My least favorite part of adulthood: Fighting

Posted on Sep 09 in our economy, personal stories, societyby TalinaPrint

It seems like every time I turn around there is another battle to be fought. Why is it that nothing is straightforward and easy anymore?

I just had a baby, right? When we found out we were pregnant we got legally married even though we were in the process of planning our actual wedding. We did it for insurance purposes because we felt it was the responsible thing to do, as opposed to going to the state for maternity benefits.

Sure the government would have paid for my health care as an unwed pregnant lady but that wasn’t in our eyes the responsible or honest thing to do. N was making good money (and supporting me), it’s his child and all we needed was a marriage certificate to get me insured, we were gonna be married anyway… So we were married at the courthouse on Halloween last year. Our unofficial marriage anniversary is coming.

I still hope to have a real wedding someday and I have my wedding gown that’s never been worn… I am a bit sad that we were married without the wedding part, that is another post topic though!

Anyway, we got married and N added me to his insurance so prenatal care and childbirth would be covered…

Now that Everly is here and the labor/ delivery are behind us we’ve begun tackling the insurance aspect of it and I am just livid right now!

We knew the homebirth cost would be paid out of pocket and that we would have to submit for reimbursement later, we didn’t know that for every single claim submitted would be denied or ripped apart piece by piece. The insurance company is throwing loop-hole after loop-hole at us as reasons they wont need to cover our claims.

First there is the $2000 bill for my perineum repair.

I had about 100+ stitches following the birth of Everly and required a hospital transport since there were deep muscle tears and the midwives had never repaired something that severe.

Insurance wont cover the $400 that the hospital billed as co-pay for the visit and they aren’t applying it to my out of pocket maximum amount.

Add the $400 co-pay to the $3500 I paid the midwife for the homebirth and I’ve paid $3900 out of pocket, my maximum is supposedly $2500 though.

Then there is the $100 cord blood test.

We had the test to determine Everly’s blood type and wheather or not RhoGam was necessary. The hospital billed this test as not medically necessary even though OBGYNs consider RhoGam VERY necessary in Rh negitive mothers.

Insurance is fighting us on covering this too.

The cherry on the shit-cake is that the bill for the homebirth was submitted to insurance back in June and when we’ve inquired about the status of it we were told it’s not in their system, so it needs to be resubmitted now.

We’ve been fighting with credit card companies over billing issues, product makers over faulty items, the water company, the bank and now the insurance company. It is just exhausting! I don’t wanna be a grownup anymore.

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8 Comments

• witchypoo says:

  September 9, 2009 at 5:17 pm

  Government has issued insurance companies a license to steal. Word.
  witchypoo´s last blog ..Mah Drawahs
• Talina says:

  September 9, 2009 at 5:21 pm

  That pretty much sums it up perfectly! Makes me so damn pissed!
• Lauren says:

  September 9, 2009 at 7:57 pm

  I am so sorry you are going through this! I have had to pay for two babies out of pocket and it is brutal. Because my husband is self-employed and we have an individual rather than a group insurance policy, maternity costs are not covered. At all! I am just thankful I have never needed a c-section. That bill would probably give my husband a coronary!
  Lauren´s last blog ..Blueberries, anyone?
• Ree says:

  September 9, 2009 at 8:23 pm

  Yep. Sometimes grownupedness sucks serious eggs.
  Ree´s last blog ..PSA – 10 Things You Didn’t Know
• Donna B. says:

  September 10, 2009 at 3:13 am

  While I completely understand your frustrations… I’m reluctant to say that it is the fault of “insurance”. I am more inclined to say it it is the fault of unbelievably inaccurate ideas about “health” in general.

  First of all, “health” insurance is misnamed. It is designed to cover costs that are due to unhealthy states… a bacterial infection, for example.

  Pregnancy is generally a condition of health, not unhealth. There are exceptions, of course. Pre-eclampsia, gestational diabetes… these are state of unhealth that pregnancy triggers. They are NOT unhealthy in themselves, as there is nothing a woman can do to make them not happen.

  However, refusal to pay for a Rhogam test and subsequent adminstration of the shot doesn’t fall under “healthy” or “unhealthy”. It’s a reasonable action to take given known factors. There is no reason why insurance should not cover this. It is in their best interest to do so.

  Had you delivered Everly “normally” — that is, in a hospital, you would not have to be fighting some of these things. Your choice to go outside the “normal” guidelines has led to scrutiny not applicable to a hospital delivery.

  This is completely unfair and unconscionable. It is also a precursor to the “guidelines” that will be implemented if/when universal health coverage is enacted.

  I support your decision to have Everly delivered by a competent and caring midwife. Now that I’ve seen how wonderful it was for you, I can’t imagine it happening any other way. And I find it incomprehensible that your insurance would not pay for your much less expensive choice of childbirth. Somewhere there is a “does not compute” module.

  Had my daughter chosen the same delivery regimen you did, there is no doubt in my mind that a competent midwife would have recommended a C-section for her. In fact, I think a midwife might have recommended it sooner than the physician did, thus sparing my daughter some of the after-effects of trying too long for a vaginal delivery.

  Insurance is misunderstood by most people. It is not a guarantee of payment for any given procedure. It is a bet. Insurance bets you won’t need it, you, by paying your premium, bet you will need it. It is a given that the insurance company will decide you didn’t need it. This is reality, but it is not fairness. Reality and fairness seldom coincide.

  Insurance bets that most women will deliver in a hospital where the cost for Rhogam testing and the shot is included in the “procedure” of delivery. You went outside the “system” and therefore must prove the efficacy of any procedure.

  I hope that you understand that your lack of insurance coverage for your “choice” of using a midwife will be magnified by universal, single payer coverage.

  Anyone reading here who has also read my blog will doubt that I am a conservative. That doesn’t mean I’m a Republican… that’s an entirely different thing. I have little use for religious qualifications as requirements for political identity.

  I am a secular conservative, which is sometimes a difficult tightrope to walk. I think you, Talina, should have every right to choose the time, place, and circumstances to give birth. Your body, your baby.

  You should not have to pay extra for your choices. That violates my political preference of conservatism., which states that you are capable of making your own decisions.

  This is why I oppose universal health care and single payer for health care. It’s perhaps difficult to perceive at first… but ultimately it results in not allowing individual choice.
  Donna B.´s last blog ..Not-So-Fun Activities Of The Last Two Weeks
• lceel says:

  September 10, 2009 at 9:11 pm

  Many Insurance Companies outsource claims adjustment – and the outsource gets paid based on what the Insurance company does NOT pay versus what they are billed. Thus the constant denial of claims – and the necessity to prove up every penny.
  lceel´s last blog ..Sing Alma Mater
• Hyphen Mama says:

  September 12, 2009 at 4:02 pm

  Yep. I love Donna B’s comment. There is a serious need of overhauling the “system”, but I don’t think anybody knows what the magic formula is.

  Mack’s birth cost us $6000 out of pocket. It sucked. Hard. Mostly because Wynnie’s cost us $1000 with a different insurance company and we weren’t prepared for $6000.

  But what the heck with credit card companies, the water company and the bank??? HUGE bummer.
  Hyphen Mama´s last blog ..How to guarantee Potty Training Success….
• teeni says:

  September 13, 2009 at 11:03 pm

  It’s awful you have to deal with all this crap now. I’m so sorry. I swear that it explains why so many people have nervous breakdowns though. Sheesh.
  teeni´s last blog ..Boxes and Meezes and Things of That Sort

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