Monday, December 05, 2005

Problems Straight People Don't Have

The insurance madness continues but took a Kafkaesque turn today. Cait called over two weeks ago to request a waiver that would allow me to have prenatal care and delivery through the birth center. They said they'd provide a response within a week. I took a day off work today to sort through all kinds of insurance and mortgage problems, including this one.

I have just emerged from a 40+ minute call (the majority of which was being on hold) in which I had to repeat the entire request process. Here's the e-mail I wrote to Cait as I was on the phone:

I am having THE SAME FUCKING CONVERSATION with them that you had over two weeks ago.
Rep: "What about the Maternity Center in Bethesda?"
Me: "They tell us you do not participate with them."
Rep: "Ok, it will be covered but as out of network because there are participating facilities in network."
Me: "Which ones?"
Rep: "The Maternity Center in Greenbelt."
Me: "It's closed."
Rep: "Well, do you have a facility you want to work with?"
Me: "Birth Care, in Alexandria."
(Rep puts me on hold)

This is AFTER I was on hold for 20 minutes while she tried to find a supervisor to "tell me the determination" because she is "not allowed to". Which kind of makes me think they HAD a determination but now I am starting ALL OVER AGAIN.

I. HATE. THIS.

Oh jesus fucking crhist. They put it through for YOU.

Yup, that's right, they requested the prenatal and maternity care for Cait.

posted by Jen at 11:58 AM

21 Comments:

  • I'm sorry, I can't help but laugh.

    I KNOW it's frustrating, but it is a funny read.



    I'm so sorry!

    xoxox,
    S

    By Blogger Shelli, at 12:23 PM  

  • GAWD.............What a nasty, hair-pulling, growling MESS!! Here's a vicious grrrrrrrr....on your behalf. *hugs*

    By Blogger deanna, at 12:53 PM  

  • Dude, it's EXACTLY the same for straight people. I had a baby four months ago via emergency c-section, and my insurance DENIED the claim until we threatened to sue them. (We don't have maternity coverage, but they are supposed to cover complications - duh, I wouldn't have had a c-section if it weren't for complications!) If you knew how many hours I've spent on the phone with insurance companies (with two kids screaming in my ear the whole time)....

    By Blogger Amy, at 1:28 PM  

  • Well, that's a relief. Don't you feel better that if Cait conceives the next Redeemer, she won't have to give birth in a stable? I mean, I know I was worried about that, cause you two don't need ANY more hassle.

    When Julia was born, Kristin's insurance refused to put her on the policy because Julia had MY last name. And because 2 years ago when we were married in San Francisco, we came back and tried to add me to her policy (they encouraged us to do this when we spoke to them about our options, btw) a move which was denied when the marriages were annulled. But when Julia was born we found out that her account is flagged for fraud, and so they had just routinely denied her application to add our daughter. Even though they'd been processing her claims from the C-section and all the hundreds of doctor's visits, tests, ultrasounds etc... she had to produce a birth certificate to PROVE that she had just given birth so that we could add the baby! All because the baby had a different last name than her.

    Do straight women who keep their maiden hames but give their babies the father's name have to deal with this?

    I'm so sorry that you had to take a day off to deal with this instead of relaxing.

    By Blogger Trista, at 2:05 PM  

  • Hahahaha.

    It's only funny because I totally understand.

    I hope this headache is almost all over for you.

    By Blogger Brooke, at 2:20 PM  

  • Insurance companies just suck, period. I have spent all morning on the phone (meaning on hold) with mine over my sick child's special predigested formula (which costs as much each month as the payment on a BMW, but he'll die if he eats anything else, hmm...). Our thought is hey, the doctor ordered it and it is medically necessary, so they should at least chip in the difference between this stuff and regular, normal baby formula. They went round and round and said his physician would have to call and expain things to them with clinical details, and I said "oh, so this is something you've done before and there's a chance it's covered?" HA! Of course they couldn't tell me that. But they could (and did) mention that the antacid he's on is, as of the 9th, not covered because they only want their victims, er, I mean insurees to use omeprazole or Nexium, but neither one of those is approved for use in infants and the doctor says he needs the Prevacid. So now we have to fight them on that, too...in our case I can see where they are coming from, because formula is expensive, period, and I could see people whose pediatricians told them to try soy instead of milk-based filing unnecessary claims, and EVERYONE seems to be on antacids these days (people hear about my son's condition and invariably say "oh, my baby has reflux!" and I'm like ALL BABIES HAVE REFLUX, IF YOUR KID JUST FUSSES FOR AN HOUR OR TWO EACH NIGHT THEY DO NOT NEED DRUGS), so it is understandable that they want to screen out the frivolous claims but HELLO...my kid is allergic to protein and needs a formula already broken down into amino acids so he can LIVE, and his reflux is so severe that he is dependent on an NG tube to eat, and hey, the formula gives him explosive diarrhea and there are no studies showing the long-term effects of using such a new, super-strong antacid with an infant...they think we would put him through all of this if it wasn't necessary??? Bite me.

    But in your case, I don't think they are exactly overwhelmed with lesbian couples seeking birth center care, so I don't know what the fuck their problem is. Sorry to hear you're having to fight with the bastids, too. Give 'em hell!

