Insurance Just Screwed Me

[Anonymous]

Well I need some major help. I'm on the Care First HMO for DC residents only. It's a small plan that only allows 2500 members I believe but is available to anyone without group coverage in the District.

Despite that I asked them twice, and they told me there were maternity benefits with no additional rider needed, they now "can't find" record of those conversations in their notes and are denying any and all maternity benefits. Holy. Crap. I'm going to have to pay out of pocket for labor and delivery!!!!!!!!!!!!!!

So I need help / direction here. I can't get on to another plan because of wait-times and exclusions, husband's plan is medically underwritten and I got kicked out with the IVF stuff we went through. The only way they will cover me is if I'm "at risk" or have complications. I have no clue what to do and now realize that this could cost us $40,000 out of pocket.

Does anyone have any ideas? Anyone know which hospitals may take need-based cases / those without insurance? We were leaning toward GW or Shady Grove but my OB only delivers at Sibley so we may have to change.

I'm in tears over here.

[Anonymous]

BCBS did a similar thing to my friend. She had a baby in 2009 and everything was covered and she didn't make any changes to her insurance. Got pregnant again this spring and only realized she wasn't covered after she miscarried at 12 weeks and got a ton of bills in the mail. BCBS told her she NEVER had maternity benefits and that her 2009 delivery should not have been covered. The asked BCBS in 2009 before getting pregnant to verify coverage and we told they had it. Long story short, they fought and fought and fought and BCBS decided to let them get the rider for now, but to waive the 10 month waiting period, made them pay for 10 months up front. Keep fighting. If one person tells you know, ask to speak to their supervisor and so on. It took my friend almost a month, but she got it done. Good luck!

[Anonymous]

Do you have a record of the dates you talked to your insurance provider about benefits? If you kept any kind of record about those conversations, I would call back the provider and ask to speak to a supervisor. The first-line response is always going to be that you are not covered, but you need to keep pressing with details and get as high as you can inside of the call center and/or somehow get someone outside of the call center to discuss your policy. The call center reps are scripted and have no ability to do anything to look further into your case.

Secondly, do you have any risk factors or prior surgeries that would make it necessary for you to be under the care of an OB? I am a mandatory c-section (first birth) because of prior abdominal surgery, so couldn't consider alternatives like homebirth or birthing center. You should look at alternatives that may be less costly if hospital birth isn't mandatory, though that doesn't mean you still couldn't end up with a hospital delivery due to complications, etc.

Third, talk to the billing people at your OB's office to see if they have any suggestions either in dealing with your particular insurance or what options there may be if you are self-pay. I feel for you and wish you the best of luck!

[Anonymous]

Fourth, lobby for national health insurance.

How much more of this are we going to take????

[Anonymous]

If you're not at risk for any complications I would look into a birthing center (or home birth if you have the space). It will only run you around $4,000 (if you can't get the insurance stuff hammered out).

[Anonymous]

OP here. Thanks guys. Other than being 38 and therefore AMA, there's nothing in my past that indicates I'm at risk for complications.

I know for a fact I talked to them twice and two different reps confirmed maternity coverage. Of course the notes from the first conversation I don't have, however, I have a name from a conversation in that same week so I can use that. The 2nd conversation I cannot find a record of - though my husband and I both remember me making a note of it. I asked again because I wanted to be 100% sure - so I hear the PP saying to keep fighting and get past the call center and I think that's what I have to do.

they said they are going to "go back and listen to the phone calls" and provided they aren't liars, I know for a fact that these calls exist. But I've been down this road before....they tell you they didn't hear anything about it on the calls and won't let you hear the calls. We had to go to bat with our stupid home security company and they pulled the same crap.

I know a lot of people go the home birth / birthing center route, but I'm just scared of that. I want to be close tot he epidural needle...

[Anonymous]

In Maryland, the oversight agency is Maryland Insurance Administration. I assume DC has something similar, and I'd call them, too.

As far as cost: I was quoted a global fee by my OB of $4,500 for all pre-natal and delivery costs. Check with your doctor to see if they do something similar.

And lastly, there is a thing called maternity insurance. I don't know how much it covers, but it might be worth looking into to see if you can get at least some sort of coverage.

