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.
Stumble it!
Filed under: 
I’m sorry, I don’t know what to say. So I am sending you millons of cyber hugs. xoooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooox
Well it was going to be millons, but didn’t want choke up you comments page.
Love Toni
Pregnancy should be the one thing that there is no preexisting clause for. Seriously. It could make some people make choices that you wouldn’t wish on anyone (no matter your views). WTF? The cost of someone not getting prenatal care because they can’t afford it should be enough of a reason to cover it, regardless of any other shit.
i can’t say anything, except i’m so very sorry you have to go through this right now.
one more thing.
i very much hope this resolves into something much more positive and you find relief from the stress soon. best thoughts for you, loralee.
motherfuckertittysuckingtwoballedbitches of insurance.
most appropriate? Kyla @ the journey just tweeted “Today was the kind of day that ends in wine” and God knows she know the insurance headaches too.
also?
the insurance system is utter bullshit.
that is all.
A total understantement but – that SUCKS. And I’m SO SORRY. You went about it the right way with good itentions, so you HAVE to believe it will be alright. Universe – Loralee needs you to throw her a bone.
Hire an attorney ASAP. Preferably one that is hot and single, that way I can sleep with him to pay your bill. I’d totally be a slut for you. That love my dear.
I am sooo sorry Loralee. That sucks sucks sucks beyond words. Sending you good vibes and hoping that all turns out well for you!! You should not have to deal with this stress right now.
That is beyond fucked up, and honestly, it sounds like they’re seriously jerking you around because you’re high-risk and they know it’s going to cost more than normal. I’ve been through several insurance companies, and every single one of them, under no circumstances was a pregnancy considered a pre-existing condition. Most of them *can’t* classify it as such. I had similar concerns with my second pregnancy, because we found out before enrollment for insurance and I didn’t think they’d cover the pregnancy. I was told by our HR and then the insurance company themselves, that it would definitely be covered and it was.
I really hope you guys get this straightened out. I know it has to be a nightmare. My thoughts are with you.
Oh, I am so sorry. You do not need to go through this with everything else you’re dealing with with the pregnancy. I’ll be praying for a resolution to the problem soon.
Apply for emergency Medicaide. Since your insurance is denying you coverage you just might be granted the insurance from Medicaide which covers like EVERYTHING. I only know this cause when my husband was layed off we had to figure something out for insurance. We talked to them about how it was possible I could be pregnant and they told us if that happened even if we were covered and the insurance denied us coverage for me and the baby during pregnancy we could get the medicaide. I hope that helps and I am REALLY, REALLY sorry for your stress. You and me are a lot alike in that we stress and when there really is something to stress it isn’t a good thing. You will be in my prayers!!!!!!!!!
That is so horribly, horribly wrong, and it makes me sick that crap like this happens all the time in our country. Here is hoping and praying with all of my might that you win your appeal.
hi..i know we really dont converse..or tweet dm…but i do follow your twitters….& just wanted to extend a big interwebs hug…..
i am so sorry u are going thru the mental & physical stress of losing your baby….& this issue with our f’d up medical/insurance world…..i think its time to get a lawyer…..it sounds like it would be tough get one financially on retainer….but there has got to be a community-type org. that would have one who does pro-bono work?…maybe the university in your area could refer you to one…?
Oh, ugh. I am so sorry. You don’t need this now (or any time, really). I will be thinking of you and hoping for the best.
Someone needs to get Michael Moore on the case. This is seriously the most screwed up thing I have heard in a long time. My heart is breaking for you. I’m waiting on pins on needles to hear about the resolution to this. There HAS to be one.
I’m so sorry. That’s just not fair. Insurance companies are so shitty. Hopefully they will see the light (and the fact that they are in fact at fault for you not getting COBRA) during your appeal. Good luck.
Whew…take a breath…you still have some options.
Maybe you have already done this, but IHC has an insurance program called Stork Savers. It is insurance specifically for women who cannot get maternity coverage with their insurance. Ask them about that.
