Insurance Just Screwed Me

[Anonymous]

It appears that it would have. What Healthy Families did was enable me to have my prenatal care covered. Care First had told me verbally twice when I was signing up that they covered prenatal, then they denied that. They also told me once I called to ask why my prenatal bills weren't being paid that I did NOT have L&D coverage - only in the event of a "complication."

The book I had said otherwise, but as we discussed last year, their mumbo jumbo is impossible to decipher. After speaking with a supervisor, I was again told: NO L&D Coverage.

But, my OB submitted a request to them to estimate L&D out of pocket and they said $1000. We were shocked, and I kept that paper as proof in case they denied anything.

So all my prenatal was covered by DCHF, and then L&D was billed to Care First with any balances sent back to DCHF. The first Explanation of Benefits left me at $1000, but then it was filed again, and somehow that turned to $500. The hospital never sent me a bill for that. I assume the rest went to DCHF to be paid off. The doctor's bill was $1700, that was denied. And one more bill was denied for $200 for the day of the baby's birth with a doc name I didn't recognize so not sure what that was. Anesthesiology?

I have a residual bill from the nuchal (from Dec 2011) which is a nightmare, but in talking with the lab directly, they explained that DCHF/Medicaid recipients always get the paid. The OB's office told me that too - they don't even submit a claim, they just do something called "Global Billing" and it gets reduced/paid.

The prenatal care ended up not being that expensive, maybe a few thousand over 9 months, but it was the wishy washy responses of Care First on the L&D that scared me. I'm glad I got the DCHF, it saved me a ton of money. I qualified again because the year of the baby was a worse financial year than the one prior, but I don't really use the insurance now.

In a funny post-script to the Care First story, my husband tried to add me to his policy again and again I was denied. We got the letter yesterday. They cited a procedure I had done 2 years ago (which never had insurance coverage and I never contested that, I paid out of pocket) as the reason. I don't get it. My husband was like, "Oh, I'm fighting this." Yeah. Good luck hon.

[Anonymous]

Anonymous wrote:It appears that it would have. What Healthy Families did was enable me to have my prenatal care covered. Care First had told me verbally twice when I was signing up that they covered prenatal, then they denied that. They also told me once I called to ask why my prenatal bills weren't being paid that I did NOT have L&D coverage - only in the event of a "complication."

The book I had said otherwise, but as we discussed last year, their mumbo jumbo is impossible to decipher. After speaking with a supervisor, I was again told: NO L&D Coverage.

But, my OB submitted a request to them to estimate L&D out of pocket and they said $1000. We were shocked, and I kept that paper as proof in case they denied anything.

So all my prenatal was covered by DCHF, and then L&D was billed to Care First with any balances sent back to DCHF. The first Explanation of Benefits left me at $1000, but then it was filed again, and somehow that turned to $500. The hospital never sent me a bill for that. I assume the rest went to DCHF to be paid off. The doctor's bill was $1700, that was denied. And one more bill was denied for $200 for the day of the baby's birth with a doc name I didn't recognize so not sure what that was. Anesthesiology?

I have a residual bill from the nuchal (from Dec 2011) which is a nightmare, but in talking with the lab directly, they explained that DCHF/Medicaid recipients always get the paid. The OB's office told me that too - they don't even submit a claim, they just do something called "Global Billing" and it gets reduced/paid.

The prenatal care ended up not being that expensive, maybe a few thousand over 9 months, but it was the wishy washy responses of Care First on the L&D that scared me. I'm glad I got the DCHF, it saved me a ton of money. I qualified again because the year of the baby was a worse financial year than the one prior, but I don't really use the insurance now.

In a funny post-script to the Care First story, my husband tried to add me to his policy again and again I was denied. We got the letter yesterday. They cited a procedure I had done 2 years ago (which never had insurance coverage and I never contested that, I paid out of pocket) as the reason. I don't get it. My husband was like, "Oh, I'm fighting this." Yeah. Good luck hon.

That's interesting...I had been wondering about L&D costs because I'm about to deliver myself, and I have Carefirst purchased individually (self-employed). If we only pay $500, that would be amazing! It's too bad that they're refusing to add you to your husband's plan, and were so contradictory about what was covered in the first place, but I'd expect nothing less from them at this point.

Again, I'm really happy for you that everything turned out okay!

[Anonymous]

OP here. To the last poster, what is your Care First policy? Mine is the DC HMO / Open Enrollment. Is that the one you are in?

I'd suggest asking your OB's billing dept to send a request to them to estimate what they will pay. Get that paper and keep it as proof - hopefully it says what mine did, which is that you have coverage. It's better to know now, because if they do follow some stupid rule about only covering in the event of a "complication" you want to know now because you can tell your doctor this. I believe that a doctor can and will look for anything to note in the file as "complication." For example, I stopped dilating at 9.5 cm and within a few minutes they were all saying "C-section." I waited it out all night and into the next day and had a c, but even if I opted for it at the first mention, they would have noted "failure to progress" and there's your complication.

If your doc knows that, they can work with you to note the file properly without doing anything wrong. It's a gray area but if you know before you go in, you're better off.

[Anonymous]

Anonymous wrote:OP here. To the last poster, what is your Care First policy? Mine is the DC HMO / Open Enrollment. Is that the one you are in?

I'd suggest asking your OB's billing dept to send a request to them to estimate what they will pay. Get that paper and keep it as proof - hopefully it says what mine did, which is that you have coverage. It's better to know now, because if they do follow some stupid rule about only covering in the event of a "complication" you want to know now because you can tell your doctor this. I believe that a doctor can and will look for anything to note in the file as "complication." For example, I stopped dilating at 9.5 cm and within a few minutes they were all saying "C-section." I waited it out all night and into the next day and had a c, but even if I opted for it at the first mention, they would have noted "failure to progress" and there's your complication.

If your doc knows that, they can work with you to note the file properly without doing anything wrong. It's a gray area but if you know before you go in, you're better off.

No, I'm in MD and we have the BluePreferred PPO plan. I think my OB would be willing to help me out if she could, in terms of noting something as a complication. Thanks for the advice!