I got a phone call today.
I have been sobbing all afternoon.
Some of you on Facebook have been aware from some of my status blasts that my insurance company has been giving me some trouble regarding this pregnancy.
Today, the final word came down:
My pregnancy and all related expenses regarding it will not be covered by insurance because they have classified it as a pre-exisiting condition.
To try and sum up what happened for you: my husband changed his job structure in August. He moved from being an employee (with benefits on a group plan) to contractor so that he could spend more time working for a company he is a partner of (without a group plan.). Having been self-employed with him for seven very rough years, I was not gung-ho on this move. I wanted to be supportive but I was scared. I wanted him to make this change in a year or two after we had a baby.
He made the move in August and didn’t tell me until the decision with both companies was finalized.
To say I was pissed is the understatement of the year. I did not blog about it because I try very hard to keep my husband and what is between us off of my blog. However, it does add to my upset, anger and anxiety. And truly? I don’t want this aspect of it to be the focus. I have enough issues and am trying to get through this with as little anger at him as possible. He was trying to do what he thought would be best for our family and made an asshat decision without crossing the t’s and dotting the i’s.
He is trying to sort out this problem, making all the phone calls, telling them not to contact me and stress me out, demanding I not worry, wanting me to not stress because I have a lot going on medically where stress is a really bad thing. Saying that to someone who has the anxiety levels that I do right now is a bit like asking someone to go out and stop the ocean tides from turning. He’s doing everything he can to fix the situation.
Back to the story.
As of August, we were sans insurance. I started looking around to see what I have to do to get insurance coverage for my family. I have to do it myself because there is no HR department and I have no idea what I am doing so it is slow going. I get all the info on cobra and start searching to see if there is any insurance policy under the sun that will take me.
No.
I am UNTOUCHABLE.
GUESS WHAT HAPPENS IN SEPTEMBER?
Pregnant.
High-risk-weren’t-trying-to-get-pregnant.
High-risk-which-means-complications-could-make-it-hideously-expensive-to-the-tune-of-tens-and-tens-of-thousands-of-dollars-pregnant.
And you know I was (and am) thrilled.
I wasn’t too worried because we were still in the window to get coverage so there wouldn’t be a lapse in coverage for me. (Which means they can’t classify me as having a pre-existing condition). So, after a lot of research we discover that there is an insurance program run by the state of Utah for people just like me. It is insurance of “Last resort”. It’s for people that cannot get private insurance, that do not qualify for Medicaid and who have significant health issues. Insurance for the un-insurable.
We go to an insurance agent and he gets regular coverage for Jonathan and boys and to see what he thinks about this program for me.
He agrees that this is the best option.
I have to spill out every humiliating and embarrassing condition and treatment I have ever had. Some of it brings me to tears because sharing it is humiliating for me. (A post for another day) We fill out the tons of forms and documents and fax it in and I am approved within the day.
I pay $400+ a month just for me with a $1000 deductible and 80/20 coverage.
It sucks, but it is a huge weight off of my mind.
During my orienation I specifically ask about the pre-existing maternity clause. The will not cover maternity for 10 months. UNLESS you are coming from group insurance it is a pre-exsisting condition. I came from one, so I’m fine, right?
Right.
Then the phone calls start coming disagreeing with that. Saying, “No, it’s a pre-existing condition”.
I freak out, stress, fax a million papers and then it’s ok.
Until it isn’t and the phone rings again.
No one seems to know what they are doing, talking about or can give me a straight answer. I have gone through this FIVE times with no definitive answer.
Until today.
They will pay for nothing regarding my pregnancy.
Apparently this coverage only covers pre-existing conditions if you have exhausted your COBRA insurance after you leave group coverage. Because I went straight from a group plan instead of exhausting my COBRA insurance I am being denied coverage for this pregnancy.
The overwhelming anxiety that has been building and building for a long time erupted and I burst into wracking, sobbing tears to the insurance coordinator. I told the man on the phone I could NOT TALK to him at the moment because it was too much for me and I was having a panic attack. I could tell he felt bad. I got his number and called my husband and hysterically tried to choke out what was happening and gave him the information.