Also, Health Insurance Companies are absolute assholes…go directly to IHC and speak to somebody in their financial assistance department. IHC is not for profit, so you can apply for financial aid. Make sure to let them know your husband is self employed…that actually helps quite a bit. I actually used to work in that department at IHC…and was able to help many, many families in your situation. They are so good to work with. Don’t be afraid to tell them what you can and cannot pay.
From their website:
Patients are asked to pay on a sliding-fee scale depending on household income, household size, and other personal circumstances.
If you don’t have insurance, or if you need help in paying for care, contact the Financial Assistance Helpline and ask to speak with an Eligibility Counselor about Intermountain’s Financial Assistance Program:
Financial Assistance Helpline
Phone: (801) 442-1128
Toll free: 1-800-442-1128
Anyway, I don’t usually comment, but having worked at IHC (my husband and I are both self employed) I hope this information puts a poor, stressed out pregnant women a little at ease!
Ohhhh sweetie, I so feel for your frustration,fear and anger. Hubby’s employer went bankrupt and we were previously in baby-making mode but now are waiting until another job and insurance come through. Prayers that everything will work out for you!
This royally sucks big fat donkey balls. I really hope that you can get some help. I would try annon.’s tip, hopefully it helps.
BIG giant HUGS!!
I am normally a lurker, but I wanted to say I am so so so sorry this is happening to you. It sounds inordinately stressful.
We found out after I had my son that our insurance covered next to nothing. Paying off that debt and finding out how bad our insurance was prompted my husband to get a new job this year. There’s so many unknowns with coverage and it is SO stressful dealing with that.
I really hope you are able to appeal this successfully. My heart goes out to you.
Holy SHIT! I went through the same pregnancy stuff where I paid and we were reimbursed. It strained us while we waited for reimbursement. If I had to pay for the peri, the OB, the heparin, the needles, the labs and NOT get reimbursed? We would have lost our house
I’m so sorry. As I mentioned on Twitter, can you get your congressman or senator involved?
Feel free to email if you need to vent. Sending hugs and prayers from here…
Oh Loralee, I’m SO sorry this is happening. I wish that I could offer some helpful advice, but being Canadian I know nothing about your health care system. (other then the fact I won’t slide a toe into your country for 3 seconds without buying health insurance first)
Hugs to you-hang in there!
Loralee, I am totally crying right now. I am so, so sorry. A similar thing happened to my best friend – she got pregnant with an IUD. She didn’t have maternity insurance because, well, the IUD was supposed to be the insurance against that. They called her pregnancy a pre-existing condition and wouldn’t cover it. She had a good pregnancy, but did have to do a c-section. They owe the hospital a lot. It’s completely ridiculous and unfair.
This is just another reason that our insurance system sucks. As an HR Professional, I don’t understand why they would have required you to exhaust your COBRA coverage before going out and getting your own coverage. That doesn’t make sense to me, and I am HOPING that means your appeal will work. If the insurance company won’t appeal, it might be worth it to try and get a consultation from a lawyer. Even if it costs a little bit, if they can fix it it won’t cost as much as the medical bills.
(BIG HUGS) to you.
Move to Canada. Seriously.
Love you, sweetie.
I gave birth at 7pm on December 30th under one insurance and checked out of the hospital on January 1st covered by another because my company changed carriers at the year turn. First carrier? Refused to pay charges because the bills were dated 1.Jan, after I was no longer insured by them. Second carrier? Refused to pay any pregnancy related charges because I was not pregnant when they picked me up. I feel your some of your pain and I’m so sorry you have to deal with this!
Bullshit. I call shenanigans. Insurance companies are nothing but hired thugs.
Good luck with your appeal, for sure.
Xo
B
Michael Moore needs to get on this! Another huge HUGE reason why the American health care system sucks.
I hope everything works out for you and your family.
We met at BlogHer and I don’t usually comment, but this is the kind of crap that makes me embarrassed to live in this country. We are a first world country with a third world health care system. No one should have to attempt to navigate this labyrinth of health insurance landmines, especially while pregnant. The creativity of our country is stifled while people stay in jobs just to protect their health insurance status and we are suffering as a nation because of it. I don’t know what the answer is for you, but I hope someone out there does. Good luck and may the power of the interwebz help you.
