Union.  (I'll be calling HCHP today to discuss
    whether I can do this) - I was wondering if anyone else has?

2. If you had a birthing experience at Framingham Union, was it positive?

3. What is the typical hospital bill for a delivery these days?

Any other words of wisdom would be appreciated?   ;^)

First, congratulations!!!  How exciting to have these kinds of things to
worry about :-)

I can't help you out on your local scene, but I too had a baby using HMO Elect.
Like you, I see an ob/gyn outside the HMO using the John Hancock part of the
plan.  I chose to have my baby delivered by the out-of-plan ob/gyn.  I'm
quite pleased with my choice, but I'm also about $2700 poorer for the
experience.  My (and the baby's) total hospital bill rang in at over $10K.  
(This was in '92 in Nashua, NH.)  Granted, I ended up with a C-section and a 
4-day hospital stay.  While this is far longer than you *might* have, you'll
want to be prepared for all contingencies.  If you choose this option and 
you're not much of a gambler, then you'll want to be sure that you can handle
the max. out-of-pocket under the policy should the need arise.  There's always
a small-but-non-zero chance that the baby might need specialized care running
into megabucks.

I'm sure there are people who think I'm nuts for paying these out of pocket
expenses when I could have had the baby for "free" using the HMO.  But I
consider the peace of mind that I had to be worth quite a few $$ (obviously :-)

Regarding the length of time to get to the hospital:  the vast majority of
births (and especially first births) take well over one hour.  But there
are always the exceptions...  This is clearly something that you'll want to
discuss with the ob/gyn handling your pregnancy.

Again, congratulations and best wishes for a comfortable pregnancy and a 
safe, easy delivery!!

    
    
    
    You must consider if you are in a position to pay both the maximum out
    of pocket for yourself, and then the max for the child (if you will not
    have an HMO doctor available for the child) if anything goes wrong for
    either of you.  
    
    I came across that during open enrollment while pregnant for my first. 
    I did not take the gamble, turns out that my "low risk" pregnancy
    delivered 14 weeks premature.  
    
    The second time around, I got to have the doctor of my choice.  I
    insured myself through Digital and my husband carried a family policy
    for an HMO doctor for the baby -- 
    
    It's a tough choice to have to make.  But I am glad I prepared for
    "worst case".

Isn't the out-of-pocket max for HMO Elect much higher than the out-of-pocket
max for the Digital Medical Plans?

    re: .56
    
    You can transfer from one HCHP center to another.  If you're
    uncomfortable delivering at Framingham, check out the HCHP book to see
    if another hosipital closer to you is covered by another center.  You
    can then transfer (it took me 10 days) and though you might not be
    as happy with your primary physician, during your pregnancy most of
    your care will be through your ob/gyn.  Also, you can sign your baby up
    at a different center than yourself, if you find a pedi you like
    elsewhere.  Its a bit complicated, but worked for me.  
    
    diane

    
    When switching insurance, is pregnancy considered a preexisting
    condition?
    
    Thanks/M.

    
    
    I switched insurance during open enrollment with both pregnancies, it
    was not a problem.  I'm not sure what would happen outside the open
    enrollment period.
    
    -b
    

    
    Hmm, make a call, and ASK!!!
    
    With TFSOs, etc, I checked with my husband's health providers. 
    They said that if I had been diagnosed by a docter as being pregnant
    and THEN switched, it WOULD be pre-existing. The key was to not go to
    the doctor for "the rabbit test" until after I switched....
    
    
    Jamd 

Over the years I have had numerous experiences with
Framingham Union Hospital. I am also an HCHP Southboro
customer. My two youngest children were both born at
Framingham and the experience was certainly better for
all of us than it was at a Boston hospital with our 
oldest. They do have a very caring and competent staff. 
They do offer their own childbirth instruction and they
do offer maternity tours so that you can see the 
environment. While I did live in Framingham at the time
I would think that the commute really isn't all that 
tough. It's location is such that it is pretty hard to 
get lost.  I've had friends and relatives from Auburn
and Millbury who have had their children at FUH. 

BTW - FUH is world renowned as a cardiac research 
hospital.

