NY health insurance, but we live in NJ... what to do! archived

Apr 27, 2009 at 6:59pm
Hello, I've been lurking for months, but finally thought of something that I needed some help with!
I'm hoping someone could weigh in on a discussion my wife and I are having:

We currently have NY health insurance that mandates that we ONLY use NY doctors and hospitals, even though we live in Maplewood. Only if we are having a life-threatening emergency or serious accident requiring an ambulance would we be able to go to a NJ hospital (and we'd probably STILL get stiffed somehow, bastards). The insurance is HIP; my wife is enrolled through her old job and is on COBRA, which the company is paying for through next year. Switching to new insurance is not a viable option right now.

Here's the issue: my wife is pregnant (in her 6th month) with our first and we're both pretty anxious about it all, as it is our first. Anxious, but apparently not too farsighted! Only a few weeks ago did it dawn on us that getting into NYC quickly (NYU hospital) might be an issue, especially if things happen quickly or something otherwise unexpected happens.

She came up with the bright (?) idea of getting an OB/hospital on Staten Island (SI University Hospital, supposedly a very good place for high-risk [which we probably are at this point] and maternity in general). While the map is telling me that it's about the same distance as getting into Manhattan, she's thinking that the potential for ridiculous traffic or other problems is probably significantly less. Neither one of us has ever been to SI so we don't really know if this is a good idea or just dumb.

Anyone that has ANYTHING at all to add to this it will be much appreciated; to hear anything about the commute from here, bottlenecks, that hospital, pregnancy etc. etc. would be a HUGE help to us. Thanks much!
Posted By: larsThe insurance is HIP; my wife is enrolled through her old job and is on COBRA, which the company is paying for through next year. Switching to new insurance is not a viable option right now.


What are you contributing to the cost of your health care? I assume the 35% of Cobra, with the employer paying 65%?

Actually, the company is picking up all of the cost of COBRA. It's kind of a long story.

It was perfectly good insurance for us for a long time because we were living just 2 blocks away from NYU up until a year ago. She only recently quit her job (Feb). But now that she doesn't commute to the city it's a bit of an inconvenience. And she has developed a strong aversion to the train.

No opinion on the Staten Island option, but I delivered in Manhattan and know a number of people who did also. Or from the other direction, friends who lived in Brooklyn who delivered on the UWS.

Obviously you need to do what you're most comfortable with, but getting into Manhattan is doable. Her OB just needs to be ultra-aware of where you are and work with you on timing to leave for the hospital (as my midwife said, we'll tell you to head in when your contractions are 9-10 minutes apart, not 5).

Lars - Also meant to ask, is she high-risk enough that a c-section is likely?

I am not sure where in Staten Island the hospital is but in my experience (we have relatives and friends in Brooklyn and LI) the traffic on the Staten Island Expressway is often awful, among the worst in the area, even evenings and weekends. I try to avoid this route if at all possible.

So if getting to the hospital requires a trip on the Staten Island Expressway there could be a problem.

Nobody has said high-risk yet, but we sort of feel that because of her age (39) maybe we will hear that term shortly. Her blood pressure, cervix and weight look good so far, and the baby is doing well (amnio, anatomy scan) but she has the diabetes test at the next appointment. Not sure if that would move her into the high risk column or what else would happen to indicate that.

Also, I should add that she is not at all attached to her dr. Her old OB announced in January that he wouldn't remain an OB after July and she is due in August. We stayed with him until this last appointment because we felt so good about him, but we finally had to switch. We've only had one meeting with the new guy and he's okay, but we'd move again easily enough.

Lars...I'm sorry to hear of your situation. Health insurance issues are the last thing you should need to worry about when your wife is pregnant. Staying in your plan...and not working in the city any longer...can certainly make things more difficult. May I ask...why did she quit with 3 months of pregnancy left? (I mean to say...was it a personal or medical issue?) Is she high risk? Please know that if you do want to get yourself a new health plan, the pregnancy will be covered...it is not considered a pre-exisiting condition.

I do have friends that have delivered in NYC with no problem. And getting there was no issue either. Funny, the only person I know who did NOT make it (and delivered 2 blocks from the hospital in a cab) lives about 5 blocks from the hospital! LOL. In my mind, it's not the drive to deliver that will be a nightmare...it;s more about all the appointments you have near the end of your pregnancy. She will have to be there once a week!

