I don't know if I need advice or a posse to help me call Anthem bad names! - Mothering Forums

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#1 of 4 Old 02-08-2010, 02:38 AM - Thread Starter
 
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So here's my drama. We have health insurance through Anthem's individual plan, which considers pregnancy a pre-existing condition and requires a maternity rider. We couldn't afford the additional $800/mo for the rider that didn't kick in until we had it for 9 months (like that makes sense anyway) and we were planning a home birth. I called Anthem, asked what would happen if I didn't have the rider and an emergency came up that required a hospital birth. The answer: You will be covered if you or the baby are in danger. I called again (3 times!) when we found out ds was breech to make sure this was still the case and every time they said the same thing. Well, our sweetie was an emergency c-section nightmare, and guess what--Anthem refuses to pay. Our surgeon submitted an appeal on our behalf and Anthem admits it was "emergent" but now they're saying they don't have to pay. I'm planning another appeal, but I'm wondering if anyone has advice or has had a similar experience?

Mama to my crazy little circus boy ('09) and feisty little sunshine girl ('12). 
 

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#2 of 4 Old 02-09-2010, 07:00 PM
 
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What state are you in? I'm guessing not Maine because I believe that Maine health insurers are not allowed to exclude pre-existing conditions. There should be an Insurance Commissioner to whom you could report such misbehavior. In addition, your state Attorney General's office may have a procedure for consumer complaints. Good luck and keep after them. I think that insurance companies get rid of lots of claims just because most people don't have the stamina to follow up on the denials . . .
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#3 of 4 Old 02-09-2010, 08:29 PM - Thread Starter
 
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Thanks Latte-- I'm in NH. And now that I've taken a few deep breaths, I'm feeling a little better. There is a second appeal process, and I've started it. I still would love to hear from other people...especially if they have success stories! I'm a little nervous that this appeal will be denied, and am really angry that I've been lied to. I think you're absolutely right-- insurance companies count on us rolling over. They've messed with the wrong mama!

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#4 of 4 Old 02-11-2010, 11:25 PM
 
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I can't believe this story, how terrible! I am so sorry you are having to deal with this. DH is pretty familiar with various issues re: advocacy and suggested you contact Carol Shea-Porter's office. Best of luck!
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