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01/21/2005 Entry: "Fucking Insurance Companies!"

Just when I thought all this crap was over and done with, I just got a call from our midwife's billing person. Apparantly the insurance company told her the request for full coverage was denied. This is completely contrary to what we were told.

For those who missed the earlier post about our quest for a midwife, a recap... I scoured the internet for a homebirth midwife in our area, finding only a handful. None but two were covered under our insurance plan. Then I realised one of those two was listed under an old address and she lived 55 miles away instead of 32, which wasn't a great option. Then I found out the second one on our provider list was listed under the address/facility she used to work at, but no longer did. Her private practise wasn't covered.

Then this second midwife's billing agent contacted us, telling us that our insurance had an exception which would allow out of network providers to be reimbursed as though they were on our network (100%) as opposed to the out of network coverage of only 70%, our situation, i.e. no provider within a reasonable distance, was within those exception parameters. So we tried to get that sorted. PreZ hassled them on the phone a few times to get them to hurry up and give us an answer. They told him it had been approved and they just needed to contact the billing agent for information/paperwork and that was it. At that point I called the midwife and booked our first appointment, which was last month (Dec 21). We had our second appointment yesterday, and our midwife mentioned that her billing person still hadn't heard back from our insurance company.

Now I get a call from the billing agent saying that the insurance company has declined to put in the exception, with various excuses like that they don't cover homebirth. This is a load of crap! A homebirth is much cheaper than a hospital stay for me and a baby, and all the associated crapola. And nowhere in our insurance paperwork does it say that homebirth is not a birthing option.

Mostly I feel really jipped because they told us it was approved, and that's why we made the appointment last month in the first fucking place.

Now we need to go talk to them again. The billing agent told me that we needed to find out what their coverage amount is for pre-natal, labour & delivery and post-partum services (because they'll pay 70% out of their "allowed" amount).

I am so pissed off right now, as well as just tired of all this crap, supremely disappointed, and now worried that we might end up with a medical bill as well. Yes, we can "afford" it, but we have insurance, and a PPO plan at that, we shouldn't need to pay through the nose outside of that as well, especially not for a service that's so much cheaper than the damn hospital alternative.

Fucking insurance companies. The US has the shittiest insurance situation ever, you pay through the nose and you get fuck all return for it. For this reason alone I might just wait until we're back in Australia if we consider having #2, or at least plan any potential birth until after we're back there.