Posted By: mschweberI am not sure where in Staten Island the hospital is but in my experience (we have relatives and friends in Brooklyn and LI) the traffic on the Staten Island Expressway is often awful, among the worst in the area, even evenings and weekends.


Worse than getting into Manhattan via either tunnel?
Hospital in SI is unfortunately just a few stops before the Verazzano bridge.

I would feel better about Manhattan than Staten Island - at least you have 3 possible choices if there is some big delay at one of the tunnels. I moved from Manhattan to Brooklyn while pregnant (also NYU) and used to have nightmares about getting stuck in traffic getting back to the city. Fortunately, most babies take their time and it's highly unlikely that you'll end up delivering in the Holland Tunnel.

Don't worry about the high-risk factor. I'm sure there are plenty of posters here who could chime in with their experiences on this as well, but I'll share that I'm 40, pregnant with my 2nd, due in a couple of weeks. And, yes, I do have gestational diabetes with this one and, as a result, am technically considered "high-risk" (I suppose), but it's really not a big deal. It just means more people are tracking me and I have had some extra appointments and ultrasounds.

Yes, it's annoying to go into the city more often, but if she can schedule things on the same day (if it comes down to that), she should be relatively stress-free.

Mammabear, thank you for your concern, I really appreciate it.

She actually quit her job when she was about 2 1/2 months along. She quit for personal reasons and couldn't immediately find work. She gave up looking last month because she is visibly pregnant, and even though nobody "should" discriminate because of that, they probably were (sucky fashion industry). Going on interviews was proving to be a waste of time. She is doing a few things from home but nothing consistent/well-paying.

Do you think that getting a different insurance for the remaining months is even possible? Then going back to the old insurance? Are you allowed to have 2 carriers at once?

Money is really an issue for now because her career provided a stable, high income (and insurance!) and I am self-employed; my business is pretty erratic right now. That is why the fully-paid COBRA is so important.

Posted By: lars
Posted By: mschweberI am not sure where in Staten Island the hospital is but in my experience (we have relatives and friends in Brooklyn and LI) the traffic on the Staten Island Expressway is often awful, among the worst in the area, even evenings and weekends.


Worse than getting into Manhattan via either tunnel?
Hospital in SI is unfortunately just a few stops before the Verazzano bridge.


Yes, I find it worse than the Lincoln Tunnel or GWB. I have spent a long time virtually stopped on the Staten Island Expressway. As long as you stay of the 80 express lanes the GWB is usually ok so what about Columbia Presbyterian which is right over the bridge?

Lars...I'm looking in to it right now for you...more later.

Spouse commutes to Staten Island and rarely has a problem getting there. BUT - the difference between where he gets off in SI at the very start of the SI Expressway and where you would have to go (closer to Verr. Bridge) can be major. When Expressway backs up, it is a nightmare. This is not an easy decision.

My insurance specified that I could only see NYC doctors. I gave birth at St. Luke's Roosevelt on West 59th Street. No problems ... yes, I did worry but everything was fine.

The thing that is so great about a midtown OB for now is that it's so easy to hop on the train and do other NY errands whenever she has an appointment.

We still haven't bought a car since moving here, we rent one day every week or so just to get groceries and do other NJ errands. Obviously, we plan on getting a car at some point, but in the meantime, getting up to GWB/Columbia might be an issue. I guess no more of an issue than getting to SI appointments if that is what we decided...

let me think about that one...

thanks mschweber and mammabear for the thorough responses. The more brains the better! And ours aren't really working right now!

Posted By: NotFromMuskogeeDon't worry about the high-risk factor. I'm sure there are plenty of posters here who could chime in with their experiences on this as well, but I'll share that I'm 40, pregnant with my 2nd, due in a couple of weeks. And, yes, I do have gestational diabetes with this one and, as a result, am technically considered "high-risk" (I suppose), but it's really not a big deal. It just means more people are tracking me and I have had some extra appointments and ultrasounds.


That's good to know, that if she is deemed high-risk, she'll be watched that much more closely.

