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Money

post #1 of 16
Thread Starter 

Is anyone else in just a horrible crappy spot financially?  I hate it so much.  It seems like no matter how hard we work or try to dig out, there's something waiting at every turn to screw us.

 

All the stupid bloodwork they had me do is going to cost me $500 because my insurance company claims that it was done outside an OB office and therefore doesn't count as "prenatal care."  Even though the explanation of benefits says MATERNITY all over it.  And half that stuff was totally unneccessary.  I don't have HIV or any other STD, I don't have sickle cell anemia, I am not concerned about toxoplasmosis, and the fricking Red Cross types my blood all the time.  I know my damn blood type but now I get to pay $100 for that alone.

 

I'm sorry, what would any reasonable person think when looking at their benefits and seeing that prenatal care is covered 100%?  When the doctor orders blood tests I stupidly assumed that was prenatal care.  It's horse s*** and shady, is what it is.

 

What do we pay these people over $500 a month for if they're just going to pull crap like this?  We aren't eligible for any kind of assistance because my husband grosses too much money.  They don't care how much gets taken out for taxes/insurance/401k, and no one cares that we have student loans, medical bills, and credit card debt up the wazoo.  I'm so sick of this garbage.

 

I can't wait to see what having another kid costs us in the end.

post #2 of 16

No real insurance this time around, but probably make too much for state aid. To apply for aid we have to have dr sign form which means paying for that appointment.  DH may push for a birth center or hospital if we do get state aid instead of having the homebirth.  Worried enough about losing another pregnancy I don't like having to worry about paying for it too.  Almost tempted to go unassisted but DH wouldn't be supportive of that.

post #3 of 16

Where was the bloodwork done? At an independent lab or at a primary care office (or somewhere else)? Who ordered the tests? What type of coverage do you have (PPO, HMO, etc)? I have some insurance experience and... this does sound wrong. 

post #4 of 16
Thread Starter 

At the lab of the hospital they are affiliated with.  I think it's a PPO but I'm not sure.  They did something similar with the Pap I got during my first exam.  Pap and pelvic is covered 100% once a year but they claimed it was because I had it done as part of a "medical condition" aka pregnancy that it is billed at the regular rate.  I think they're crooks but all I can do is call them and bitch and see if I can wear someone down.

post #5 of 16

It's hard to say without seeing how things were billed & processed, but usually when you have a preventative service (like PAP) by itself, there should be no cost-sharing (copay/coinsurance). But if there is a non-preventative service at the same visit, then cost-sharing would apply; however, if it is coinsurance (a percentage), it should probably only apply to the non-preventative services. 

 

I would try to talk to the billing offices to make sure things were billed correctly. Sometimes things like a missing diagnosis code or procedure modifier can make a big difference. The hospital/doctors office want to get paid, so they should be willing to rebill if it will get the insurance company to pay. And if they still won't pay the labs, you should be able to file an appeal - it makes NO sense to me that bloodwork ordered by an OB & related to pregnancy should be considered anything other than prenatal care. 

post #6 of 16
That's definitely BS! If prenatal is covered, then it should be covered. ((HUGS)) I would definitely fight this! Do you have an agent you can call and or go see to get it refiled

Money is very tight for is as well. The end of October DH and I decided he should quite his job and start his own business. Then the end of November I saw 2 lines when I was just tryingto provide to myself I was just sick.

We wanted more kids but was hope to get out of debt (had a 2 year plan set) and get his business really going. He is doing great, we have enough to pay the bill and feed the kids but that's it right now.

We pay $365 a month for health insurance and they don't cover maturity until we pay $10,000 out of pocket.

We spent $12,000 on the first (ob/hospital), less than $2,300 on the second (bartered with my midwife, midwife/home) and we'll spend $3,600 on the third (previous midwife married and stopped practicing so we have a new midwife that has to travel 2 hours, midwife/home).

Our 3rd (as well as the second) prenatal and birth cost include everything! Not only do I feel more comfortable at home (resulting in a much better birth experience), but is costs us thousands of dollars less.
post #7 of 16

I would definitely fight with the insurance company about it... it was ordered prenatal testing that is not done in the doctor's office and many of those are required by state law (HIV, STDs, etc)

 

I'm in a really crappy spot financially... I do qualify for state insurance but I'm not fond of the level of care people in my state receive. I had state insurance for my first 2 pregnancies and was treated terribly. I don't foresee us affording better insurance anytime soon so I'm going to have to just bite it and deal with it somehow. I feel very frustrated by it all though.

 

I hope you can figure something out where it won't cost you $500, if possible have the doctor's office write something up for the insurance or have them call the insurance co to explain. That might help.

post #8 of 16

MDC really opened my eyes to the world of US healthcare. I'm from England so we have free healthcare. We have no idea what healthcare actually costs because it is always free, we pay nothing. People on low income get medication free and can also have help for costs for travelling to healthcare appointments and help for glasses and wigs. I now live in Spain. Similar system. I pay my social security payment each month, healthcare and a pension is provided for me. My local hospital also provides all clothes for mother and baby during my stay and even provides nappies! I just have to take wipes. In the UK though the hospitals don't provide nappies, in my local one you can use their cloth for free, or take in your own sposies. I have heard a friend of a friend was severly berated for not stopping to get nappies on the way to hospital (she'd gone into early labor and so wasn't completely prepared and went straight to the hospital).