The kicker in all this? Because we went with HIP Utah and have been on it since October, the window for us to apply and obtain cobra extention for our group plan IS CLOSED NOW.
So I? AM ROYALLY SCREWED despite my best intent to do everything the right way.
There is one small glimmer of hope; I can appeal.
Because we tried to do the right thing, went through and agent, brought it up with people at orientation and were eligable for COBRA coverage at the time, we may be able to have it covered, but I am not holding my breath.
If it doesn’t?
It could ruin us.
Yes, I’m sure we can be on some payment plan until we die and figure something out but even with payment options it could very easily send us back to living at pretty much the poverty level or damn close .
We just escaped from that hell not long ago.
I cannot go back to that.
Please don’t tell me it’s “Just money”. I have lived for years and years having so little of it and know the hellish stress it brings. I can’t go back to that. We’re barely making it as it is.
Anyway.
I guess tomorrow we start the appeals process.
I’ll let you know how it goes.
P.S. We don’t qualify for Medicaid. I’ve already looked into it.
Filed under: 
That just SUCKS. I’m going to be keeping my fingers crossed that you get a favorable response from the review and/or that the company that administers COBRA would allow you to retroactively join up.
This stuff? Is why we need a more sane healthcare system, because this is just too damaging and awful. Here’s hoping that the collective wisdom of the folks above has some possibilities that will help you out as well.
In my state (MA) this is illegal. I thought it was all over the USA. You have two things that you need to do right away. Call the insurance commissioner for your state and report your insurance company. They’ll send you a document to fill out, but once you do, then they will do an investigation.
Second, if you have (and I’m sure you must) a consumer reporter on local TV stations, call him/her and get her to investigate. They solve a LOT of insurance problems. One here in town is an acquaintance and I know that she does at least one or two insurance claims a week.
You should also talk to an attorney and have him write a strongly worded letter saying that you are investigating suing the insurance company, and then send it return receipt. Threats DO move insurance companies. Their first second and third response is to deny deny deny. But if you fight it, they usually relent. I would guess less than 5% of people actually fight them because it’s such a horrible thing to do, but with a high risk pregnancy this COULD ruin you financially.
Also, if you have PUBLIC hospitals, especially teaching hospitals, see if you can get on free care. It’s not well know that hospitals offer this, but you should talk to your doctor’s social worker and see if she can help you with your insurance problems.
I’m sorry this is happening to you.
From what I can gather in the short time I’ve been denied, because it is an insurance company run by the state and not a private company, they can classify pregnancy as a pre-existing condition. .
Why the hell this is I’m not sure.
I am also not sure what legal rights I have.
My husband is leaving town tomorrow for a week (Such great timing) and I honestly do not know if I can hack through this without him, so I probably won’t know anything for a little bit.
You all?
Are so lovely and kind you make my eyes leak with gratitude.
Loralee,
I’m one of your newest subscribers. I love reading your blogs. Thank you for being you, being human, and sharing your story.
Insurance in the U.S is a JOKE. Talk about discrimination. Somebody probley was given a bonus for declining you coverage. I have MUCH Empathy for you.
There is something so wrong with your situation and with this “pre existing pregnancy clause” OMG! I was hit with an illness (as a single mom many years back, I’m married now and have coverage) However my illness required surgery. Because I had no health insurance, I had to pay these bills alone. I have no complaint about paying bills that I incured. What I do strenuously object to is the fact that every one of these doctors & hospitals refuse to reduce my liability to them. I was not asking for a handout or free care. I simply requested that I be allowed to pay the same amount they would have been paid by an insurance company. I was billed, in some cases, more than double what an insurance company will pay.
Healthcare in this Country needing help is an understatement.Did you know that if a pregnant teen will have medical coverage under her parents’ insurance.Yes prenatal care and the birth is covered. However insurance companies will not cover the baby. Insane.
Without a change we will continue to see babies born in restrooms w/ out the proper prenatal care, or back alley abortions.
More ,stories need to be told to make the changes this country needs.
