Wednesday, July 30, 2014

Our Battle With Insurance

This is a story about our insurance and how terrible everyone and everything is.
Travis and I have Humana insurance for our family, but because I am only 25- I am also still on my parents Aetna insurance (making Humana my secondary insurance.)
When I found out I was pregnant with August, I searched for an OBGYN and selected one from the list of doctors that Aetna supported.
My first appointment included a slew of tests, all the same tests that everyone gets when they're pregnant.
A few weeks went by. I saw my new doctor again, and was sent to see a specialist to give me the okay to try for a vaginal birth after having a previous c-section due to placental abruption.
Then I got the bill from my first appointment. Over $1200 dollars AFTER insurance!
That didn't even include the actual appointment, only the tests I'd taken. I called the insurance company in a panic.
"What are these charges? These are ROUTINE tests. I can't pay for a $90 urine culture every time I go in for a checkup!"
And they said, "Your doctor and her clinic are covered but the lab she uses and the hospital she delivers at are not covered."
So. Why the heck was she listed as a provider for me to choose?
I was able to talk the amazing Salt Lake Regional hospital into dropping the charges for me, but first I had to spend HOURS on the phone with them, with the clinic, with both insurance companies, and I had to GO IN to the clinic and the to hospital about 4 times, to sit in the chair across from the billing-lady and re-describe my situation. I also had to screen daily calls from the collections company even after the hospital told me my charges had been dropped.
Luckily I had the sense and capacity to put in so much freaking effort, or that bill would have been one of the many bills I had to pay.

So, I set out to find a new OBGYN, now half-way through my pregnancy. My primary insurance (Aetna) had covered most of my visit and tests to the prenatal specialist I had seen (just not the OBGYN), so I decided to find a caregiver at the same hospital- LDS hospital.

I started going to Dr. Laine at the Avenues Women's Center and planned on delivering at LDS hospital. I called and recalled Aetna double checking that this hospital and doctor were covered. I was happy they were- not just for convenience, but because I loved Dr. Laine and trusted her with the delivery of my baby, despite my being high-risk.

About two weeks before I delivered August, I called LDS hospital to pre-register.
They asked for my primary insurance. Then my secondary insurance.
"LDS hospital is not affiliated with Humana," they said, "So we won't take your secondary insurance."
"Wait, my baby is going to be exclusively insured by Humana, does that mean you won't take his insurance?"
Yes. That's exactly what that meant.
At my appointment the next day, I asked my doctor her advice. She assured me that she was positive that babies are automatically covered by the mothers' insurance for the first 30 days. I was hopeful this was true, but doubtful- since insurance people don't even have any idea what's going on- how could doctors?
The next day, however, my doctor called me and said she'd spoken with Aetna and double-checked, baby should be covered.
I also called Aetna to re-discuss my policy. They assured me that the baby would be covered.
"Just to clarify, one more time," I said, "You're looking at my specific policy?"
"In which, I am not the policy holder- I am the dependent. So you cover the dependent's dependent."
"Please hold. No. We do not. Your baby is uncovered."
Then, I double checked with my own coverage.
"We've met our deductible," I said, "So are MY bills at least going to be covered?"
"All necessary prenatal care is now covered at 100%," said the Humana insurance worker, "before your deductible it was covered at 80%."
I fist pumped and did a dance. There's some good news!
But I was wrong. Because the insurance agent said NECESSARY and PRENATAL.
Which means silly ol' things like ultrasounds aren't covered and labor, delivery, and hospital stays aren't covered- because those are maternity bills, not prenatal bills.
I also called LDS hospital again to ask about rates for the uninsured. They were able to give me actual numbers and prices for things, something no one else was capable of doing. If I had a normal delivery and the baby remained in the hospital for 48 hours, and we paid while we were still checked in- August's bills would be $1300 (which didn't include the pediatrician visit, or my own bills). They also gave me the number for the anesthesiologist, since even though I still believed my own bills would be covered, I suspected the epidural might not be.
So I called the anesthesiologist's office and asked about prices.
"It's $800 for the insertion and first hour of the epidural and $200 for every hour afterward," I was told.
"Great, is that the price that you bill the insurance or is that the discount for self-payers?" I asked.
"You'll need to talk to your insurance about that."
"No. I mean, $800- that's how much you bill the insurance company, correct?"
"You'll really need to call your own insurance."
Because no one has any idea what's freaking happening.
That is what I continued to glean from this entire experience- no one in the medical field, at the hospital, or even working in an insurance office understands insurance.
After asking about my delivery costs and being told about prenatal billing, I have decided that the actual job of insurance agents is to intentionally mislead people. But I digress.

