Tuesday, November 4, 2008

Insurance Is A Nightmare!!!

I know I have been going on and on about this, but it doesn't seem like it is going to end anytime soon. I will be on the phone tomorrow with my insurance again. Probably bawling my eyes out because they don't want to cover ANYTHING!

I understand that they didn't cover the infertility. It's in the book that they don't and, though it irritated me, I understood that. I don't understand this. They are supposed to cover maternity and they aren't.

I recieved another explanation of benefits today and this is what they said: For the ultrasounds (the original that was measuring a week behind, the second one where we finally saw the heartbeat and the ones I had because was bleeding WHILE PREGNANT!) they said that "medical necessity cannot be determined." Apparently I was just supposed to overlook the bleeding and let my baby die (which is exactly what I thought was happening). Maybe I can understand the first two not being necessary. In a normal pregnancy they would never have happened. But, I'm an infertile and infertiles are high risk.

Then they won't cover my first beta because the "Diagnosis is not consistent with the patient's medical records." WHAT?!?!? There is a reason I was seeing a doctor for this and he helped me reach my goal. The real kicker is that they covered the second beta. Now someone please explain that one to me. If the diagnosis wasn't consistent for the first beta, then why was it consistent for the second?

Am I insured by a bunch of quacks? I thought our insurance was really good. I'm quickly realizing that they will say whatever they feel like saying just so they won't have to cover me. And maybe the things they covered weren't really covered. They are referenced under a discount. "Patient not responsible." Does that mean that they didn't cover it and my health system covered it for some reason? What do I need to do to determine medical necessity? My clinic sent them my records. Is this a lost cause and I am fighting a losing battle? Should I just pay it and forget about it? That's a chunk of money that I'm not sure I want to part with. 5 ultrasounds (not including the one my OB did or the two I had for the NTT) at $150.00 each...plus, office visits and lab work. Ouch. I don't know what to do and this is stressing me out!

On another note, I went and voted after work. I get off at 4:30 and was home by 5:00. I wasn't even there for 10 minutes. I was expecting a long wait so this was a very pleasant


I Believe in Miracles said...

Fight them!! I know you can work your magic.

And we were pleasantly surprised too. Quick!

Kriss said...

I used to do medical insur. claims. You need to contact your doctors office mgr or claims specialist to call your insurance. Also you need to make sure your doctors office is putting in the correct ICD-9 codes for diagnosis. Like for instance on the beta test that they don't have your diag as infert but instead maternity or pregnancy. They should be able to put an ICD-9 code that says threaten pregnancy.

Mercedes said...

I used to do some medical billings. It sounds like they aren't billing right. I would talk to your doctor's office. Maybe they have someone new that doesn't know what they are doing.

Mainly a midwife said...

That is just crazy. Anything done after you are pregnant should be covered. I hope this gets worked out for you soon.