I agree with what Texan Mama says:
“I’m not kidding… you should so totally call your local TV station and get them to publicize it as a human interest story”
I truly believe your help is out there. By sharing your story it helps all of us.
You deserve kindness after dealing with those bozos!
And one other thing I thought of last night – my current insurance will cover pregnancy complications, though it won’t cover a pregnancy. Probably not the case with yours, but I figure it’s always worth asking them about *every* piece separately, because the byzantine rules can have weird-ass loopholes like that all the time.
Wishing you lots of calm as you deal with all of this.
email me your address and I will send you cupcakes. It’s a cupcake emergency.
FREE OF CHARGE.
cupcakes to the rescue!!!!!
I’m really sorry, and I think of you daily.
k
Insurance Companies are of the devil. I really hope that they will cover you. A-holes.
This is so shitty. I am SO sorry Loralee. What an extra thing to have to deal with. That IHC thing that was brought up sounds promising though.
I’ll be thinking of you.
It’s considered such because you’re not enrolling in a group, employer-sponsored plan. The law (HIPAA) that protects pregnancy only applies to that kind of insurance. Any lapses in coverage and/or changing to private insurance make that law entirely unhelpful.
It is, however, still entirely unethical.
Oh crap, that’s pants. Really pants. I hope you get something worked out.
Gosh, I hate it when everything I can say sounds really understated…
I’m so sorry. That really just plain sucks. The way we do things related to health care is totally ridiculous. It’s not right. I hope you find some solution, somehow, and I wish I could say or do more.
Everybody else has said how sorry we all are, and we ARE and I AM, but I wish it could really come across the screen as a real and true huge hug and someway to cheer you up!!! I wish you and pray for you that your appeal will pass. otherwise that IHC post looked kinda promising above. The Stork one? I hope they can help you if the appeal doesn’t, but maybe try them now at the same time as the appeal. Your baby sure must be so precious for all these things to get in the way of it’s arrival. That at least might bring a ray of comfort. Just a tiny pearl of satisfaction. xoxoxoxo
Insurance companies are the devil. I think it’s ridiculous that they’re trying to classify your pregnancy as a pre-existing condition. Stupid, stupid, stupid. I hope that your appeal brings you better news. I’m so sorry to hear about this. :(
I’m sick for you. It is absolutely NOT just money. Here’s hoping your appeal turns things around. In cases like this, hospitals and doctors often slash fees in half or waive them all together. That happened for us once when my daughter had a life threatening emergency with no insurance.
Ok, so are we all in agreement that you can’t be middle-class and sick in this country? Are we just going to put up with this because it is the way we have always known it? I have known another way – Single-payer universal healthcare, in Australia. We call it Medicare and it is very similar to Medicare in the US, except everyone gets it, no matter their circumstance. It works very well and costs LESS than what the US spends each year on a healthcare system that doesn’t even remotely work.
Can you imagine if health-related prices got regulated here and Medicare for all was introduced – how flipping awesome would that be. Healthcare and insurance prices are inflating at such a high rate and our pay-checks are not.
There is fear surrounding the change, but the change needs to happen – can you guys please write/call/meet with your local member of government about this – share your stories, let them know what is happening out here on the front lines. Call 1800-828-0498 to get linked directly to your local representative.
The state budgets are getting finalised in the next couple of weeks and our government needs to know that we need a complete overhaul similar to every other rich democratic country and also the short-term bandaid of Medicaid Waivers for the sick middle-class.
More insurance IS NOT THE ANSWER. INSURANCE DOES NOT HELP SICK PEOPLE ANYMORE. THEY ARE PUBLIC COMPANIES WHOSE GOAL IS TO MAKE MONEY FOR THEIR CEO’s AND INVESTORS – and this means saying no and denying care when it is actually needed.
The middle-class hold this country together – we pay for schools, police and fire etc and we are slowly being forced out of the middle-class and into the lower. This country is about to implode on itself.
Also too, you can vote on http://www.change.org for the top ten issues to be brought to the new government. Right now, single-payer healthcare (medicare for all) is at number two – please vote! It is such a great website and such a great idea!!
