fun with health insurance

on

ramona is like seven & a half months old now, & i am FINALLY being cleared for refunds for some of the medical expenses i paid related to her birth. i think i’ve written about this before, but here’s recap: because i am disabled, i have medicare for my primary health insurance & it’s pretty all right. it pays a nice chunk of my medical bills, but i’m still on the hook for lots of deductibles & co-pays, & until the first round of obamacare reforms kicked in, i was responsible for all of my prescription drug costs (which was really stressful & expensive when i was on fertility drugs).

also, you can’t just add your baby to your medicare plan. if i had medicaid, which is for low-income americans, my baby would have been automatically enrolled upon birth, but i didn’t. the medicaid program here in kansas was called healthwave, & i spent a lot of time while i was pregnant crunching the numbers, trying to figure out if i qualified. as just a single, pregnant person, i did, & had i enrolled, ramona also would have been automatically covered when she was born. but kansas accounts for the incomes of all members of a household, even if they are not married, so i needed jared’s income information as well, even though we don’t really share money (we split expenses, but we don’t mingle our bank accounts) & we’re not married or anything.

so i kept asking jared to get me his income information. but because he’s a graduate student on a fellowship, his income information was really complicated. he has income streams coming from all kinds of random places, like various grants & stuff, & because he spent the first half of 2012 as a regular KU employee teaching assistant & the second half on a research fellowship which pays once a semester instead of every two weeks, it was extra confusing.

i called healthwave multiple times for insight on how to record jared’s income information on the application, but they only confused me more. i asked jared to make us an appointment to discuss it with a KU lawyer (i couldn’t make the appointment myself because i’m not a KU student), but he didn’t get around to it before he left for his fall research trip. i had a meeting with an insurance advocate at lawrence memorial hospital, but she was just as confused as i was. ultimately, we decided that we had a good nine weeks between the time that jared returned from his research trip & when the baby was due, & that was plenty of time to figure shit out & get the application finished. i joked a few times, “yeah, let’s just hope i don’t get pre-eclampsia & end up giving birth like two months prematurely to a baby who needs hundreds of thousands of dollars of emergency medical care in the NICU!” seriously. i said that. am i psychic or what?

so we all know what happened next. jared was home for all of one week (thanksgiving week, which limited our ability to talk to lawyers/advocates/social workers, etc) before i wound up on hospital bed rest. ramona was born five days later. she was whisked off to the NICU to be put on a ventilator & a central line & who knows what else, & we had no idea what to do about health insurance for her.

we figured out that she would be automatically covered by jared’s health insurance for the first 30 days of her life, & she was out of the NICU & home with us within 30 days, so crisis averted on that front. jared spent a fair amount of time on the phone giving various medical providers his insurance information over & over again, but in the end, everything was covered. just her hospital bill, not including doctor fees, labwork, medications, etc, was about a quarter of a million dollars, which is a sum of money that i can’t even fathom. so thank god that was taken care of. & once we were in the whole “emergency birth” situation, a hospital advocate walked us through the healthwave application & got that mailed off for us within a matter of days, so that ramona would have insurance once she’s more than a month old. i knew she qualified, based on our combined income. the income level for children’s health insurance is higher than for adults.

but i assumed that i had nothing but medicare & was responsible for any of my own bills that medicare didn’t pay. so…i paid my bills. the deductible for my hospital stay was more than $1000. the fees for the surgeons performing the cesarean were close to $300. prenatal care was several hundred, labwork was several hundred, the ambulance transfer to kansas city was around $75. each lung x-ray they did on me while i was on bed rest (& they did like six) was $250. & all of these costs are after insurance. these are the costs i was responsible for.

so i paid & paid & paid some more medical bills, & about a month after ramona was born, i was informed that i too was being covered by healthwave, & that it retroactively covered all of my medical expenses starting about three months before ramona was born, until eight weeks post-partum. i asked what to do about all the bills i’d already paid, & i was told to contact the providers, give them my updated insurance info, & ask to be refunded.

so. i did. because i had such a complicated birth, i had like two dozen different providers to contact, but i diligently made a list with all of their billing numbers, the amounts i paid, the dates of service, etc, & i started calling.

& calling.

& calling.

there were times when i’d called a provider on a twice-monthly basis for upwards of four or five months, & when i called again for an update, i was told there was no record of my previous calls. i gave the same providers my medicaid information over a dozen times. i was told that my refund was in process, call back in a week, only to call back in a week & be told there was no record of my calls or any refund. i was told i had to call medicaid directly & ask what the hold up was, & when i did, i was told the providers had to call directly & that i could not be given any information about my own health care claims.

but finally, within the last couple of weeks, i’m seeing some motion. the surgeons have cleared me for a refund. the anesthesia associates have already refunded me. the hospital says the refund is in the process. my regular obstetrician has cleared me for a refund. & all it took was seven months & literally dozens of phone calls.

the crazy thing is that if i just hadn’t paid those bills, medicaid would have paid them automatically when i was approved back in december. but because i paid them, they showed zero balances & weren’t submitted to medicaid. nine times out of ten, when they were submitted, they were rejected because they showed zero balances. it’s like i was being punished for trying to be a responsible person who pays her bills on time. it makes me wonder how many people end up in a similar situation, but just don’t have the patience or the knowledge to call & call & call & insist on being refunded. how many hundreds or thousands of dollars are they being cheated out of by a broken health care system with impenetrable fee structures & bureaucracy?

4 Comments Add yours

  1. Ella says:

    I can’t imagine how frustrating that would be but good on you for being diligent (i mean, when we’re talking about 1000s of $$, it’s necessary but you seem really organised about it which probably helps when arguing with cogs in a system set up to rip off honest people.). I’m glad it’s all getting settled. I have thought about all of this a few times since Ramona was born – $$ adding more stress to an already stressful pre-term birth, surgery, recovery. Dude, you’re awesome for your perserverence and attitude through the whole ttc, pregnancy, nicu, recovery, parenting process. It has been really inspiring to me (who just coincidentally experienced some of this at similar times).

    1. ciara says:

      perseverence? or simple obsessiveness? i was already keeping notes on everything we spent on baby costs, so i had everything written down before i knew i was going to have to fight to be reimbursed. it’s definitely super-stressful sometimes. i remember once i was calling providers to get updates & ramona started screaming & some woman was like, “i’m sorry, i can’t hear you over the sound of that crying baby.” hello, that crying baby is why i’m calling you! i can’t even explain her tone of voice. it was like she was implying i was a monster for trying to make a phone call when my baby was crying. like you really have that much control over that stuff? there are days when you just won’t get anything done at all if you don’t ignore your crying baby a little bit.

  2. Hope says:

    Ugh. Health insurance in our country is so fucked up. I’m so sorry that you had to deal with all this. But I hope you get a bunch of fat checks out of it!

    (which would just be your own money coming back to you when it never should have left in the first place… but at least it would be coming back).

    1. ciara says:

      still waiting. the hospital reimbursement is the one i’m the most looking forward to because it’s for over $1000. they said it was approved for processing on june 26 & processing usually takes 10-15 business days. um…or more, i guess? it’s a good thing i’m not totally counting on that money to, like, pay my rent or whatever. i swear, this is how people spiral into financial ruin.

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