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 knew another blogger who adopted a baby from Korea… their insurance said she was covered. When they brought her home, she had some physical and developmental issues… anyway, the insurance was denying coverage 100%. So they called the local TV station. Got their story on the air. And, POOF. within a week the insurance co. called them and covered everything. They don’t want bad media. Try it, if everything else fails. It couldn’t hurt… it’s only a phone call. The worst they can say is “no” and then you’re no worse off than you are if you do nothing. Just consider it.
So, here’s to holding a “Funding Loralee’s Pregnancy” bake sale… :)
Hugs, Mrs. I’m not a particularly religious person, nor do I pray often, but you’ve been in my thoughts for the past few days over this and I sincerely do pray that things work themselves out for you.
I agree that you should look into legal representation. I know it’s just another expense to add on the pile, but it could potentially save you thousands! (You obviously know much more than I do, but I thought in Utah it was illegal to consider pregnancy a pre-existing condition.)
Also, this sucks.
Isn’t it always classified as a pre-existing condition? Mine was.
In my not-so-humble opinion insurance people royally suck. They never seem to be able to get their acts together and give you a straight answer until it’s too late. I’m sorry you’re having to deal with this crap, especially feeling the way you do.
This is just awful – I am so sorry. If the insurance system actually worked, you wouldn’t see so many people want single payer.
Although there’s nothing I can do because I know so very little about US health-care, I could always marry you and whisk you away to Canada. Sleep on it.
wow, what an ordeal. prayers and good wishes for a miracle.
i love doug’s offer, btw…funny! hope it made you smile!
I love you, Dougie.
Oh sweetie! I am so sorry you’re going through this. You’re doing everything right and you’re getting hosed! I was fired when I was six months pregnant with my firstborn and it was a mess as well. I found that by keeping my medical providers informed, they were really willing to help me with the insurance. After all, they can charge and do more if they’re getting paid by the insurance company and if you do have to pay out of pocket, I am sure they will work with on a payment plan. I hope everything works out!
Honey, I am praying for you nightly.
Also please do appeal. When I was pregnant with my little man, the insurance would just routinely deny my Zofran, just for the heck of it, and as soon as I would appeal they would approve it. It almost makes me think that these companies are so full of middle managers, that these weasels deny things just to justify their jobs.
Hang in there! (((HUGS)))
Hi- I know this is Oregon and not Utah and you already said you don’t qualify for Medicaid- but our state funded medical program (OHP) covers children and pregnant children for sure- even if no one else in the house gets it- if you are pregnant- they cover you. Like I said, I know you said you already checked medicaid- but does Utah have anything like OHP?
On the upside (yeah right) at least lenders perceive medical debt differently than the type people intentionally get into- and yes- you may be paying it all off until you are a great- grandma… but… pink onesies and binkies and hair pretties- Oh My! Hugs-
Oh babe,
I have no clue of insurance cause we don’t have that sort of system here.
Just sending you a warm cuddle and my love.
Uh, ditto to what everyone else has said. That is absolutely awful. A few people recommended getting in touch with lawmakers. That actually might help. The Utah session starts in a few weeks and they might be looking for their pet causes. You’d be the perfect example of the health insurance industry gone wrong. I have all the local contact info for legislators if you need it. And, of course, appeal like crazy. Good luck … That sounds like such a nightmare.
girl, i am so sorry. i am sending you good vibes, prayers, whatever your flavour.
have you tried going directly to the hospital, or IHC?
This is so crazy to me, the timing of this and the fact that we just held an insurance meeting for our company and that was after I had to sit down with reps from insurance companies and be nauseous at how little they care for the actual employees how need HEALTH COVERAGE.
Our healthcare system gives me anxiety and I’m not pregnant, or even thinking about being pregnant. When I worked at a high-risk perinatal clinic I literally had to help a patient prove to her insurance company that she had twins because they were denying coverage on one of her newborns. UNREAL, and so endless vexing.
All of that to say: I’m so sorry, babe, and I’m here if ever you just want to shout into the void or cry it out. Really. Hang in there, sweets.
…and i suppose they told you that they are “just doing their job” too. ARGGGH! I’ve got you in my thoughts. Hugs, Vx
So sorry you are having to go through this.