[Anonymous]

I don't know if this will make you feel better or not, but a regular hospital delivery, provided you don't have any complications, should not run you $40K. I just had a c/s and the total cost before insurance would have been about $28K - about 4.5 to the OB for prenatal care and delivery, about 22K for 4 nights in the hospital (but you would only have to stay 2 if you deliver vaginally, and you might even be able to check out early and only pay for one night), and about 1K for anesthesia. So I am guessing around 16-17K for a vaginal birth? Still a lot of money, I know, but less than 40. And while you are checking things with insurance, I would confirm that you have NICU coverage should you need it (does that fall under "regular" policy or maternity?) - that's where things can get really really expensive. My DD spent 3 nights in the NICU and the bill was around $20K.

[Anonymous]

OP they did the very same thing to me. I sent letters to the Mayors office who put me intouch with the Department of health. I am happy to giVe you the email address of the lady who helped me of you provide an email address. They have all yr callS recorded. They told me to provide the exact dates that I called so they can look up my conversations. I told them I didnt know the dates so they said they could help me. The next day I called back asking a new person for the dates and times I called and she gave me the entire lost so I spoke with a lawyer friend who told me to write to the President of the company as well as the Mayors office. It worked the paid.

[Anonymous]

I have BCBS Carefirst, not sure if I am o the same plan as you though. I had to add maternity to my coverage and it is an extra 140 I think a month. For self employed people, there are fewer plans that will cover maternity for some reason and it was tricky. They did have a 10 mo waiting period but they waived it because I had been previously insured with no lapse. I had to get proof of that and then have it faxed an d they sent verification to me that they were waiving it which I kept.
It is horrendous but the fact is not all insurance has maternity coverage for women unless they pay extra. This sucks especially because women do get pregnant on BC and they may not be paying for the rider at the time and then they have to choose between 30-40K in debt or terminating. Nobody should have to make that decision. I am self employed and pay 700 a month to insure myself and my baby DD and I am pregnant again. Without maternity I would be paying 560 a month but I wont risk it. 140 more a month is a lot though when you arent even trying to get pregnant.
On a positive note, hospitals will arrange a payment plan with very little paperwork at discharge for your bill no matter how high it is. It just might take you a while to pay it off.

[Anonymous]

OP here.
Thanks - all this info is tremendously helpful.

I just spent an hour on the phone with a "supervisor's assistant." Apparently you can't get to a supervisor. And it gets worse:

I have things spelled out in my benefits book that say hospital stay is covered for 2 days for vaginal birth and THEY JUST TOLD ME IT ISN'T. I had to fax them the damn pages from their own stupid book and she's saying "well is says on the top that unless you have that coverage..." But it doesn't say that anywhere. I think this is going to turn into a bigger fight than with just these morons at Care First.

I had asked twice about the maternity coverage and was told I had it, therefore it wasn't ever offered to me. Believe me if it was, I totally would have taken it.

[Anonymous]

It should be illegal to issue health insurance that has no maternity coverage to a woman in my opinion. I have to wonder whether group plans just always have it and individual ones like these issued to self employed people sometimes do and sometimes dont. For you it is even worse since they TOLD you it was there but really a lot of people would assume something like this was there for any woman and wouldnt even ask. You would have to be completely abstinent to not be risking possible financial ruin without this on your coverage. And no woman should have to be worrying about that when they are pregnant. I'm so sorry this looks like it is going to be such a PIA and I hope you are able to sort it out even if it takes way longer than it should...

[Anonymous]

I have a friend who was diagnosed with a rare type of leukemia that requires a wildly expensive type of chemo.

Two months after she started therapy, her insurer dropped coverage for that particular type of chemo. They said that as long as they dropped it for everyone, it was legal.

How anyone could possibly opposed national health insurance, I will never understand.

[Anonymous]

I am the PP who recommended getting out of the call center if possible. I had an issue with fertility prescription insurance where some meds showed with my co-pay ($40) on the internet and then I received a call that the meds would be $1400 because I was out of fertility med coverage. I was in fact out of coverage, but I knew the $40 co-pay had shown up or I would have never ordered the meds. I got nowhere with the call center and then accused the insurance company of baiting and switching me, which I felt that they had. I somehow found my way out of the call center and into their consumer affairs office based on that statement. The woman there went out of her way to help me. Her initial research showed no internet issues the day of my order, but I kept pressing her as I knew what I had seen. She found someone else in IT who confirmed there was an issue with their site on that day and they ultimately honored my $40 co-pay. All of that is my way of saying to press hard on the insurer for previously confirming your maternity coverage and don't shy away from making bold statements if it will get them to hear you!!!!!!!!!

[Anonymous]

Go give birth in England
Or Mexico?
Canada is also a good option