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Wednesday, December 9, 2009

#35 - THE INSURANCE COMPANY - ANOTHER COUNTRY HEARD FROM

So here I sit, waiting for Jeff to come home so we can discuss what is probably the most important information we have gotten since Gracie’s death. Among other things, I am completely dumbfounded by this information. I am frustrated beyond belief, and I am feeling let down and somewhat betrayed by my team.

Perhaps I should have left well enough alone, but I called my insurance company today armed with diagnosis and procedure codes to verify whether or not chromosomal analysis is covered by my policy. A large part of why I called was to gather information, so we have it, God forbid this happens again. A large part of why I called was just to find out. 

I was told that it is NOT listed as an exclusion, but is instead listed as something that is paid for when medically necessary (which means that they will not pay for it as part of a routine screening, but will pay for it when it is needed for definitive answers – like after a stillbirth). I gave her a brief synopsis of our situation so she understood why I was asking and what I was looking for. Without any further questions from me, the service rep went on to give me some interesting information…

(Gracie was born at 0229 on August 1st, and we were told during the next 8 hours that my insurance would not cover the chromosomal analysis of the placental tissue and the out of pocket cost was $1700. We told our midwife that aside from an autopsy, we wanted any testing on me, Gracie or the placental/cord tissue that was covered by insurance. Pathology testing was done on my placenta, which determined that there were no visible clots in the tissue, and the amount of infarct. The fact that this was done absolutely means that they still had my placental tissue hanging around for a few days after the baby died.)

On August 3rd at 9:30 a.m., someone from the hospital called my insurance to find out of “chromosomal analysis on placental tissue” was covered by my policy; she was told that she needed to call back with procedure and diagnosis codes. 46 minutes later she called back with three different procedure codes (no diagnosis code), and she was told that all of the procedure codes were eligible procedures based on medical necessity. A second person made a THIRD call – on the same day at 1:30 p.m. with the same procedure codes – the only difference is that she had a diagnosis code. She was given the same information – eligible based on medical necessity.

I have been trying to figure out for the last 4 hours what the hell has happened. I have to wonder if someone was just guessing whether or not my insurance would cover the testing, and I feel like the ball was completely dropped after two different people got confirmation that the tests would likely be covered. I feel like they should have called and asked us what we wanted if they weren’t sure after the insurance company said that coverage was based on medical necessity.  It should have been OUR decision, not theirs.  Another part of me feels that this stinks of CYA, but the rest of me says that this theory doesn't make sense. I have no idea why they would feel like they need(ed) to do this, because we don’t blame anyone for Gracie’s death, and we were very clear about that. I don’t know what to do at this point. I really want to know why the hell they did not do the tests once they knew they would probably be covered, but I haven’t figured out the best way to do this, or if it is ultimately a battle that I should pick.  I am so mad and disappointed, but I have no idea where to direct it.  I really like our midwives and the doc that we have dealth with - I feel like the midwife who delivered Gracie did everything she could possibly do for us during the worst moments of our lives.  I hate to think that any of this falls on them, but I am not sure where is it really falls. 

The testing, or lack thereof, ultimately makes no difference in our outcome. Gracie would still be dead, regardless.  BUT…that chromosomal analysis could have given us a pretty immediate answer about cause of death. It would have given us a definitive answer to the T18/T21 question, which would allow us know if we could rest a little easier or have cause to keep our vigilance up during the next pregnancy. Instead, it will be a guessing game. 

4 comments:

The Blue Sparrow said...

Im so sorry that your "team" dropped the ball with this one, and yes it seems to me that they did. How frustrating! We had to do the same testing but our insurace agreed to pay right away.

Jessica said...

*hugs* I know insurance can be confusing. I work for an insurance company myself. I am wondering that if two people said it would be covered that the person you spoke to was wrong? What I would definately suggest is to file an appeal for any denials you receive. I am so sorry you have to go through this frustration.

Allison (Ali) said...

I'm so sorry that you are having to deal with all of that. it does seem like a case of CYA. I work in the Insurance Field and run into that a lot unfortunately.

Holly said...

Wow that can get confusing fast! Seems like someone messed up. I wish that you could know for sure.