While I was pregnant last year I had HMO Elect and was with HCHP in Acton. I
had a high risk pregnancy and when it came time for me to be referred to an
approved ob.,my primary care physician offered me the choice of going into Boston 
or staying with local doctor and delivering at Emerson Hospital in Concord.  I 
chose to stay with Emerson.  Later the ob. told me that if I went into labor 
before 34 weeks he would refer me to Worcester Memorial or into Boston (my 
choice). Fortunately I didn't need to be referred.

Kathy

    
    My first son was born at FUH, when I was living in Nashua, NH at the
    time.  It's about an hour's drive, and the commute was really really
    hard on my husband.  It was also a real pain if he just forgot
    something at the house, or I wanted something "special", he couldn't
    just buzz home and get it.  
    
    I was in the hospital for 8 days (C-section, and I'm diabetic, and the
    baby was very jaundice etc etc).  I stuck with FUH because my Dr at the
    time was Dr. Wilson from the Southboro Medical Group, and I didn't want
    to switch Dr's part-way through my pregnancy, especially being a
    high-risk pregnancy.  
    
    In general my experiences with FUH have been positive - that was almost
    9 years ago though, so my information isn't very current.  I would
    strongly weigh the inconvenience of a long drive for "visiting" reasons
    though.
    
    CONGRATULATIONS!!!  and Good Luck!
    
    Patty

    
The following is being posted for a member of the PARENTING notesfile
community who prefers to remain anonymous at this time.   If you wish
to contact the author by mail, please send your message to me and I will
forward it to the anonymous noter.    Your message will be forwarded with
your name attached  unless you request otherwise.

Carol Stolicny, PARENTING co-mod
-----------------------------------------------------------------------

	I'm entering this in order to get suggestions for my sister who
is currently 4 months pregnant.
	She was informed at her first doctor's visit that her HMO will
NOT cover an epidural for her delivery.  Apparently HMOs pay an
anasthesiologist less than other health plans, thus the ruling.  They
deem it medically unnecessary.
	This is her second pregnancy, had an epidural with the first and
definitely wants one for this delivery.  When she sounded shocked by
this rule, her doctor (new to her) tried to downplay the need for an
epidural.
	Any suggestions on how to handle this situation?  She doesn't
need the added stress of battling an HMO and is prepared to pay out
of pocket for it need be.
	This ruling sounds outrageous, verging on unethical if not
illegal.  Or can HMOs do whatever they please?

thanks-

    If I were her, I'd call the HMO and find out the whole story. It has
    been my experience with 2 different HMO's that they will pay for
    whatever the doctor deems medically necessary. So I'd ask a few
    questions if I were in her shoes. Is this the same doctor she had for
    the last delivery? If not, maybe he doesn't want to do the epidural for
    some reason.  If she needed it the last time, maybe she needs to
    discuss it more with her doctor to see what criteria he uses to
    determine if it is medically necessary.
    
    I have also found that different doctors groups under the same HMO plan
    follow different rules. I have heard that my HMO doesn't cover some
    things sort of as a general rule of thumb, but when I was switching and
    right after I switched, I found out that as long as my doctor wrote the
    referral for a particular sevice, that was all that was needed for it
    to be covered.  That's a whole lot different than the experiences other
    people have had with the same HMO for similar problems.
    
    I guess I'd do some more legwork to find out what the HMO's rules
    really are, and what criteria they use for exceptions [and there are
    always exceptions].
    
    Cathy

    	I agree that your sister needs to check directly with the 
    	HMO.  We are no longer in an HMO but, when we were, there 
    	was DEFINITE differnce between my Primary Care Physician, 
    	my son's, and my husband's.  Two were willing to do whatever 
    	was necessary and/or requested.  The third was very tight-
    	fisted.
    
    	Peggy

"Medically necessary" and a doctor's advice is likely to change with 
circumstances.  For instance, if petocine (sp?) is used for induction or 
to speed up delivery, it is usually more painful than natural labor, and
mothers are more likely to request and be granted anesthesia.  (But there 
is a balancing act between the two drugs than partially counteract each 
other which is in the hands of a skilled anethesiologist... statistically 
an epidural raises the odds for a cesarian.)

"Unethical", however starts to sound too strong to me.  I don't want 
to argue with a mother's choice, especially an informed one, but...
I've had several mothers of two babies tell me that one of their 
epidural's was _wonderful_ , and the other was _not_ wonderful.  (Again,
circumstances vary.)  And information for her on different situations 
and choices may help her with personal and financial decisions.