 

I really wish everyone had access to this healthcare. All I can say is if you don't like the US system contemplate moving abroad for future children. I thought it was a bit crappy that I only got 3 months maternity pay (although I pay as a self employed person so to be honest getting anything is a bonus) but the UK has 9 months maternity pay (not a massive payment but better than nothing). Apparantly in America maternity pay isn't standard. I really admire people with large families because I have no idea how you do it.

 

Seriously I wish you all had a trouble free healthcare system where you get ill, go to the doctor, then go home. And all that without paying a penny. If anyone ever wants any advice on settling in Europe or how the social security and welfare state in Spain or the UK works feel free to ask.

post #9 of 16
Thread Starter 

Well, uprooting and moving to Europe really isn't on my list of plans.  ;)

 

I don't have a problem with the concept of our health care system per se, but somewhere along the line it has become corrupt and dysfunctional.  Something needs to change for sure.  At this point I'm all for a Canadian or European style where we pay more in taxes instead of into an insurance company but Americans are fanatically opposed to more taxes of any kind, so I don't know how successful such a venture would be.  I don't care anymore, I just would like to get what I pay for.

 

I'm calling tomorrow but confrontations and phone calls both give me major anxiety.

post #10 of 16

Sorry to hear about this.  We are also in debt due to medical bills in the US even with insurance.  It is very frustrating.  Ninetales, you might consider a short professional letter as well after your phone call if it doesn't go as planned.  

post #11 of 16
Ninetales, I'm sorry. This sucks. I ended up in a similar situation with my first pregnancy. Took over a year and a half to pay everything off. I wish I had more backbone to argue with the billing department. Good luck with the phone calls tomorrow. I hope you can get these blood tests covered.
post #12 of 16

We're still digging out of student loans, credit card debt (from husband's grad school) and other sundry expenses.  Just as I was pricing doulas, the dog we were watching escaped and got hit by a car, resulting in a $2k vet bill.  That's right, two thousand dollars.  We now have a vacation planned for next week that we can't pay for and our little savings is essentially eradicated.  I make decent money, but it always feels like we're digging out of some horrific monetary emergency.  I've been going through the accounts and trying to automate things and so on, but we don't spend a ton of money on non-essentials, so it's hard to know where to cut back. 

 

Anyway, it is super frustrating, and I'm sorry so many mamas out there are struggling with money issues during what should be an exciting time.  I'm hoping something changes in the next few months, though with the rate things are going, we'll still just be digging out.  Good luck to everyone.  Don't know what else to say really.  Money problems just suck.

post #13 of 16

That is amazing!  I think it's pretty sad how low a priority family is in the U.S.  And we wonder why we have so much crime/so many violent criminals!  For a nation that bases their politics on so many "family values" I have say...the proof is in the pudding.  End rant.
 

Quote:
Originally Posted by fazer6 View Post

MDC really opened my eyes to the world of US healthcare. I'm from England so we have free healthcare. We have no idea what healthcare actually costs because it is always free, we pay nothing. People on low income get medication free and can also have help for costs for travelling to healthcare appointments and help for glasses and wigs. I now live in Spain. Similar system. I pay my social security payment each month, healthcare and a pension is provided for me. My local hospital also provides all clothes for mother and baby during my stay and even provides nappies! I just have to take wipes. In the UK though the hospitals don't provide nappies, in my local one you can use their cloth for free, or take in your own sposies. I have heard a friend of a friend was severly berated for not stopping to get nappies on the way to hospital (she'd gone into early labor and so wasn't completely prepared and went straight to the hospital).

 

I really wish everyone had access to this healthcare. All I can say is if you don't like the US system contemplate moving abroad for future children. I thought it was a bit crappy that I only got 3 months maternity pay (although I pay as a self employed person so to be honest getting anything is a bonus) but the UK has 9 months maternity pay (not a massive payment but better than nothing). Apparantly in America maternity pay isn't standard. I really admire people with large families because I have no idea how you do it.

 

Seriously I wish you all had a trouble free healthcare system where you get ill, go to the doctor, then go home. And all that without paying a penny. If anyone ever wants any advice on settling in Europe or how the social security and welfare state in Spain or the UK works feel free to ask.



 

post #14 of 16

OP, that is so frustrating! I hate dealing with crappy insurance issues! I hope you can get that fixed without having to pay it.

 

We had really crappy insurance for my both my kids, bad enough that we pretty much had to pay the entire cost out of pocket both times, even though the birth center was in network. Major hit to the wallet since we don't make that much money to start with. One of our reasons for choosing to have a third child now rather than later is due to the fact that we recently switched to insurance through my workplace, which actually covers maternity stuff, unlike DH's plan.

 

 

post #15 of 16
Thread Starter 

I called the other day and the woman I talked to just gave me the stupid runaround.  Don't you realize that you can say the same thing over and over and it doesn't change the fact that it doesn't make sense?  So I said it was pointless and I would just be filing an appeal.  If they turn me down again I'll appeal it for an external review, and if they do it again I'll take it to the state level.  If worse comes to worse, I realize that my gigantic chiropractor packages were never run through the insurance, so I can always try that later because that will definitely exceed my deductible.

 

I also called the new company and figured that the birth is going to cost me at least $4500.  But, once my chiropractor visits are applied to the deductible that should help.  And the hospital is pretty easily convinced to reduce the bill, I had it done with the last birth.  But still, irritating.  I pay them so much and it seems like they do so little for me.  I guess it's a good thing when I consider the alternative which is paying the entire thing on my own.

post #16 of 16

Spain's health care system might be great right now, but they can't pay for it. The whole country is going bankrupt, and those benefits are going to vanish in a puff of smoke pretty soon.

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