Insurance would not pay for ultrasound to diagnose miscarriage! Sooooo angry!

[Anonymous]

I am so irate and I need to vent. I had a miscarriage in July and a subsequent D&C. I initially went in with some bleeding and they did an U/S - found heartbeat. Next day, bleeding was much worse and a second U/S indicated that the baby was gone and I had too much tissue remaining, so they booked me for a D&C. I was 7 weeks along and so excited, so it was a really devastating experience. I have spent the last two months trying to get over things.

Sooo... I was shocked to get a EOB from my insurance that indicated they would not pay for the second U/S that was used to detect that the baby was gone! Turns out that they put a comment in saying "This is patient's responsibility." I had no idea that it was my responsibility to know if I needed a D&C or not! Shocking!

My OB's office has been great and I went in to their office today to call the insurance company together. The nurse called the company and we found out that the reason insurance would not pay is that their system indicated that I had an "Abortion"! Yeah right - I hate to call it a spontaneous abortion, but that is what a miscarriage is. For whatever reason, their system is totally wrong. I know is insurance, because the doctor's office pulled up my records and showed me all of the codes.

I just find this so insulting. It is really upsetting to have to keep reliving such an awful time!

Has anyone else dealt with anything so ridiculous?

[Anonymous]

I've had to call my insurance company a few times regarding denial of coverage for certain procedures. In every case, the cause for the problem was that the doctors office used the wrong billing code. Once the doctor's office re-submitted, the procedure was covered. It is a very complicated system, so I'm not faulting the doctors office, just saying that it happens.

[Anonymous]

OP here - yes - that is exactly what I thought, until they showed me the codes, as well as the look-up values. When we were on the call with insurance, they said that since it was an "elective abortion", they would not pay for the ultrasound. Believe me, this was a much-wanted baby and this was not elective. It seemed that the lady on the call didn't understand that the medical term for miscarriage was "spontaneous abortion".

I have already spent several hours on the phone trying to sort this out and I am just so frustrated and traumatized

[Anonymous]

Out of curiosity, what insurance company do you have?

[Anonymous]

I'm sorry you're going through this.

I had to battle my insurance company when they refused to cover the standard 20-week ultrasound. These companies can be so frustrating to deal with!

[Anonymous]

You shouldn't be dealing with this, your doctor's office should. They should be able to communicate with your insurance company about why this procedure was done.

[Anonymous]

Sounds like my insurance company - Blue Cross Blue Shield.

Anyhow, in my ongoing battles with them last year, which I won rightfully, I learned to take notes, take names, and work my way up to managers and then the managers' managers. I also learned to hang up right away if I didn't like the representative's tone of voice right away.

I'm sorry you're going through this, but I'm sure you will work it out. Best of luck to you.

[Anonymous]

I'm nnot surprised to hear I'm not the only one who has gone through insurance hell.. they really are denying and making things very difficult. I agree with PP's- document and keep at it- appeal etc.. I went through my husband's HR rep for the insurance company that gave me the account rep handling my husband's company - that person got things expedited- though I had to do a lot of explaining to get resolution.

I'm sorry you have to go through this- but keep at it..

[Anonymous]

how awful...esp at this time! What's your health inusurance? Unite Health Care?

[Anonymous]

OP here - thanks for the validation! My doctor's office was making the calls for me today and they are going to give me an update tomorrow, so I am hopeful! I have Blue Cross Blue Shield Federal Employees Plan, which is supposed to be better, but this was just so shocking!

The hardest part was having to relive some of the feelings I thought I had put behind me

[Anonymous]

I am the Benefits Administrator for my company and I can't begin to tell you how many times I have fought insurance when they wrongfully denied a charge. The fact of the matter is, computers do most of the processing of any insurance claim. When you call the number on the back of your card, the person that answers and looks at the claim is usually just reading what the computer "decided" based on the code that it was given. So I agree with PPs about escalating to a human that actually knows something about medical procedures. It is my understanding that no federal insurance plans offer any coverage for elective abortions. However, you and I know that is far from what happened.
I am very sorry for your loss. I myself recently went through a second trimester miscarriage and my medical care resulted in several run-ins with my insurance company. At a time when you are already barely hanging on, getting an EOB like that can push you over the edge. Please know that you are not alone.

[Anonymous]

OP here - you have no idea how much your advice helps! I am steeling myself to make a few follow-up calls tomorrow. Your company's employees are lucky to have someone like you looking out for them!

[Anonymous]

OP I hope you fight your bill and win. I had to pay something like $400 for my miscarriage. Kicking a woman while she is down much?

[Anonymous]

....mine was not outright rejected, I just had to pay my entire $300 deductible and then asstd charges that were not fully covered. Sucked.

[Anonymous]

"Benefits Administrator" here - OP, did you get anywhere today with your calls? I hope so. If not please post back as I'd be happy to try to help.