You need to move to a country with a different health-care system ASAP!
I hope you are able to work it out.
I? have SO been there. I spent the last five months of my last pregnancy jumping through insurance hoops trying to do the right thing and having insurance companies say one thing and do another. (I wasn’t even high-risk– we were just dealing with a change of employers and a whole bunch of mis-information that was brushed off as an “Oops!” by COBRA Insurance #1 and made us ineligible for Insurance #2. We went with Insurance #3, and Insurance Scam #4. And then COBRA #1 wouldn’t pick us up again, even though it was their mistake.)
We didn’t qualify for Medicaid, either.
After spending weeks on the phone with HR, we finally got Insurance #2 to back-date our enrollment, scraped together a thousand dollars to cover the past month’s premiums, and our baby was born via emergency C-section with Cigna insurance in an IHC hospital about five hours after the check was mailed.
IHC wrote off about 90% of our stay, because Cigna refused to cover it.
Sorry for the long post. What I really wanted to say was, I’ve been in a similar place. I know the despair, the depression, the panic, the sobbing to insurance agents, the feeling of utter helplesness, having serious financial strain, and all the added stress those things add to an already-stressful pregnancy. I’m sure you feel like the rug keeps getting pulled out from under you, and then you’re being pummeled by it.
We had a last-minute miracle. I hope yours comes a lot sooner than that.
E-mail if you’d like to chat. :) I’ll be thinking about you and praying for the best…
Since the refuse to cover you – at least they should refund the money you’ve paid in.
Aw honey, I feel for you. I’m hoping everything works out with the appeal – keep us updated, there might be someone here with the answer.
Oh Heck. That just sucks. I hate insurance companies. I am so sorry and I’ll pray that your appeal works out.
Hi Sweetie,
You know, I know, exactly what you are going through. Because it is not PC I won’t rant here but I will give you a phone call.
I love you,
Amy W.
Oh honey. If Dougie doesn’t come through, I will. After all, we’d be legal in Canada! Plus, I’d be more likely than him to play with your magical boobies! Er, kidding.
But in all honesty, I agree with whoever said to call your local tv station. I know it’s probably the last thing you want to do, go on tv and embarrass yourself with all your medical issues out there, but it’s not you that will be embarrassed in the end, it’s the insurance companies. Maybe it’s just ’cause I grew up in a place that had universal health care (and yes, there is some insurance to cover extra costs and prescriptions and such) but I cannot understand how this can happen in a place that isn’t in South West Africa.
Put up a paypal link and a “donate to Loralee’s Healthy Pregnancy Fund”. I’d give you whatever extra I have out of my stipend.
Oh, and what I don’t give you, I’ll knit you in baby clothes. Just give me a colour and I’ll knit as much as I can before that precious, HEALTHY child comes kicking and screaming out into the world!
Hang in there, in the middle of appealing, Id look into using a midwife instead of an OB, (if you can, I dont know your risk level) and possibly into WIC. (Women, Infants, Children) they can help get prenatal care and food to pregnant, nursing and children under 5 or 6.
Any chance you could become a Canadian before your due date?
So sorry, Loralee, that just really sucks.
Insurance companies are a legal scam. I can not believe that people have to deal with so much crap to have it. Everyone should have it no matter what.
I am so sorry that you are going through that. We had issues with insurance companies when I was pregnant with Anthony. I actually had to go to the ER because I had a full blown panic attack in MN. We had COBRA and when I went to the Dr. in MN they told me that what we only had coverage if I stayed in FL. It was a nightmare we also did not qualify for medicaid. Jose had to join the Army Reserve so that I could get coverage.But we really tried everything before we came to that conclusion. Because they had a special thing for Iraqi veterans. What sucks the most is that we had been paying Cobra for 3 months, a $1000 a month.
I really hope things work out for you.
Oh Loralee, this sucks great big donkey dongs! I dn’t even know what to say. I do have a suggestion. What if you called the local newspaper and found a symptathetic reporter? I’ve seen amazing things happen when the media gets involved and there’s a risk of embarrassment for the insurance company. I’m in PR and have access to information on reporters from newspapers across the country. If you would like help tracking someone down, I’d love to be of assisstance.
is it too late to move to Canada?
