You read it right. Twice in the last year. I didn't write about it because it's more than I want to put out there and really what was I going to say that would've been new? I think I had all the normal feelings of loss and sadness and all that - so I didn't mention it. But I write about it today because I'm finally off the old insurance and need to tell you about what they did to me.
Let me start by saying I appealed everything and as it stands right now I believe they are going to be paying, so I may be running a risk of screwing that up by writing but I am tired of hearing people say they aren't sure about health care reform.
In June we moved. At the end of June I was feeling dizzy all the time and decided to pee on the stick and see. We'd been trying to conceive up until Dan lost his job in May and we knew we'd have to take the COBRA insurnace, so we weren't aiming for getting pregnant especially in the middle of the adjusting to a new job, packing up the house, moving three states away, and unpacking. But of course it seems this sort of thing always happens when you relax and aren't thinking about it. We were delighted to find out I was. I should explain, I lost a pregnancy last November (at 11 weeks) and I'm 36years old, so I knew I would be labeled as "high risk" and knew I needed to see a doctor right away. I called my insurance to find out what to do, they said I was not covered in another state unless it was an emergency and I could go to the emergency room if I felt it necessary.
Dan and I carefully weighed what to do. If I had a condition that wasn't covered by insurance when I went on the new insurance, it could be considered a pre-existing condition, and may not be covered. We decided I couldn't wait another day and the best thing would be to see an OB, one that would be on the new insurance, just pay for the first visit out of pocket. I would be spending a week in Illinois in August anyway and could see my regular Illinois OB while there and get all the necessary ultrasounds and expensive stuff while I was there dealing with the house (we haven't sold yet) and the insurance would be happy I was in network. Then I'd be back in TX when the new insurance kicked in, for the next round of appointments. I got on the phone and made all the necessary appointments in both states.
After that first out of pocket visit was when the complications started. Abdominal pain (I'd rather spare you the details) and some unsatisfactory labs. My OB decided to get me on a prescription and monitor closely. During this time we tried get the insurance company to cover the appointments since the situation had changed. Again they said they would not cover anything in TX and I'd need to again pay out of pocket for all the additional labs and ultra sounds. The insurance company said it wasn't an emergency enough to pay because I wasn't going to the emergency room. I couldn't bare the thought of sitting in a large city's emergency room with a rambunctious 5 year old trying to get very detailed and careful ongoing care over the next three weeks, out of the doctor who happened to be on call. Instead, I continued to see the OB, I was sure it was where I was going to get the care I needed.
The week after, I went in to my TX OB for an ultra sound -no heartbeat. At this point, she ordered a DNC (they remove the contents of the uterus) and run several follow up tests on the tissue to try and figure out why. We scheduled the DNC and all the follow ups. The billing department called for the pre-approval, the insurance company denied it and said if I was having an emergency I should go to the emergency room and they would cover that. I asked my OB if I went to the emergency room what would happen, she said they'd send me home to wait it out. My body would expel the cells on it's own, sometime in the next month. Or if I was having severe pain they'd do a DNC and send me home. I asked - what about the follow up tests? She shook her head. I asked who would do the surgery she said the doctor on call.
I spent frantic hours on the phone with the insurance company fighting about it. One insurance operator said they would cover the proceedure with my OB, the next operator on the phone with the OB said they wouldn't, I would have to go to the emergency room. It was like treating the heart attack but not allowing the heart surgeon to do the surgery and asking for the emergency room doc instead, then throwing the EKG results in the trash all because a person is out of network. The OB's office gave up and said they couldn't schedule anything unless they received payment up front ($1,200.00 at the minimum just to reserve the operating room) or a pre-approval from the insurance.
I considered just staying home and waiting it out. Pictured myself home with Ella, while Dan was at work and nobody to call to come watch her. I pictured, emergency situations and an ambulance. I pictured paying for the operating room out of pocket. I imagined not knowing why it all happened and attempting this all again because I didn't know about some thing the follow up test would reveal. I was hysterical for two days wondering what to do and I called my OB in Illinois to see if she could order the tissue sent from the emergency room to her office in Illinois for follow up tests and at that time I talked long with my dear nurse practitoner. Then I called the insurance back and asked them some very specific questions. It became clear, if I was in Illinois, like I was last fall with the last miscarriage, the insurance would cover everything 100%.
Dan packed me, the kid and the dog into the car and drove me to my mother's that night. We left Thursday night at 5pm after work and arrived in IL at 22 hours later at 2pm on Friday. My doctor in IL rearranged her vacation and saw me at 2:15pm that day and scheduled my procedure for 6:00pm that evening. The insurance company wouldn't approve it because it wasn't at the correct surgical location. Both me and my doctor would have to wait until the approved surgical location was available on Monday. We waited, and on Monday it was all covered 100%.
Now let me put this in perspective, I miscarried and the insurance company made me drive 22 hours, 1500 miles to be in-network and then made me wait three days before they would cover anything.
I'm sure they would insist they would've covered any life threatening situation and this was not. They would be right, this wasn't an instance where I was going to die in that moment, it was an instance where somebody else was dying over a period of two weeks and they made me drive across three states before they'd pay. Again, in fairness, I've turned in all the old bills under an appeal, and the agent on the other end of the phone said she'd recode them as an emergency and it'd be likely they'd pay because of the outcome. But I can't help but think about if I hadn't lost the pregnancy. What then? - Crisis averted and the insurance doesn't pay a dime? I'd have piled up a hefty collection of ultrasounds and labs by now. I'd owe thousands.
So bloggies, I write this for several reasons, if you didn't see much of me when I was in IL, now you know why - I wasn't feeling well. If you missed me writing here and have wondered what was up, now you know why - I didn't know what to say, and most importantly GET BEHIND THIS HEALTH CARE REFORM! This quagmire of red tape, paper work and pre-approvals is effecting the care we get. The insurance company is dictating my health based on how somebody codes something. It's ridiculousness. If your argument is that you want the government to stay out of it so you can continue to make your own health care choices - I say to you WAKE UP! We aren't making our own health care choices and neither are our doctors. The insurance companies are.
Follow up: I'm fine. Still disappointed, but expected. The tests all came back normal and we'll be clear for take off next month. It's likely you'll not hear much more about it unless there is good news to share.