Moving to States for 2 years - can I still access NHS?

(20 Posts)
mathanxiety Thu 07-Feb-13 18:32:53

Yes, find an ob/gyn, or find a midwife practice. You need to check with your insurance company that you are choosing one from their list if your policy has a preferred provider option (ppo), and you need to check if not a ppo that your chosen doctor or midwife group accepts your particular insurance. Insurance companies provide lists of medical professionals accepting their insurance so the process should start with the list. It is wise also to find out what hospitals the doctor or midwife has admitting privileges for. Usually, if there is a professional building attached to a hospital the doctors and midwives who see patients there will have admitting privileges in that hospital. Normally, a hospital pediatrician will see your baby in the hospital -- a lot of times that pediatrician will also have an office in the professional building and will put your baby on their books if they are accepting new patients or refer you to another if not.

My experience was to choose a university hospital and I found care there really excellent, with great attention paid to patient comfort and no real need to pack anything for the hospital more than a going home outfit for you and baby plus a few toiletries and items for comfort during labour. I had four doctor managed pregnancies and deliveries and one midwife managed. Pediatrician-wise, choosing the hospital pediatrician was the best thing I could have done. The nursing staff in the pediatrician office were excellent and could answer any questions over the phone. While my DCs all had very straightforward medical histories it was nice to know that a teaching professor was looking over their charts, listening to their breathing, advising on feeding, etc.

Then you need to call and see if they can fit you onto their books.

An epidural canula can be inserted during the 'window of opportunity' phase of labour, and then you have the option of going ahead with epidural pain relief if you want it later, or you have the option of being partially numbed but conscious if you end up with a cs. There is also a walking epidural option that allows more freedom of movement while still affording pain relief. Important to remember that an epidural is the only form of pain relief given -- no gas and air, no Tens. While episiotomies may look horrible, a controlled cut is favoured over a tear in the US and stitching and nursing care afterwards are generally excellent as that is what staff are used to doing so recovery is normally quick and straightforward. They give you icepacks for your fanny and are very good about infection risk. (Plus maternity pads -- you don't buy or bring your own)

NatashaBee Thu 07-Feb-13 18:13:44

You need to find an OBGYN first, they are usually linked to certain hospitals and you would deliver at one of those (you can usually find info about which hospitals they work out of on their website). You also need to make sure they accept your medical insurance company, and check that your insurance company cover all the tests that you would like to have and don't have any restriction on the number of scans you can have (the company's HR department should be able to help with that). It will be a doctor rather than a midwife delivering. You can usually book a tour of the hospital before you give birth, and they run antenatal classes too. I found the pregnancy care here pretty amazing to be honest - you tend to be kept in for longer here even if you have a straightforward vaginal birth, I was in for 3 days, it would have been 5 days for a c-section. My room was a private one, with room service, DH was allowed to stay overnight too. There were lots of breastfeeding counsellors and staff around to help. Some differences between the US and UK:

- no gas and air
- they like to keep you on your back with continuous monitoring
- if you're having a boy, they usually like to circumcize them shortly after birth. Make sure you let them know that you don't want this done
- c-sections are more common here, if you want one you should have no problem getting one on request (whether your insurance will cover without medical need is another story though)
- episiotomies are fairly routine here - make sure you let them know if you don't want them to do one 'just in case'
-waterbirths don't really exist here, although you can spend your labour in a bath if your hospital provides them
- the bill can rack up quickly, make sure you understand exactly what your insurance covers and be prepared for the costs. DS was in NICU for a few days after birth and our total bill, if we hadn't had insurance, was over $50k.

You will also need to pick a paediatrician who will be your child's regular doctor - do this in advance, so you can put their name down on the various forms and your baby's notes will be sent to them directly. Again, you need to make sure they will accept your insurance.

There's a US version of One Born Every Minute, I think they showed it on UK TV, so you might want to see if you can track that down - I found it very informative.

PuffPants Thu 07-Feb-13 17:50:23

Math, yes, that was our big concern too but they have assured me its covered. As we are already on the company's group policy, they consider we're just changing location rather than new customers. Phew. I have no idea about co-pays though, not got full details of policy yet.

My head is spinning with how maternity operates in the US. I have no idea. Do I just turn up at a hospital and say I'd like to have my baby here please? Is ante-natal care very different? Will a doctor rather than a midwife do the delivery? Will I be forced to have an epidural? (Hopeful face!!) Will anyone come and see my after the birth like they do here? Am very much at sea with it all!

mathanxiety Thu 07-Feb-13 17:41:23

$40 sounds right to me even with insurance.

Puff -- does your DH's insurance specifically say you have maternity care? Maternity care is not always the same as a pre-existing condition.

NatashaBee Thu 07-Feb-13 17:11:15

I would definitely do that, if possible. Your prescription cover might be better than mine.