Sorry, all I can offer is hugs from far away.
I don’t understand how Utah, the land of a dozen kids, has problems with pregnancies. Maybe they expect you to give birth at home, aided by the rest of your kids and the other wives.
Get a lawyer. Yesterday.
Then repeatedly remind your dear hubby that this is what happens when you vote republican.
(sorry we didn’t get to see you at christmas)
chairty.
my sister had to have surgery to remove a tumor a few years back and she was not covered by any insurance. The bills came to over 10k- she was only 19 (i realize your bill will be MUCH higher). The hospital had charity programs that she could apply for, she received them and it covered a HUGE chunk of her bill. Ask your doctor and hospital if they know of any charity organizations that you could apply for.
*fingers crossed for the appeal*
People who say “it’s only money” have obviously never been poor and make me want to absolutely batsh*t crazy with rage.
I am so so so sorry and will be saying a prayer that this will all work out for you.
Oh my! I am so sorry Loralee!
Crap.
I second many of the suggestions-especially the media options, and a paypal button. People here in Blogland can come through for you-I’ll even blog it for my measley little audience and get it to any corner I know of.
I’m adding this to my prayer list.
How horrible!
Wow, I am so sorry, Loralee. Yet another example of how sick our healthcare/insurance system is in this country. I really hope your appeal is successful, and that those asshats in the insurance company pulls their heads out of their sphincters and realize that what they are doing to you is horrible.
So, not that I know anything about skipping this country to seek healthcare elsewhere, but… if the appeal doesn’t go through… maybe they will take care of you in Canada or Europe? I have heard of people who went elsewhere to get surgeries that would have bankrupted them in America.
Anyway, you will make it out somehow.
I am sick at this. I feel so sad for you and am hoping for the best. Please keep us updated. Maybe we could start a ChipIn.com widget to raise money for you?
I know, I KNOW, that the states passed a law about a decade ago making it illegal, ILLEGAL, for anyone to classify pregnancy as a preexisting condition.
That said? Go to planned parenthood. The were my doctors for kid one, and they were AWESOME. Yes, they totally deliver babies.
Don’t be afraid to contact CEO’s, Vice President’s of the hospitals, insurance companies etc. You can usually find the contact information on the websites. My husband had to deal with a situation in another state and for 6 months we left messages with the people in charge of our “situation.” Of course nothing ever got resolved. So one day my husband actually called the Governor, Lt. Governor, Attorney General of the state. He had to leave messages on their machines, but a six months situation resolved itself in THREE DAYS. You will be so surprised at how much red tape get’s thrown out the window when the Governor is calling you.
It is also surprising how much more the CEO or Governor will care about your situation than people who do it because it’s their “job”.
Anyway, I really hope that things work out. Nothing is worse than having that kind of stress while you are pregnant. Many hugs and prayers are being sent your way.
This happened to me with my oldest. We appealed and we won. Stick to your guns, honey. xoxoxox
There’s a reason the appeals process exists – anyone is capable of making a mistake.
Here’s hoping this is resolved quickly!
Please don’t tell me it’s so bad I need to send you homemade rolls again…
Oh Jesus. I’m so sorry. I hope that glimmer of hope becomes a reality.
Firstly I am going to apologize that I did not read the gabillion of other comments. I am eating my cup of noodles and writing at the same time while supervising my class doing the same.
So, Let me tell you that I completely understand about the financial thing. We went bankrupt while I was off with my broken jaw. No one would pay me and without my salary, we almost lost the house etc. I had to sell my wedding rings. So the money stress I get.
I know there are agencies in the states that will cover the costs of medical bills. I do not know what the name of them happen to be, but I do know that they exist. Someone emailed me a name at one point because they wondered if I could apply for assistance while in Canada.
Call back or have Johnathon call the insurance agent and ask if he is aware of any such provisionists. And, begin the appeal…NOW. Write a letter to your senator etc and ask what they would like you to do…Take the anger, hurt fristration etc and push it into actions…if I find the name of the agency sent to me, I will email it to you.
