Sarah Stultz: Health care woes hitting too close to home

Published 9:49 am Tuesday, March 28, 2017

Sarah Stultz is the managing editor of the Tribune. Her column appears every Tuesday.

“Can you believe this?” I said to my husband as I explained to him a letter we received in the mail last week.

As many people know, we have been working in the last few months to gain a second opinion into my son’s seizures after going through a period that he had several breakthrough seizures and many unanswered questions. As a parent, unanswered questions are horribly unnerving, and we wanted to resolve a few issues to set him up on the best path to success.

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I started out needing to get a referral from my son’s primary care doctor to get a second opinion, which was a little bit of a hassle because his primary doctor recently moved to a different hospital.

After a little bit of work, and tracking down his primary doctor at her new hospital, I got the referral and we were sent up to the new hospital in St. Paul.

The neurologist we met with at that hospital was extremely friendly and asked us many questions. He said he believed we could find out the most answers at a different place called Minnesota Epilepsy Group, which has two locations in the Twin Cities — one in Edina and one in St. Paul — that the hospital works directly with.

This practice specializes in seizures and epilepsy, and already we feel like it is a good fit for Landon. We have felt validated in our concerns and believe that through these specialists, we will find answers to what has been plaguing him since he was only a week old.

While we are happy about this, this past week, we received a letter from the initial hospital in St. Paul, informing us that the hospital had made the difficult decision to terminate its contract with our insurance provider. The letter stated that their formal contract had expired with the insurance company, and after more than six months of discussions they have not been able to reach a new agreement. They said their reimbursement rates offered by the insurance company do not provide reasonable payment for the care they provide. While the cost of delivering care has continued to increase, the insurance company has not offered a reimbursement rate increase for several years to help offset rising costs. In a nutshell, the contract with the insurance company could end in July, and that hospital would then be considered out-of-network for the members of the insurance company.

What does this mean for us? It means higher costs for us, the customer. As a family that unfortunately goes to the doctor maybe more than others as we’re dealing with the seizure-related issues, this was heart-breaking.

Though most of Landon’s care will be handled through Minnesota Epilepsy Group — and that facility is still covered by our insurance — if Landon ever has to stay overnight for any kind of monitoring, that would be done at this other hospital now in question with our insurance company.

Up until this point, we have been blessed with what I consider to be minimal health insurance problems. While we have to reach a deductible before our insurance coverage kicks in, it has helped us out immensely with all of our son’s medical bills.

What’s even more challenging is finding medical professionals who are making progress with your child, only to find out that our insurance company may no longer cover this care.

What can be done to fix this?