Replacement of OB unit at Monroe Hospital puts strain on IU employees

Usually, a pregnancy requires monthly doctors visits, ultrasounds and prenatal testing, but Yvonne Dwigans' has required more.\nSix months into her pregnancy, Dwigans' baby is experiencing complications and will need antibiotics as soon as he is born. Shortly after birth, he will need to be moved to Riley's Children's Hospital in Indianapolis. \nIf that weren't enough, there are even more complications with her insurance. Dwigans is an IU employee with Anthem insurance, which does not cover procedures at Bloomington Hospital. The only other local option, Monroe Hospital, recently closed its obstetrics unit to create an intensive-care unit. And Dwigans doesn't have a gynecologist to deliver her baby or a pediatrician to communicate with her doctors at Riley. \n"I'm having to change gynecologists for the third time, and now I'm not at all happy," Dwigans said. "People say, 'Well, you could wait -- that Bloomington Hospital might become in-network again.' But with my situation, we can't wait around and see."\nDwigans' story tells one of the key problems for Anthem insurance providers. Since Jan. 1, Bloomington Hospital is no longer considered in-network for Anthem insurance. This means that women who planned to have obstetrical procedures done by doctors who perform operations at Bloomington Hospital will either have to pay much more, or change doctors to one who works at other area hospitals. \n"Women are being forced to make a decision about services, whether to spend more out-of-pocket or to go out of town, or maybe get all of their services out of town, and I just think that would be really nerve-racking," said Elizabeth Sturgeon, practice administrator for Aegis Women's Healthcare, a large obstetrics provider in Bloomington that does all of its serious procedures at Bloomington Hospital. \nSturgeon said the average in-network plan breaks down payment to roughly 80 percent to 20 percent, with the patient required to pay 20 percent of the cost of services. Out-of-network, the plan is usually 60-40, with the patient paying 40 percent of the price of services as determined by Anthem. \n"For us it financially didn't make sense to have an OB unit," said Dean Melton, president and CEO of Monroe Hospital. "There was no flicker of hope that we'd get the number of patients we needed to stay open, and we felt that, given there was another viable option in town, it had to be done."\nHowever, Monroe Hospital's announcement to eliminate its OB unit for an intensive-care unit was made the same day the AnthemBloomington Hospital contract expired, Dec. 31, 2006.\nSturgeon said the majority of obstetricians in Bloomington, including Aegis, are credentialed with Bloomington Hospital. This means that the obstetricians at Aegis are on-call for deliveries and other obstetrical procedures at Bloomington Hospital.\n"We empathize with the patients," Sturgeon said.\nShe said the physicians at Aegis cannot take their services to another hospital because they are accredited to be on-call at Bloomington Hospital.\n"Working on-call to a hospital that is 15 to 20 miles away would make providing care very difficult," Sturgeon said. "We're really stuck here." \nAmanda Roach, Bloomington Hospital's media relations coordinator, said Anthem and Bloomington Hospital are still negotiating and hope to come to an agreement. \nErika Lee, communications director at the IU Graduate School, recently underwent an obstetrical surgery at Bloomington Hospital that has required many doctors' visits, some covered by her Anthem insurance, some maybe not.\n"I don't think people realize how pervasive this is," Lee said. "All of their doctors deliver babies at the hospital. The surgery I had happened at the hospital." \nLee and her husband are trying to have a family; she says she's not looking forward to potentially having to take a day off of work to go to Indianapolis for doctors' visits. \nDwigans echoed Lee's concern, saying when she goes into labor, she will have to drive about 35 miles to St. Francis Hospital in Mooresville to have a new doctor deliver her child. \nSturgeon is recommending to patients that they consider all options first. \n"They need to talk to the hospital first and understand what their actual out-of-pocket will be before they make a decision to actually switch their care," Sturgeon said. "It's always better to have continuity of care all the way through the delivery simply because, if you're being followed for something like diabetes during your pregnancy or high blood pressure, you want someone who knows and understands what's going on with you." \nSturgeon said that Bloomington Hospital being out-of-network hurts Aegis because 40 percent of Aegis patients use Anthem insurance. \n"Particularly for obstetrics, it's very scary," Sturgeon said. "You establish care with your local physician ... someone who is seeing them through nine months of care and then actually switching at delivery to someone who they don't know. It's very scary"