The day came, and I went I to labor. Being a huge sissy, having a traumatic first delivery, and also being quite anxious to meet my baby- we headed straight to the hospital after two hours of laboring at home and I got an immediate epidural. I labored at the hospital for 15 hours, pushed for three hours, and vaginally delivered a healthy baby boy.
We paid for August while we were there, and headed home after two days respite.
After two weeks, we went to visit the pediatrician and have August circumcised. Another week went by and we went back to the doctor with August because he had a double ear infection and needed medication. And throughout the first month, we also had to go in three times to redo his Newborn screening test as twice they didn't get enough blood and once it came back abnormal and needed to be double-checked.
I gave the clinic our Humana insurance card- since that is the insurance that Grey, Micah, and Travis are all on. Technically August hadn't been added to insurance yet. Travis had tried twice to add him, but once it had been too frustrating as he held a conversation like this:
Travis: I am calling to add a baby to our plan.
Agent: You don't have a baby on your plan.
Travis: I know. My wife just had a baby.
Agent: You don't have maternity coverage.
Travis: I know. But she's not pregnant, she's already had the baby.
and once he called and was lost in the maze of answering a machine pretending to be a person.
Machine: If you are calling about medical benefits, say benefits.
Travis: Benefits.
Machine: I'm sorry, I didn't catch that. If you are calling about a payment plan, say Payment Plan.
Machine: I'm sorry, that's not an option. Would you like to speak to a representative?
And both phone calls turned into an hour long wait on the phone, which Travis then had to hang up on- because he hadn't set aside more than an hour and a half to deal with that nonsense.

And then the bills came.
First was the epidural, luckily after insurance it ended up being only a bit over $300. I was happy to pay it and excited so much had been covered. I even called my mom and told her it was the best $300 I ever spent.
Then about a week later, I got August's pediatrician bills and my hospital bills.
My hospital bill (which didn't include any DOCTOR or EPIDURAL bills, FYI) was for about $1700.
I called our insurance.
"I'm wondering why I'm being charged so much," I said. "I don't think this bill is right."
(Please remember, we are paying a lot of money every month and are covered by TWO insurance companies.)
"That number is correct."
"But we've met our deductible this year!"
"That's very lucky, otherwise you'd have to pay 100% of these bills."
"No. I talked to someone and was told that I only had to pay 20% before the deductible."
"We cover 80% of PRENATAL care, but we don't cover any labor and delivery charges before your deductible has been met."
So what the hell is the point of a deductible?

August's pediatrician bill was only for $80 so I happily called to pay it.
"Actually, I don't know why they sent you a bill at all," said the woman on the phone. "The insurance is still processing this claim and isn't accepting August as covered."
Oh duh! That's our fault! Despite the many calls to the boys' insurance, I still hadn't successfully added the baby.  I hung up and quickly called Humana. August was now about 5 weeks old.
"I'm calling to add a dependent to my insurance plan."
"Is the dependent a newborn?"
"When is the baby's birthday?"
"April 23."
"Please hold."

When someone finally came back, i was told that August couldn't be added to our insurance because he's over 31 days old.

