Thursday, April 18, 2013

We Were Spoiled

Jon got a new job in January. And with it came the worst health insurance experience we've had to date. I guess were were spoiled with his last job, under a different insurance company. We never had issues.

I used to hear other preemie parents complain about getting denied, getting the run around, and being on the phone all day with insurance. I felt so bad when I heard this and I took a sigh of relief that we were spared this one preemie headache.

We were able to get all the therapy we needed, including an intensive tube-wean at Seattle Children's Hospital, no questions asked. Every surgery, every CT/x-ray/MRI scan, every specialist we saw, really everything we wanted or needed for Jack's medical well being was covered. There was a reason we called him our Million Dollar Baby.

Enter new insurance. 


It has been a nightmare.

I was chatting with one of Jack's medical providers today and she said this specific carrier is notorious for trying to find any and every way to deny claims. While Jack was in therapy, I spent time getting new prescriptions from the pediatrician for each therapy, praying to God that the exact right billing code was put on them and that it will go through smoothly. And we were told that our insurance no longer covers Jack's feeding tubes. Umm. Ok. 

It's not like we are paying top dollar or anything for this insurance! Oh wait. That is exactly what we are doing. 

Anyway, I have to tip my hat to all of you that have been in the insurance trenches, spending precious time getting coverage. Some of you have been doing this for years and I never appreciated the struggle. 

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Anonymous said...

My husband may be leaving his current job and this is my biggest fear!!! We were so blessed that it is hard not to fear how the next coverage may be! Especially when also thinking about having another baby someday without knowing whether they will or won't be a micro-premie as well! So hard!

Michelle said...

We've dealt with this headache and it is SOOOO frustrating. You almost want to send them a picture of your micro-preemie with see-through skin and tubes everywhere and say, "It's not rocket science that THIS baby might need a little help (therapy)!" It really was infuriating. We had such trouble getting speech therapy covered. Good luck!

Amy said...

dealing with the insurance companies can make a person go mad...I truly believe that it's the RAINMAKER movie scenario - they deny in hopes you give up or that you don't know enough to know to keep fighting! You know that I fought with Medicaid (something low birth weight babies get automatically) for TWO years over $1500 because the lady that entered Ryan's initial info enter his discharge date, not his birth date, so they would not cover the hospital deductible. I had to go to a HEARING!!! The guy that heard the hearing apologized like like no tomorrow over the error. Little do these folks know that they don't want to mess with a momma, much less a PREEMIE MOMMA - we are fighters!

heather lesoine said...

Lately, we haven't had too much trouble with insurance...except for the premium costs! That being said, Jack has been covered by my husband's insurance and has Medicaid (or Medical Assistance) through the state because of his low birth weight. Does your Jack qualify for Medicaid in Montana? That would help with anything that isn't covered by Jon's insurance. While they do have income limits, they usually don't apply for preemies.

Julie said...

do you think Ryan would be interested in handling my insurance issues too? :) UGH.

Jessi said...

And sometimes you won't know how good or bad it will be until a few months in :(

Jessi said...

We will have to look into it again, Heather. Last I heard, we do not qualify.

Amy said...

I've been on that battle and it's horrible. I completely adore my pediatrician because he and his office have stood right next to me and taken them on. I have notebooks filled with info on date/time/person spoke with.

So exhausting.