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.
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!
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.