"Regardless of his age, he is my dependent and needs insurance," I said.
"In your state, it's illegal to add a child to your insurance after he is over 31 days old," said the agent.
"But my other children are on my insurance."
"Well, if this was a new plan, you could add him- but now you need to wait until the open enrollment period. "
"But he needs his immunizations!" I said. "He has already been to the doctor nearly half a dozen times, he needs insurance."
"You can get him covered under the adorable care act, but he won't be retroactively covered," the agent said. "Go to to find out how to do that."
"So he would be separately insured, on a different policy than the rest of my family."

I called the doctor's billing office back to explain that my baby no longer had insurance and ask how much I would owe them for August's hospital pediatrician visit, circumcision, PKU tests, two-week check-up and sick visit.
The price went from $80 to over $700.

So now, in case you're wondering- we owed about

$350 to my OBGYN and clinic
$200 to the specialist I saw at the beginning of my pregnancy
$300 for the epidural
$1300 for August's hospital stay
$1700 for my labor, delivery, and hospital stay
And $700 for August's pediatrician visits.

All totaling about $4550
Which doesn't include many smaller bills that I've lost or forgotten about, like for ultrasounds or other lab tests and doesn't include any bills for medications or prescriptions. I always paid those immediately and without thinking- since they were usually for less than $150- which, while a huge pain, were not so high that I couldn't pay them.

Honestly, I know that these bills aren't that bad. I know they're a small price to pay for a healthy, happy baby and mother. When Grey and Micah were born we were blessed to be on Medicaid, so our bills (which totaled over $100,000) were all taken care of. And I'm grateful that my family is in a financial position that -while these bills are a huge pain in the butt- they're not impossible for us to pay.
What frustrates and angers me, is the confusion, and complication of insurance. Before I found out I was pregnant, I called so many hospitals and spent hours on the phone with insurance trying to predict how much it would cost to have a baby, and everyone refused (or was incapable) of giving any estimation.
I know there are a million factors. I know that the price mothers pay can range from $80 to $100,000. I understand. But why, oh why, can't insurance look at my policy and say "for a healthy baby you're looking at an average of 5-10 thousand dollars."
And when I call with questions, why is everyone a confused idiot?
Everyone in the medical field was always willing and hoping to help me, but they couldn't get around barriers either. Insurance stepped between helpful, talented doctors that were willing to help and an anxious mother that was willing to pay for said help and muddied everything up!
The best and easiest interaction we had was self-paying for August after his birth. We knew what amount was expected of us when, and what factors could change the cost. Insurance confusion took away any such surety with other bills.
We do need a health care reform in the this country, but so far- the government seems to be making things worse. I'm not looking for advice, sympathy, or anything- (unless you have a good recommendation for insurance in Utah, since apparently our entire family needs to switch plans to get August covered)- I just want to air some frustrations!
My husband owns his own company, and I'm sick of being penalized by the government (in so many more ways than just this) for daring to run his own business, because insuring your family yourself is THE WORST.
My children all have chronic ear infections and need tubes, and have for  years. And we can't afford to get them. I can literally SEE cavities in my kids' mouths and we can't afford to go to the dentist and WE ARE NOT THAT POOR.  We don't have a lot of money, it's true- but we have more than many people in our situation.  We are above the poverty line, and yet- when our children are hurting or sick- it puts us under serious financial strain to help them- and we often need to make the decision to "tough it out" for a while.
Grey fell and broke his collar bone a few months ago, and I have now received over six different bills from taking him to have it x-rayed. It wasn't even set in a cast or anything. Just x-rayed and announced broken. Why do I keep getting bills for this? I keep paying them, too- which is obviously why they keep sending them. Why ask for a moderate amount of money when you can ask for a ridiculous amount and then happily ruin someone's life if they can't pay?

