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!
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!