This web page reports experiences people have had with the George Washington University Health Plan. It is part of a set of web pages that provides information on DC area health plans.
Reports from
For the my first 8 years at UMCP, I didn't have much need of my health care plan, so I didn't have any complaints. Then my wife became pregnant, and the nightmare with GW begin. I urge everyone to avoid them.
Back in April, we requested that GW allow us to use certified nurse-midwives in charge (our kid is expected in November). We've spent hours on the phone and writing letters trying to find the appropriate person to talk to and getting any kind of response. The most recent thing we've heard is they will think about it, and that they might allow coverage by certified nurse-midwives, but that we are out of luck, because there was no possible way that they could make a decision like that in only 7 months.
My wife is Rh-negative, I am Rh-positive. In this situation, a pregnant women needs an injection of RhoGam at 28 weeks in order to avoid developing antibodies to RH-positive blood.
Under most HMO's, if you need a RhoGam injection, the doctor just takes a vial out of his refrigerator and gives you a shot. GW Univ. Health Plan has a unique approach. They force the doctor to write you a prescription for RhoGam. You tend must find a pharmacy that stocks RhoGam, get a vial of RhoGam from them, and then bring the vial back to the doctor so that you can get your injection.
This would only be moderately annoying, except that few, if any, pharmacies stock RhoGam. They can only buy it in lots of 10 doses, each doses costs $70, and most doctors administer it directly. We spent 4-5 hours calling pharmacies, trying to find one that stocked RhoGam. None did. Eventually, we called up GW and asked for help. One of their people spent several hours calling around, and said they the pharmacy of the GW University hospital stocked RhoGam.
At this point, it was already a week after my wife was supposed to have her RhoGam injection, and getting down into the district to pick up the RhoGam would take a whole afternoon. This was already a week after my wife was supposed to have the injection, and she was trying to schedule stuff around a busy work schedule. We decided to just pay the $70 out of pocket at the doctor's office to get the RhoGam injection.
Moral of this experience: When GW does cost-benefit analysis, the value of your time is zero. Forcing us to get the RhoGam from a pharmacy saves them money, since our pharmacy plan pays for the drug. They fact that this would cause each patient to spend hours on the phone and making extra trips to the pharmacy and the doctors office is irrelevant to them.
After my son's birth, I've had to deal with getting letters demanding payment from all of the health care providers that were refused payment by GW. Several labs and doctors sent GW bills for care my wife and son received while at Holy Cross Hospital (my wife's labor failed to progress and eventually they performed C-section) and had them refused by GW. Of course, GW never directly contacted us or informed us that they were refusing to pay the bills.
Generally, the excuse GW gave is that the lab used wasn't one of their approved laboratories, or that some official piece of paperwork hadn't been done properly. Of course, this all happened while we were at the Hospital and we didn't have the chance to make any mistakes. Any and all paperwork problems were the fault of GW and/or the hospital. Never the less, I am still dealing with the bills 9 months later.
Update 26 months after my son's birth, GW informs me that they have absolved me of responsibility for all of those bills.