Appeal question re: insurance

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Appeal question re: insurance

Postby nataliesmom » May 13, 2007 6:59 pm

A little background: I tried to do all my homework re: insurance coverages before getting pg this time around. I thought I asked all the right questions based on my previous pg. However, as I have since learned (through multiple phone calls by me, my father, the Drs office, etc, many of the individuals we spoke with didn't have a clue what they were talking about when they were "answering" questions about my coverage.

I was originally told that I had a global co-pay to the OB's office and that the deductible did not apply to maternity coverage, I had a co-pay each time I was hospitalized as an inpatient and another for outpatient services - again, the deductible did not apply. Home health (b/c it was maternity related) was covered 100% with no deductible.

What we have since learned (after spending 2 weeks on home health infusion therapy) is that home health is only covered 80% after meeting the $500 deductible. That means I'll be on the hook for somewhere between $1500 and $2000 - a far cry from $0!!! I'd have been better off having 2 inpatient hospitalizations for that! :shock:

We are planning to appeal this. The logic makes no sense whatsoever. I save them thousands of dollars by staying at home yet I have to pay huge amounts aout of pocket. Had we had accurate info up front, I would have said no to home health and elected to be admitted to the hospital.

Does anyone have experience appealing in this type of situation? Any advice you can offer would be much appreciated. I am truly hopeful we can help them see the absurdity of the situation.

Thanks!
Amanda
Natalie 1/12/04
Emery 11/2/07
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nataliesmom
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Postby 3sEnough » Jun 04, 2007 6:20 pm

Natalie,

Have you had any luck with the appeal? My insurance would not cover home health 100%, either. Basically, I have a $500 deductible and the insurance covers 80% of medical after deductible is met.

Because of this my ob decided that it was much better for me to go to the hospital every time - home health would have to be paid on a quicker basis whereas my hospital bills can be paid a little over a very long period of time.

Shoot, if I was able to be on home health then I probably would have been able to keep working, just lug my machines around with me. Oh well. Now I just have to deal with another issue on top of my hg.
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Postby nataliesmom » Jun 06, 2007 10:28 am

We haven't started the appeal process yet. BC processed several of the home health bills wrong the first time around so we're waiting for that to get corrected first. My father worked in employee benefits for 30 years and actually still has a connection with the brokerage company that matched my husband's employer with BC for our health insurance. So, I'll definitely be working with both of them when I do the appeal.

It's just so frustrating to have to deal with this on thop of everything else. It really makes me appreciate the insurance coverage I had when I was pg with DD.
Amanda
Natalie 1/12/04
Emery 11/2/07
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nataliesmom
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