Sick? Know your HMO entitlements

Here are a couple of things I learned from my son’s confinement:

1.  Know your medical benefits.
Even though our employers use the same HMO,  the benefits were very different – mine (higher room rate – all incidentals must be paid upon discharge),  his (no cash out – subject to deferred payment via payroll deductions).  We had to sit down and compare line by line before deciding to use mine.

2.  Know your rights under the contract signed between your employer and the HMO.
All HMOs have liason officers at the hospital.  Ask them the nitty gritty so that you won’t be unpleasantly surprised when you get the bill.
For example:  My employer has an agreement with the HMO that if a regular private room cannot be provided within 24 hours,  I am entitled to an automatic upgrade to the next class, so long as it isn’t a suite.  Now,  did you know that in MMC,  the next class to a regular private room is not a large private room but a suite?  I went ballistic when I called the call center and they said that I had to pay extra for the large private because it was within the same “class/category”.  
Also,  did you know that the 24 hour count is used according to the hospital’s billing cycle?  So even if I had been admitted at 4pm on the 19th,  since MMC’s billing cycle starts at 9am,  I needed to find another room by 9am on the 20th or be charged extra.  Weird.

3. ER is convenient but will cost you extra.
When we rushed Andre to the hospital on the 19th,  he was suffering from dehydration.  His pedia recommended that he be admitted right away.  Rather than wait for a room to be found,  I requested that he be sent immediately to the emergency room so that he could be hooked up to an IV, and have his blood extracted and Xray taken.  Anyway, the ER costs were covered by our medical plan.  I’m glad I did because it took me some time to get a room for us (there’s a lot of sick children).

4. Make HR your BFF.
I don’t think that I would have been able to process our medical papers or get the kind of attention from the HMO that we got it if it hadn’t been for the help provided by HR.  We were able to get discharged even at the extremely odd hour of 945pm yesterday because all the paperwork had already been accomplished.

Being hospitalized is mentally and emotionally draining.  It is good to know your entitlements before *knock on wood* you, or a loved one,  needs to be confined.

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Motherhood has a very humanizing effect. Everything gets reduced to essentials. ~Meryl Streep

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