And then yesterday, I got a letter from Aetna asking about my secondary insurance. Since I try to be honest and proactive - I called Aetna this morning to straighten everything out.
The horrifying culmination of our conversation was that apparently Aetna didn't know I had other insurance and they refuse to be my primary insurance (although we originally told with confidence that Aetna was our primary- and we based all of our medical decisions on that information) and NOW, Aetna is going to be rebilling all our claims processed by them since 2012 and renigging on all the payments they made.
"You'll get all your doctors bills again from the last two years, after we've pulled out funding- and you'll have to resubmit them to Humana as your primary and then again through us."
So now I have a lot of bad words trying to get out of my mouth.
I spent a long time pacing around my room bawling, and calling my mom, and looking up rental houses in the woods so we can just move away and never have to interact with other people- because everyone else is THE WORST.
And then Aetna called back and said "Never mind, we were actually wrong. Forget what we said a few hours ago."
I'm torn now between extreme anger that they're all clueless and they ruined my whole day and so much gratitude that they're not rebilling all my doctors.

But. Sheesh.
I hate them.
I hate them all.
I even wonder (often) if it would just be better to be uninsured.
Then, if my child needs tubes, we can just go, pay, and be done. We won't have to pay $600+ a month for insurance that won't even cover anything. Insurance that is mostly useless. Insurance whose primary goals are to intentionally mislead me, rob me of my money, and avoid paying for any of the things my family needs.
And yet. We keep paying, and (big surprise) we keep getting screwed over.

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Jocelyn said...

Oh. my. gosh. This makes me hate everybody and everything to do with insurance. I am so sorry.

Lana said...

Matt was really interested in not having insurance but I was too scared. His plan was to put the X amount of dollars ($600 apparently in your case) in the bank in a specific checking account labeled MEDICAL and never touch it until one of us had to go to the doctor. Bc he works for a small company we are also screwed, however, actually worked for us and we have an extremely high deductible but pay less than $300 per month and our costs are negotiated at a lower rate, but we still put about $300 into a health savings account for that reason alone. Insurance is the worst. (and ours doesn't cover ER at all, can you imagine!?) It might just be better to save your money each month.

Party of Three Heads said...

Becky, email me some time when you get a chance, and I can give you my hints/tips of what I've learned about insurance. Some might be different state to state, but it's worth a try. Especially with all those bills you guys are left owing.

Betsy Reddoch said...

For our insurance here in Utah we have Altius for my husband and our twins. We pay $381/month out of pocket since it costs WAY less than covering them under my work policy ($1300/month!!!) It is a high deductible plan, but the well child visits are 100% covered, and there is a negotiated rate for other things. A sick visit runs about $80 - $100 for the kids. When I had to take one of my boys to the ER for steriods when he had RSV the bill came to about $650. Overall we've saved a lot on this insurance. That said, I am the only one in our family with any health problems, and I am sticking with my work policy because it is SO MUCH better at covering things (including maternity if I get pregnant again). It's all a balancing act.

barbara woods said...

my husband and i pay 700 a month and we are retired but we have better insurance then you do. Of course they just said they were going to cut everyone check so that we will only draw 80 & of what we do now. if they can't drive you crazy they will starve you to death in this country while giving billions to country's that want to kill us

Crump it up! said...

That sucks! For my second we had private insurance and paid over $12,000 for her, a vaginal birth with no complications, 24 hours in the hospital. I went with a midwife for my third, I paid less than $3000. Insurance is horrible!

Polly said...

I laughed out loud because you accidentally typed the "adorable care act". Insurance is such a mess. I was a nervous wreck all day after stupid Aetna said they weren't your primary insurance and then changed their mind and said they were. I might need therapy to help me deal with insurance stress.

Unknown said...

That is insane. I too have Aetna and got a similar bill when I went to my first prenatal appointment. Mine was for $2000 and they just wanted me to pay ahead for future appointments. I was so upset I didn't go in for another checkup for almost 2 months until I found a better provider. Egh insurance and having to try to work through them!

MARCIE said...

Thanks Polly for clearing that up. I thought the Adorable Care was just for babies!

Unknown said...