If the mother must stay within her health plan, she may benefit from 
more information about labor choices (medical choices/benefits/risks and
techniques for coping with "natural" labor) that are given in prenatal 
courses that include Lamaze (etc.) techniques.  More information and 
preparation is always a help.  Drugs can be wonderful, and so can labor 
be without...  (again, circumstances vary!)  I only say this because it 
sounded like the doctor was trying to communicate with her, and it will
be very important for their communication and trust in each other to grow!

So from an insurance point of view, I can see the perspective of this being 
an elective procedure that may be only partially covered (...in some 
circumstances!).  Do they partially cover it, rather than totally out of 
pocket?  In the meantime, while she follows up with the HMO  
(and they _do_ pay attention to customer's reactions, as I've found recently
when asking about one-vs-two day stays...), she should also follow up with 
other patients of the doctor and hospital to get a feeling for how supportive 
of the mother they are.  Hospitals have been competing for the baby business,
and some are developing a reputation of a caring bedside manner and listening 
to the mothers and their coaches during labor.  When it comes to your 
comfort in the experience, the personal relationships (including their 
attitude toward your right to request treatments and refuse interventions),
will have as much or more of an impact as the actual treatments used.

So, as well as talking and writing the HMO, get more info to back up 
your discussions, and find a doctor and hospital you can communicate with!

Best Wishes!
Tanya

Definitely push back. While epidurals are optional, I got the
impression they were a pretty standard option, virtually
always available for those who wanted them. Check back with
the HMO. If they say it is the Dr's discretion, there
are still a few months to find a new OB and get in some
pre-natal visits if her current Dr won't budge. If it really
means a lot to her, he should appreciate the stress of her
worrying about it. I certainly don't advocate doing a
procedure solely because someone wants to have it (and
no HMO is going to do that these days!), but this is a common
procedure for childbirth. My wife had epidurals for both 
deliveries, and loved them. The second we all but had to
wake her up to tell her it was time to deliver! Find out
exactly why the Dr doesn't support it. Maybe he genuinely
feels they are not necessary or has some medical concerns,
or maybe he's a sexist jerk who thinks women were born to
have babies and should live with the pain (doubtful, but
you never know!).

Well, this is more along the line of "who's covered, and who's not."

For seven or eight YEARS now I have tried to get Digital to cover my
entire family under my health insurance, just like they do for my
heterosexual coworkers.  Most of you know what health problems Justin
has had since he was born in Oct, 1992.  Digital has never covered him,
despite the fact that I was paying for *family* coverage under the 
John Hancock expensive medical plan.  They only counted it as for
Evan and myself.  Justin and Shellie had to be covered under her job,
so my family has been paying for *two* family plans.

Shellie was laid off from her job a few months ago.  COBRA for her and
Justin would be around $500 a month.  Colorado Springs isn't exactly friendly
toward gays, and both of our lawyers recommended that we *not* try to
adopt each other's birth child here.  Colorado's laws had been set up so
that if I were to try to adopt Justin, Shellie would have had to give up
her legal status with him AND HE COULD HAVE GONE TO ANYONE WHO WANTED TO
ADOPT HIM; we could have lost him forever.  

Finally, a few months ago, one of the lawyers gave us an alternative: permanent
legal guardianship.  On May 17 we went to court (spent $2,000 we didn't
really have, since Shellie had been laid off) and Shellie and I became 
permanent legal guardians to each other's birth child.  Shellie's former 
company said there would be no problem covering Evan under her insurance
(COBRA now or soon).  DIGITAL, on the other hand, had to think about it.
It is now 2 months later and I just found out that they are *probably* going
to put Justin on my insurance ("unless we hear otherwise...") but that they
ALMOST TOOK EVAN OFF OF MY INSURANCE BECAUSE SHELLIE IS HIS GUARDIAN!!!!

Dear God, you can't win for losing!!!!!!

(Can you tell I'm just a *trifle* miffed?)

I think I'll go get lunch.

      Carol

    
    
    		I have a question I hope someone might have an answer to..
    
    		With Digital downsizing, If my wife (who does not work) was
    		to become pregnant prior to myself becoming TfSOed, would
    		the medical coverage for maternity be covered right through
    		the end of the pregnacy, or would it end after my package
    		$ runs out?
    
    			Thanks,
    			Bill

    I think you would have to continue the insurance through COBRA out of
    your own pocket.