    By Anonymous Anonymous, at 2:43 PM  

  • omg. i did laugh... i admit it... but grrrr

    when i was first added to beth's insurance the hr rep told her she could use flex spending. well, when she went to PAY TAXES it turns out that her company took out for dependent care (read childcare), a benefit which i did not need... grrr.. that was fun to throw away $300/yr on! Boy did THEY get an earful in HR!!!

    By Anonymous Anonymous, at 3:16 PM  

  • jeezus what a royal PITA!

    By Blogger Sophia, at 3:35 PM  

  • Yes, for once, in all the litany of challenges you've had, Jen, straight people DO have this issue. David's circumcision was denied because it was somehow filed as for ME! Since I kept my maiden name, we had so many variations of David with Dan's last name, David with my last name, the hospital records, which called him BabyBoy PXXXX (my last name), and the insurance policy was Dan's. It took us SIX months of constant calling to get the right procedure covered for the right person with the right name. Just be patient--it WILL all work out, but there's likely to be a lot MORE phone calling in your future.

    Just don't forget to call your insurer when you go to the hospital, even if you're preapproved, as we nearly lost all coverage by doing this after the allowed period.

    But I'm sorry it's such a pain.

    By Anonymous Anonymous, at 5:11 PM  

  • All right, straight people, I love you and I did not mean any disrespect. However, I stand by my claim. If you can show me a straight couple where they approved maternity benefits for the HUSBAND, I will eat my words.

    (That said, this same insurance did for a while have us listed as follows: me, male, 33, Cait, my female, 26 year old child.)

    By Blogger Jen, at 6:10 PM  

  • (But Andrea's story was close.)

    (And I KNOW everyone has problems with insurance. Believe me, I know. I've spent YEARS of my life on the phone at this point.)

    By Blogger Jen, at 6:12 PM  

  • that sucks.
    At least you are no longer having to talk to insurance people about sperm washing. That is on my top 100 freaky customer service moments.
    Did you get everything sorted??

    By Blogger Calliope, at 12:30 AM  

  • Good lord. Thats terrifically funny, in a "that sucks so much and is so totally absurd that I must laugh" sort of way.

    I hope it gets worked out soon.

    By Anonymous Anonymous, at 7:39 AM  

  • (channeling Karen from Will and Grace)

    GOOD LORD! It's frustrating to be SO MUCH SMARTER AND MORE COMPETENT than the people who are making the decisions that will affect YOU, isn't it?

    Oh well, at least you'll have some really interesting stuff for the "waiting for your arrival" section of the baby book.

    By Blogger hd, at 9:12 AM  

  • That said, this same insurance did for a while have us listed as follows: me, male, 33, Cait, my female, 26 year old child.)


    hahahahaha - Thankfully, Narda and I each have our OWN insurance - for now...

    OY! I'm so sorry, sweetie, but I cna't help but snicker just a little bit.

    OH the brilliant ones out there that we all get to deal with!

    By Blogger Shelli, at 10:22 AM  

  • OMG...this is so insane as to be funny.

    This is why, in spite of the cost, we've maintained double insurance for Jill since she went back to work. We do have her on the lightest plan her company offers, and both of us on the cadillac plan through my company. A waste of money, but the experience of life is less frustrating.

    I do have one random recommendation -- use the one advantage we have in this situation over straight people.

    Whenever one of you is calling with a medical question or situation, just say you ARE the person you're calling about. It also works for financial stuff, as long as you have the info to "prove" you are who you say you are.

    We did a bunch of 401k/IRA rollovers and transfers this year, and if I hadn't been able to just say I was Jill during some of those transactions, they would have been 1000% more difficult. (Does it go without saying that she knew I was doing all this?)

    By Anonymous Anonymous, at 10:29 AM  

  • Nope, can't claim my husband has ever been mistaken as pregnant. My father-in-law on the other hand has had one too many beers go to his belly over the years and... oh, that's another story. I hate dealing with insurance, and I can only imagine how much more frustrating it must be for you. Ugh! Hugs to you guys and best of luck in sorting all this out.

    By Blogger lagiulia, at 11:08 AM  

  • Chiming in because I managed a customer service call center for a medical management company in my previous life. Let me tell you they are equal opportunity screwer uppers, I've seen it all, including semen analysis approved for payment for women, OB packages approved for husbands and even dependent children.

    I really wish you luck, it can be infuriating. I'm fighting over claims now with my own insurance company. It seems that my ob ordered some prenatal labs which I had done at a lab that participates with my insurance company. However, my primary care provider is supposed to use a different lab so they denied the claim...even though it was NOT my primary doc that ordered the tests. UGH

    By Anonymous Anonymous, at 11:11 AM  

  • Oh fer fuck's sake, could they make any more difficult? I better not say that and jinx it, lol. I really like Liza's suggestion, though.

    By Blogger Unknown, at 3:43 PM  

  • Oh good Lord. That's awful. I couldn't get our insurance to tell us if a drug rider we wanted to add to cover the fertility drugs would indeed cover the fertility drugs. Their advice? Buy the rider and then we can tell you! It's all so freaking nonsensical. But it was a funny story.

    By Blogger Katie, at 3:40 PM  

  • Sorry they are such a PITA. As said above, insurance company's SUCK! I had twins and it took me a year to finally get them to realize that we weren't sending in duplicate claims (they kept denying baby b's claims), that there were TWO babies-arghhhhhhh!!!!! I feel your pain.

    By Anonymous Anonymous, at 3:03 PM  

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