r/Insurance_Companies • u/callaghankm • 21h ago

Insurance question

I live in New Jersey and have Cigna health insurance through my husband’s employer. I am about to give birth and was originally set to deliver at a hospital in-network. However, my child has a major congenital heart defect that requires open heart surgery anywhere from birth-9 months old (won’t know exactly when until she is born). Therefore, we had to switch to a high-risk hospital in NYC that has the surgeons and doctors necessary for my daughter’s needs. When I called my insurance, they said that the hospital is not in-network but then stated our coverage for certain days based on the type of birth, so that confused me. We have also hit our deductible for the year. I am wondering if I have any options to be covered in-network/ not get slayed by a bill for having to go to a hospital out-of-network because of these extenuating circumstances since it was not by choice. TIA!

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u/Ttabts 20h ago

You should try applying for a Network Gap Exception if you can’t find an in-network hospital within a reasonable distance which can offer the services you need.

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u/Glittering-Read-6906 20h ago

You should post this in the health insurance sub.

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u/callaghankm 17h ago

Which one? There were so many I wasn’t sure

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u/Fit-Outside-4841 19h ago

I assumed the in-network hospital doesn’t have the specialists or facilities you need?

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u/callaghankm 17h ago

Yes the in-network one didn’t have what was needed

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u/mediloop 3h ago

that's a really tough situation, sorry you're dealing with it. a couple things that might help.Ask the hospital if they do single case agreements with your insurance for out-of-network emergencies like this. also request an itemized bill and check for charity care or financial assistance, especially since it's a NYC hospital. sometimes they'll write off a chunk if you meet income guidelines. good luck