I hope it all goes smoothly for you and you thanks for the advice! Good luck with your delivery!

Staten Island from NJ by public transit is very difficult. Columbia Presbyterian is on the subway (a straight shot from NYP) but IIRC it is the station I found scary because you have to take an elevator.

Posted By: mschweberStaten Island from NJ by public transit is very difficult. Columbia Presbyterian is on the subway (a straight shot from NYP) but IIRC it is the station I found scary because you have to take an elevator.


If we did decide to go to SI we would definitely get that car soon. Or rent for appts.
I am going to look at a map because I'm not sure if I even know where Columbia Presb is...

thanks!

I am aging myself. It is now actually called NewYork-Presbyterian Hospital because Columbia and Cornell merged their hospitals. It is at 168th street and Broadway (1 and A trains stop there)

I delivered at St. Luke's/Roosevelt and it was no issue getting into the city (twice! They sent me home to labor b/c I hadn't progressed far enough to be admitted the first time). I can't remember the stats, but apparently most labors get hard-core very late at night or in the wee hours of the morning, so odds are in your favor of little/no traffic.

Regarding the car, get one ASAP. I joked to myself that I would take the train into the city when I went into labor, but there wouldn't have been a shot in hell that I could have handled it. No way, no how.

Posted By: mschweberI am aging myself. It is now actually called NewYork-Presbyterian Hospital because Columbia and Cornell merged their hospitals.


Please. I remember when Manhattan was mostly bubbling lava.

I should also note that she has a strong aversion to the train and (even more so) the subway. She had a panic attack when she went in for her amnio and she thinks that it was partially due to being on the train again.

I know I am painting quite a picture of NY crazy/no car/can't drive but, hey: this is who we are!
So if we did do the NY Presb she would definitely want to drive in for appts.

Did your wife's former employer offer more than one health insurance plan? What coverage was offered to employees who lived out of NYC when they were hired?

I switched my health care plan when I moved to NJ because I discovered that my then present plan would not cover NJ practitioners. Moving out-of-state was one of the conditions which enabled a switch even though it wasn't done during a transfer period.

Assuming that the employer does offer more than one plan and that one of the plans offered includes NJ coverage, I don't know if your wife being covered by COBRA would be an insurmountable obstacle but it is worth looking into. Another consideration is that HIP is a relatively inexpensive health plan for what it offers. A NJ plan, even if you could switch at this time might require your wife to contribute towards the coverage beyond what the company is now paying.

lars, based on everything you've said, you have got to get a car ASAP.

Former employer DID offer other plans, but since we were living in NY at the time and undergoing treatments that were best covered by HIP, we stuck with it longer than we should of. We could've switched last summer when we had already moved to NJ but didn't. Her OB didn't accept the other insurance offering I believe and that was the clincher.

The real obstacle is the cost at this point, it's tough to swallow paying any extra when it is getting covered 100% by her old job until next February. I believe COBRA for the two of us was upwards of $600 a month (x10 = $6000). The cheapest insurance we've found for NJ is $290 per person (didn't price it for couple yet) but has high deductible etc.

re: car, we're definitely working on it, but again, she is the driver so that only really helps for the appointments. No matter what, it'll be a car service when it comes time to give birth.

Make sure you have a 24 hour car service lined up i.e. Maplewood Taxi closes in the evening.

Good idea, thanks! Anyone have any recommendations on that?

I've heard stories of undependable taxis...

Lars, I don't have much to contribute other than wishing you both very good luck and congratulations on the addition to the family. I do have one thought on your question about whether you are allowed to have two insurance carriers at once. Technically, it's probably possible, but you could end up in a situation where each one is saying the other should be paying the bills, and meanwhile no one is paying the bills. So I would recommend against it. That happened to my mother when Dad was in the hospital, and AARP was refusing to pay on something because it said the catastrophic insurance or Medicare should pick it up as the "primary" carrier, and it became a bureaucratic nightmare. I'm probably remembering that wrong, but it was along those lines, and it wasn't fun. I wouldn't try it.

But how exciting for you guys, new in NJ, in such a great area, and with a little one on the way! Stressful, yes, but a bunch of good events, all the same. :smile:

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