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.
