In January I got a letter denying my midwife in network consideration so I wrote them a letter to appeal. I really put a lot into it and really thought there was no way they could say no to me. A couple weeks ago I got a letter denying my appeal. According to my benefits, they can accept or deny any out of network provider as in network for any reason they please. If I'd like to I can write a letter stating my position and they'll call me within 30 days to set up a phone conference.
My husband works for Starbucks and we have Premera Blue Cross, based in Washington. I am really stumped as to what to put in my level 2 appeal. Do I need to put the same information as my first letter? Should I just do a recap of what my first letter said? My midwife is only going to bill them $3400, I'll need to finish up my deductible, a little under $200, and then pay 30%. I never put specific numbers into my first letter (I basically just mentioned it'd be cheaper), should I do that this time? I don't really have numbers or a hospital birth in my area, but I do know that insurance companies make deals with hospitals and sometimes don't pay a cent after the patient pays their portion.
I'm just so confused and overwhelmed and I really need them to consider my midwife in network. Luckily, in the worst case scenario we will only pay her $2200 before the birth. How will we know if we need to do that?! I'm already almost 35 weeks, there might not be much time left to get this all figured out.
I hate insurance companies!!! What's the point of paying those premiums every month if they won't even help me when I need them?!