I spent the entire morning on the phone with Kaiser, the Department of Managed Care, and even ehealthinsurance who originally sold me my health care policy, in an attempt to unravel the impossibly tangled and complicated web that is my labor & delivery bill, which I believe is incorrect. And, you know what? There may be no fixing this. I may just have to give up and recognize that yes, I was probably overcharged by several thousand dollars, and there may be nothing I can do about it.
The Department of Managed Care has closed my case. All they did was send it twice to Kaiser to review, and they of course defended their position, and so the DMC has washed their hands of it. Huh? I called them up and said, so, you just take Kaiser's word for it that I was billed correctly and that's it? It made no sense. I had a long conversation with a woman who seemed somewhat sympathetic (especially to this issue of B incurring all his own charges from the minute he was born, which everyone tells me is not correct); it turns out they may have made a mistake in closing my case, so she said when I get the letter that confirms it's closed to call them up and ask to speak to a specific person. But even then there's not much I can do but take Kaiser to arbitration (because of course I signed away my right to sue when I took on this policy).
Then there's the issue of that $600 bill I got handed back in January for birth charges that at the time they said they covered, but they have now a year later decided they're not covering. Of course Kaiser has denied my complaint with the standard "read your policy, you owe us" letter. What do I do about that? I finally broke down and paid it today because I don't want my credit ruined. But it's already two weeks late so honestly my credit may be dinged anyway.
I just wish there were somewhere to go, someone to help, someone to sit and talk over all of this with who can just HELP ME. But there isn't. I've asked around and nobody has a clue how to find a lawyer who handles things like this - not even lawyer friends of mine. And honestly - I'm not even sure I'm right about any of this. It sounds right, but the language in my policy is so vague; they say "some" maternity charges are covered but some aren't; they say B is "covered" for the first 30 days, but it doesn't say he's "covered under your policy" as in subject to my deductible. I just don't understand how I can have a $1500 deductible and a $3500 out of pocket maximum per year, and yet last year I was charged between $6000 and $7000 for the birth. How can this be? Can someone explain this to me? Does this mean if I ever have an accident or major illness I can just be charged hundreds of thousands of dollars because the care isn't subject to my deductible? If that's the case why bother having insurance?
Anyway all of this stuff makes me so crazy and angry and frustrated that I can hardly stand it. And at a certain point I had to ask myself, what's the point of all this? Why not just drop it and have my sanity back? It's all paid for. I spent this whole day with my stomach in knots and full of rage. Maybe sometimes you just have to walk away.
It reminds me of when I was sued that time - the same frustration, the same rage, the same feeling of knowing I was right. But unfortunately I couldn't walk away from that since I was the one being sued, not doing the suing. And that was two years of torture that I'll never get back. But this - I can just walk away. There won't be another birth so I'll never, ever have to deal with this situation ever again.
One thing I will tell people in the future about Kaiser, though, is that your insurance doesn't really cover anything. So just act as if you have no out of pocket maximum because obviously you can be charged anything, and even years later have bills pop up for items that were covered at the time but now aren't. Just enjoy the free vaccinations. Oh yeah, and I'm still waiting for the bill from our whole ER adventure, and subsequent mole removal. I can't even imagine how many thousands that's going to cost me. God I hate them.
Just further proof that if you want something done right in this world, you have to do it yourself. Another anxiety-addled blog about the pursuit of single motherhood. Join me, won't you?
Is there a Legal Aid organization in your area that can give you advice? I know it's tempting to quit fighting and avoid the stress but that's exactly what they are counting on. From what you are discribing it definitely sounds like they are in the wrong. I also don't know if there is any value in contacting the Better Business Bureau as they are a business. I'm sorry you're dealing with this. Ultimately I guess you just need to decide what it's worth. I'd hate for them to 'win' but you have to consider the impact the stress has on your life.
ReplyDeletePeople often assumed it would be cheaper for me to give birth than adopt. But with a $2,000 deductible each and a separate $5,000 maternity deductible, it would've cost just about the same. And adoption would have been cheaper had I gone through a complicated pregnancy or delivery.
ReplyDeleteI believe it's standard for the baby to be considered its own self from the moment of birth. In our case, birth mom was on Medicaid but baby wasn't, so all his medical expenses (and none of hers) fell to me. My insurance company had to cover him retroactively back to the minute he was born. This led to a great deal of confusion with regard to birth name, given name, and the two hospitals and three clinics we used in the first weeks of his life. Thankfully he was born in a very small town in a rural area, so it's easy to get through to humans and there's little red tape when figuring stuff out.
I work for a pet insurance company and some of our competitors policies are so confusing, even our legal/compliance team can't decipher what they mean. And that's just for a property and casualty product! So I don't doubt for a second that your policy is vague and open to interpretation.
At least where I live, a child is covered under the mothers policy for the first 30days. Mother and baby should be counted as the same admit as long as they are discarded at the same time (ie: one room and bed charge). The exception would be a child who has to spend time in the NICU. Its all very frustrating and confusing. I'm pretty sure insurance companies like it that way so they can get out if paying things.
ReplyDeleteMedical bills can be so frustrating. I am still trying to make sense of mine- some of the stuff they covered for D&C #1 they are denying for D&C #2.
ReplyDeleteInsurance companies suck and Yes its all a scam, IMHO! I too sometimes wonder why we bother paying premiums when we end up paying so much OOP :-(
ReplyDeleteI have been looking up plans on ehealthinsurance the past couple of days, facing potential job loss :-( It is likely that your "out of pocket max" did not include your deductible. Normally its included, but I saw a lot of plans like that on ehealthinsurance, not sure if they were Kiaser plans. So that is small print that people can easily miss.
Also its likely that from the moment of birth B had his own deductible that needed to be met. Presuming that, if we do the math the its $1500 + $3500 OOP + $1500 for B = $6500 which seems to be what your bill was. This is all just conjecture on my part....but it *may* be what happened.
Your post makes me realize I need to call my insurance co to see if indeed the baby has his/her own deductible to meet upon birth. I would be surprised if they said no and that the baby was part of the Mom's deductible since techinically your status changed from Single to Family the moment he was born.
Also (I know from experience) that many time there could be labs used, or Dr's used, who are "out of network", especially in ER etc where one has no control over who is attending. So, that is another way of them dinging the patient since that is not your OOP In Network but OOP Out of Network. So when they say Max OOP it is very misleading.
As I said its a scam :-( but what to do one still need to buy it. I totally understand your frustration. I have been there too. I am dreading my c-section bills :-(