What a freaking nightmare. I too have experience with this situation because I am still on my parent's insurance but I also have 3 kids. I think the thing that frustrates me that most is that NOBODY will tell you how much they charge for things. Like, don't they have a set rate for how much they charge for deliveries, ultrasounds, epidurals, etc? NO. Its all "depending on insurance". Asking to pay cash just confuses the billing office because that is asking them to not bill insurance. And, they are robots and need to bill insurance or their heads explode. HUGE HEADACHE. SO ANGRY. So sorry you had to go through it too.

Unknown said...

One more thing. When JJ was circumcized I called specifically to ask if it was covered. They told me it was covered 100%. Then I got a bill for $300, called the insurance, and they told me they changed their policy and now circumcisions are "cosmetic". So yeah. They lied.

Unknown said...

I have never commented before but I really enjoy reading your blog. My husband is a medical student and very into health care reform and we hate how it is all set up. Insurance is the worst. It is putting our country in million dollars of debt and costs are continually hidden! It would be so much nicer if you could know all of the costs up front and your insurance says we pay x percentage of all costs, that way you could budget for things like a baby and then when really unexpected things happen insurance can cover those things. Vent deserve to vent!

Scott & Ali said...

We used to do an extremely high deductible plan for our family that had a very inexpensive premium and covered basically nothing. We would pay out of pocket on the day of service and not claim insurance and get pretty significant discounts. We saved so much money doing this, especially considering that hospitals/doctors/etc adjust prices if it is not going to insurance. Since The Affordable Care Act has been put into place, these super high deductible plans that cover almost nothing are no longer available, and the alternative plans and coverage available end up costing way more and covering basically nothing. It is maddening to try and get prices for medical services. It's like these prices are floating around in space somewhere and can only be found when it is time to send a bill, never before. So frustrating.

Jessica and colby said...

Get gap insurance for an extra 15 a month. It covers the deductiblesame and makes your policy 100 percent covered instead of 80/20. I paid a 60 copay for my baby nothing aelse.

Casey said...

BECKY!! What the?!?? I am so sorry! I can't even believe all of this! Those lame-o's!!!!!!! GRRRR, you have every right to be so angry!

Oh, and to answer your question, there IS NO point to deductibles. Insurance strategically makes it so you rarely ever meet it, and then when you do, they give you some other excuse (like they did to you) as to why they won't pay. Ugh ugh ugh!

Unknown said...

Wow, that is insane to read about. People in the UK don't realise how lucky they are! I've lived here for 5.5 years now and payed about £50 in medical AND dentist bills. All free or subsidized, no insurance or anything. I'm from NZ originally where healthcare isn't free either, but not quite as bad as the crazy system that seems to operate in the US. BTW, August looks so cute in his cloth nappies! We use cloth on my twin girls (except this last week, molar diarrhea madness yuck) and it has been much more cost efficient... and adorable :D

Sabrina Craig said...

This is horrible, I’m sorry that you had to go through this. This isn’t just about money now, it’s about the poor quality services of the insurance. Insurance companies are supposed to support us with our problems, not add up to them. Anyway, I hope things are going well with you and the rest of the family. Take care.

Sabrina Craig @ Medical Attorney NY

Unknown said...

Wow! I can't even begin to imagine the frustration you felt when you encountered problems with your insurance. I know just how confusing insurance can be because it varies from case to case. However, everything should've been elaborately cleared up when you called them the first time. Otherwise, expectations would build up and explode once the insured receives the bills, thinking they were covered 100%. At any rate, I do hope you don't get to experience another one of those issues again. Thanks for sharing that, Becky! All the best to you!

Clifton Johnson @ Insuring theProduct

Unknown said...

This is terrible! Insurance companies should be making these kind of processes easy for you, and not add to the burden. Everything seemed to be disorganized, and nobody was aware of what, where, or to whom the bills were supposed to be charged. I’m sorry to hear that you had to go through all of this, I can only imagine the stress you’ve felt at those moments. Anyway, I hope things are doing better for you now, Becky. Take care!

Jason Hayes @ DECO Recovery Management