There is no frickin’ way that is legal. Or ethical. Lawyer up.
Also: PayPal? I would be more than willing to donate to the Cover Loralee’s Pregnancy Fund. For real. You don’t deserve this crap.
Ummm, this sucks. I’m sooo sorry. This is seriously why I voted Democrat in this election — I had health insurance drama — my job wanted me to pay $600 a month when I was only taking home $2,000 a month. It was like Whaaat? There’s got to be a better way and I liked the Dem’s solutions best.
Politics aside — we got to find an answer to your solution first! I’ll be praying for you!
This is not a good situation. I wish you a healthy pregnancy. But, for a moment, let’s assume your pregnancy does cost you hundreds of thousands of dollars. I know, from experience, that some hospitals will forgive debt for hardship situations. You do not have to be dirt poor to get this assistance. They will also accept very, very small monthly payments, even on tremendous debt, with no interest. I am not saying that this is idea and that it isn’t horrible, but it might not be financially devastating. I wish you much luck, and I hope for a resolution. Please relax.
Oi. What a miserable situation.
Wow – That is beyond words horrible. I am sorry you have to deal with this.
Have you considered getting an advocate? (I have been watching the bestlife Oprah week – need something good in my life and they talked about this on their show with Dr. Oz.) Is there someone you can ask? Someone smart, bitchy and doesn’t take no for an answer to jump all over their shit?
I am sure you are well equipped to take them on, but if you are high-risk pregnancy, then it would be nice if you were able to concentrate on being well and good thoughts rather than evil insurance companies.
loralee, i wish i could fix your problem! but i can’t. however due to alot of tumultuous turmoil (that sounds kind of cool) recently in my life i can pass along a tip, a tool , you might call it. to help you alleviate the ovewhelming stress. it works. go to a mirror, stare yourself in the eye. DIRECT SELF EYE CONTACT. now, grin and don’t look away from your own eyes for 60 seconds. i’m serious!!!! you will feel like a fool for about 15 seconds or so and then the most amazing thing happens………the smile becomes real. by about 45 seconds you will be physiologically benefiting from the joy of laughter and giggling. it’s very important that you don’t break eye contact with yourself and you don’t stop smiling for 60 seconds. I know this sounds trite, but…………I EFFING DARE YOU TO DO IT!!!!!!!!!!!!!!! I DOUBLE DARE YOU!!! sometimes the smallest patch of blue sky can brighten the dreariest day. stress is a chain of bondage and sometimes just breaking a few links can trigger enormous relief. i mean come on…….. invest 1 minute. final instruction……….. repeat as needed. smiles,,,,,,,,, steve
Oh, Loralee. I’m so sorry. That’s a bitch.
Debt is no fun, and insurance companies are the devil.
Thinking about and praying for ya’ll.
Lo,
If you need any help in talking to the Insurance, CALL ME!! You know this is what I do all day long! If I can be of any help PLEASE LET ME KNOW – SERIOUSLY!!! I will stay on hold for hours for you!
Keeping my fingers crossed.
I’m going to really hope all goes well with the appeal. I have a LOT to say on this subject, so I’m pretty sure you’ll be getting an e-mail from moi. Take care and I won’t tell you to relax, as that’s sort of out of the mental-question. I’ve been there–truly. So, how about I just tell you to eat cheese and ice cream. Because that will at least help the short term.
xoxo
My husband and I don’t have insurance. We both have pre-existing conditions that no one will touch. So, we just go to the doctor when we have to and pay out of pocket. it’s all we can do. and it sucks.
I hope you find something you can do to make this right. And I agree with LouCeel; If they won’t cover you, I would stop paying the premiums and request a refund of what has already been paid to them.
I hate insurance companies! I am with you 100%!! I hope thigs turn out better! Good luck!