Oh, Loralee. I think we all know what a royal pain in the ass insurance companies are. I will be praying for you guys and for a quick resolution to this whole mess. Many hugs to you1
well..fuck.
that’s really all i can say about that.
HUGSHUGSHUGSHUGS.
UGHH! I really do not know what to say about this!! You should emigrate to the UK and live with me and get free healthcare!!! thrrrrrp to your insurance people!!
First time commenter, Ive got a clotting disorder too (Factor V Leiden Thrombophilia)- my last sucessful pregnancy cost $70,000- yeah, that Lovenox will do it every time. My most recent pregnancy (ended in miscarriage at 10 weeks) cost $11,000 just for the first 10 weeks, plus a D&C… I totally have been there with insurance companies. I say stick to your guns- theyre only being total douchebags because they think you will give up. I havent been one of your readers for all that long, but from what I know of you, there’s not a chance in hell of that happening. Go to it! No one puts Loralee in a corner!
I am appalled and quite struck by the number of people in your comments that have been in similar situations. How can this despair and frustration and evidence of a situation gone so WRONG be so common?
I also think there have been some great suggestions, and am finding a glimmer of hope for you.
If all else fails we can at least find and stalk the people responsible. You know I am always good for that!
[...] Today I feel like insurance companies are of the devil. [...]
Well, CRAP.
Cobra is FREAKING expensive, I’ve paid it for just me before, and I can’t imagine what it would be for a family of 4.
I think you guys did the right thing. I’m just praying that the appeal people realize that.
I was JUST in your shoes not even a year ago. By some miracle of GOD on the last month of my pregnancy I re-applied to Medicaid and lo and behold I GOT IT. I was approved for Medicaid on March 15th and on the 24th my baby was born. MIRACLE I TELL YOU – FREAKING MIRACLE.
I hope you find something, anything to help with the costs of this pregnancy. The last thing one needs during this time is the stress of not knowing how in the hell you’re gonna pay off thousands of dollars in medical bills.
HUGS!
I would ABSOLUTELY be all over that shit with my state senator, and I’d get a lawyer, too.
The bottom line is that — and this is what Mr. Lady means — through HIPAA, it is illegal for pregnancy to be considered a pre-existing condition, but unfortunately, HIPAA only applies to group plans. Individual coverage, and periods without health insurance, are a loophole where it can be considered such.
It’s fucking bullshit, and the thing is, is that it’s poor public policy, no matter what your politics, to leave pregnant women uninsured. Period.
Your options, lawyering/senatoring up aside, are to come clean with your health providers — honestly, this is the first thing I’d do — and ask them to charge you what they receive from the insurance company. Often, they deliberately inflate their costs to account for insurance-related overhead, and to them, it makes no difference, but it can be a VERY significant discount for you.
Secondly, do not fear the free clinic. I know it’s Utah, so I don’t know what your Planned Parenthood options are, but when I was broke, I got all of my care through PP, and it was spectacular. No matter what your personal beliefs on the organization as a whole, their providers and employees are top-notch at a tremendously low cost, and I cannot say enough about the quality of care I received there.
Much love to you. It’s not “only money”. It’s a big fucking deal, and you deserve better. I want to fight like hell on your behalf. Let me know what I can do. I mean it.
i’m also a first-time commenter (twitter follower) and oy vey! i’m so sorry you are going through this all.
when we were unsure about coverage in our first pregnancy, someone pointed out to me that the hospital had a “plan” that covered a pregnancy from start to finish with prenatal to delivery. it was a set fee, but you had to see staff doctors instead of your own private ob. it was not an exorbitant cost and i think meant for situations like this.
i would definitely call a few of your local hospitals and see what they can do for you. everyone else’s ideas for media, legal, etc, are all good but might not happen immediately. an existing program at a hospital might put your mind at ease.
best of luck and blessings to you.
Uh, insurance companies ARE the devil! I’m sorry you’re dealing with this. They are heartless, moneygrubbing bastards. Someone should tell them ‘it’s only money’. I hope your appeal is approved.
That Mother F’n BLOWS! What is this world coming to when a pregnant woman who has done all her due diligence to be covered gets royally screwed?