PuffPants Thu 07-Feb-13 16:53:49

$40 for an inhaler??? Wow. I wonder if my GP would prescribe me extra before we leave? I didn't say in my OP but I'm actually pregnant so I guess I'll have to let the GP know we're going away otherwise she'll wonder why I'm not turning up to ante-natal apts...

NatashaBee Thu 07-Feb-13 16:15:10

I would ask what your prescription cover is - DSD uses inhalers and there's no generic equivalent (usually you can buy the generic version of a medication for around $7). Her Advair is $40 and salbutamol another $40, plus the Singulair tablets at $40 a time (although have just been told there is actually a generic for those). It could get very expensive if your medical insurance has high deductibles and co-pays, or limited prescription cover.

PuffPants Thu 07-Feb-13 16:01:17

No Math, of course not. We will have health insurance arranged for us by DH's company. We do plan to be in the UK fairly often though for visits so I was just wondering what the situation would be if we needed to see the doctor or my prescription ran out.

Thanks for the replies. Interesting.

mathanxiety Thu 07-Feb-13 05:45:00

Puffpants, if this is in lieu of getting health insurance in the US, please don't try living in the US without health insurance.

I've been in the US for a year, got an infection on visiting my mum, NHS direct advised me to sign up as a temporary resident to her doctor to be seen and get antibiotics - Dr knew my living situation and had no prob.

But if I had an ongoing prescription tbh I'd sort it out in the US

Want2bSupermum Sat 26-Jan-13 00:29:07

You need to have health insurance if you are moving to the US. With insurance, the prescription charges are not that bad. For inhalers you can get them at low cost through costco, Target or walmart. My sister gets her from Costco and pays $5 per inhaler. Ironically it costs her less to not use her insurance (her min copay is $10).

specialsubject Tue 22-Jan-13 21:53:31

NHS access is supposedly on residence, not nationality or paying taxes. You are supposed to deregister if you are leaving for more than 3 months.

no, the GP won't find out unless they happen to write to you or call you at your address and get no reply. You don't get deregistered for not going to the doctor.

All the gappies stay registered for their year or so abroad. And if a recent Panorama is to be believed, the NHS is apparently supposed to treat anyone who comes to the country, emergency or not.

those are the facts. The ethics, I leave to you. (It is possible to be an expat and still pay UK tax, e.g. if you rent out your house here)

make sure you have proper insurance for your time in America.

kelly14 Tue 22-Jan-13 18:51:07

my parents have lived in dubai for 8 years, they own a house here in uk outright (which i live in) they still pay national insurance contributions, the few times they have come home, my mum had to go A & E and fractured her foot and my dad went to doctors and all was fine.

AlohaMama Tue 22-Jan-13 17:14:07

You're going to need health insurance anyway. On my plan, most prescription meds are $5-10 per item. Not sure how much it would be for inhalers but if you're only away 2 years and get a new prescription just before you leave, I'd be surprised if it ended up costing that much more in that short time.

hermioneweasley Tue 22-Jan-13 14:19:33

Puff - are you planning to tell HMRC that you're out f the country or are you going to keep paying taxes here too? <hoiks judgey pants>

PuffPants Tue 22-Jan-13 14:15:39

Are we supposed to declare it to someone? What would happen if I didn't tell the GP but made an appointment on visits home? Would they actually know if I didn't tell them?

timidviper Tue 22-Jan-13 14:10:02

The NHS can only have a duty of care while you are out of the country for 3 months maximum. If you are away for more than 3 months the advice to GPs is that they should give a prescription for sufficient medication to last until you can find a doctor in your country of residence and obtain a supply there.

Pascha is partially correct on cost. Reliever inhalers (blue) are usually cheap and you can get Ventolin/salbutamol from some pharmacies now at below prescription charge cost. Preventers, particularly combination ones like Seretide can be extremely expensive if you are on those. They can run out at £50+ each.

Sort your insurance and get organised asap in America

Pascha Tue 22-Jan-13 14:04:04

When you return permanently to Britain you can reregister as NHS patient.

Pascha Tue 22-Jan-13 14:03:21

If you emigrate for longer than 3 months you do give up your rights to ongoing NHS treatment I'm afraid. You will need to sort insurance out in America and get your inhalers that way.

If you came back to britain and found yourself needing acute medical attention you will be able to get treatment on the NHS but if you just need more inhalers your GP is supposed to do a private prescription (although with inhalers that might be cheaper than NHS prescription anyway...)

PuffPants Tue 22-Jan-13 13:59:54

We're moving to the States for 18 months - 2 yrs. does anyone know if, during that time, we will still be able to see our GP/dentist on return visits home?

I have a regular prescription for asthma inhalers, not sure how I will deal with that over there.

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