Criminy. *hugs* atcha! Ay yai yai. Good luck with every thing! I’m glad you’re getting a break with VDog right now. :P
hi – I just stumbled upon this and I just wanted to say how bad I feel for you – How awful that something that should be so wonderful is turning into a nightmare! all i could think of is flying to the uk for a few months and going to an nhs hospital – at least you wouldnt have to pay! – we are so lucky in the uk and we dont even realise it. I do hope it all works out well – I will be thinking of you ((((hug))))
[...] he came back, I explained my situation, reminded him they have ruled my pregnancy a preexisting condition and that we are having a very difficult time in addition to our family expenses just keeping up [...]
[...] Why does this matter? Well, because there are women just south of the 49th who are denied coverage because of pre-existing conditions – or what their insurance companies have deemed to be pre-existing conditions. Like pregnancy. [...]
[...] many of you know, my insurance company deemed my pregnancy a pre-existing condition and so my prenatal care and hospital stay will not be covered. While this sucks big, hairy donkey [...]
Please accept my apologies for the lengthy comment..
I’m sorry for the hellishness that’s health care for you. This post was written 6 months ago-so what was the outcome? Was your pregnancy/delivery paid for by HIP Utah? If not, did you manage to pay for all of it out of pocket?
I am currently also in a health care nightmare.
I had cancer 9 years ago. The best kind of cancer if there ever was such a thing – Hodgkin’s disease – right up there at the top with testicular cancer. I was working for a company with group plans and insurance paid for all treatment-related costs. We had 2 healthy kids a few years after that. I was laid off when I was pregnant with our youngest (I didn’t bother looking for a job since I presumed no one would hire a visibly pregnant woman. I stayed home a couple of years). My husband was in a group plan with the employer he worked for at the time, so medical care was not a huge issue.
Fast forward to Dec 2007 when husband got laid off. We were all out of health care. We got on COBRA and paid all 18-months of it (see paragraph below on why), exhausting it and a lot of our savings. After our family COBRA plan exhausted, my husband and private health insurance. We pay for it ourselves, it’s reasonable monthly premium with not so reasonable 80/20 and $2500 deductible.
It was very discouraging to be laid off 2 weeks prior to Christmas, and it propelled us to start our own business sooner than planned. We are not rich by any means – we’re 2nd generation immigrants with not much of anything materially – the money that we are using for our business is from selling our house and moving to a much lower cost city. What we do have is the entrepreneur bug and have big dreams.
The kids and husband have some medical coverage. I, on the other hand, have been denied insurance at every company except HIP.
As you know, HIP is for those of us un-insurables.
Even though the cancer I had is coined the “best cancer to have” medically, even thought I have been in remission for 7 years, even though I have been healthy all these time, incurring less than $1000 of medical costs while I was on COBRA for the entire 18 months duration.
NO CAN DO. You had cancer? Tough luck. No insurance for you. Take a walk, have a nice day.
HIP wants $700/month with $2500 deductible and 80/20. Just for MYSELF.
I can’t breath.
I can’t afford that. So I don’t have HIP. I don’t have health insurance.
After my chemotherapy and radiation therapy ended, all of my oncologists advised that I start having mammograms after I turn 30, because the bulk of radiation was delivered to my chest and neck area. I am now 32 and I have not had done it. I do feel fine though. However, I was also “fine” for my whole life except the 5 months leading up to my cancer diagnose.
I’m willing to pay for the mammogram out of pocket – what I am afraid is, what if it comes back showing something bad? How will I pay for it? For I am without health insurance, and if it does come back with bad results, I would have yet ONE more “pre-existing condition”…
As a result of my medical history, the current health care system (lackthereof!) is not making entrepreneurship and owning a small business easy at all.
Even if I start paying for HIP now, which I can’t afford, I will not be covered for anything significant for at least a year.
So, no mammograms.
It’s infuriating to know that the US is the only developed, civilized country where affordable health care is not easily accessible. Even friends in Thailand have that luxury.
[...] of you know about my insurance woes and health problems and that the State of Utah declared my pregnancy a pre-existing condition. That we lost a [...]
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[...] Today I feel like insurance companies are of the devil. |I got a phone call today. I have been sobbing all afternoon. Some of you on Facebook have been aware from some of my status blasts that my insurance … January 6, 2009 … I got a phone call today. [...]
I don’t know what to I do.
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