Lots of prayers for you sweetie…Love ya..
oh baby. I’m so sorry.
I wish there was something I could do.
You have my prayers that this will be resolved. oh my sweet girl. I am so so sorry.
The blogosphere is an amazing place though, with lots of people with pull and resources and voices. They will pull together for you.
:( I’m so, so sorry. I don’t know what else to say, but I wanted to let you know I’m thinking about you. I’ll keep you in my prayers.
*hugs*
Get thee to Planned Parenthood post haste. They have fantastic OB/Gyns (mostly women)who volunteer their services so you can pay on a sliding scale. Many of them are high risk pregnancy specialists. Despite what you may have heard, Planned Parenthood is all about healthy mothers and babes, not just birth control. Their counselors can also get you in the door for sliding scale and fully sponsored hospital fees. ((Hugs))
Oh Loralee, this absolutely infuriates me.
How do people who make these decisions look at themselves in the mirror?
I’m so sorry, hoping for the appeal to work.
My wife and I went through a similar situation with our first kid. I ended up having to go back to the reserves to have them pay for the pregnancy. Not a good thing. I really feel for you.
You’re right, insurance companies are of the devil, just ask any doctor, they get screwed over all the time by them too. I’m absolutely sure the only reason they denied you coverage is because they found out how expensive the coverage will be. This is a battle well worth fighting, I think geting the local news involved is a good idea too. Good luck with everything.
I know you have mixed feelings about prayer, but now seems like a good time to get on your knees.
You’re in my thoughts and prayers.
I’m so sorry babe. I know the stress and the back-and-forth uncertainty of it is the absolute worst. They suck suck suck and I wish them all raging UTIs until they change their minds and fix things as they should be, preferably with a notarized document of verification. Signed in BLOOD.
Hang in there, you know we love you.
I am so sorry Loralee. I wish I had something to say or help…this is truly messed up. Sending hugs your way…. xoxo
Sending you a huge {{{{{{HUG}}}}}}
Now…
1. Get a lawyer
2. Call your congressman
3. Call the local paper
4. Call the TV station
5. Calm down and think about the baby!!!
i am a medicalsocial worker in st. louis, mo…if i can help let me know. what about medicare parts a & b based on your med’l condition (not referring to pregnancy), does your obgyn have access to hospital social workers…not trying to up your stress.
That more than sucks. That should be illegal. I’m so mad for you!
I’m so sorry! That sucks in a “words cannot express” sort of way. I hope it works out in your favor. It HAS to. The was insurance companies try to – and successfully – screw people over is nauseating.
And because I’m a conspiracy theorist, is there any chance the company that provides your COBRA coverage is the same company who provides the high risk coverage and they were just trying to find a way to avoid paying for the pregnancy coverage altogether?
I’m SO sorry, sweetie. You are in my prayers.
LL,
Everything will work itself out, it always does, we just forget when we are on the top of the slope looking down.
I know it is easy for me to say as I sit comfortably at the bottom, for today, but we are all cheering you on.
You will be fine, you will get through this, God is on your side, and I have it on good authority Satan was an underwriter.
:)
Oh wow. I’m so very sorry you’re going through this. I had an insurance scare during my last pregnancy but nothing at all like this.
I send you strength and good luck vibes.
xo
I’ve had my fair share of insurance related trauma due to my digestive problems, but they pale in comparison to this. So sorry.
I was just going to chime in with a few others who have mentioned that IHC can write off hospital bills. I’m not sure where that leaves you with OBs and pharmacy bills though.
I would recommend that you see a midwife for the delivery if your high-risk problems were only during the pregnancy, but it sounds like there is also increased risk during the delivery, so I assume that’s not an option. Besides, if the big costs are during the pregnancy, saving $2500 by avoiding the hospital for the delivery isn’t going to make a difference.
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 [...]
[...] discovered Loralee’s blog sometime last summer. She and her husband have been through some seriously bad times with health insurance over the past year. They just had a baby earlier this summer, and are currently tackling the [...]
[...] about her new baby, healthcare, depression, and occasionally a topic she considers silly. It was a post on healthcare and the subsequent tweeting and retweeting of this post that caught the attention of Valerie Jarret, [...]