Yesterday I spent a great part of my morning on the phone trying to iron out an insurance kink. A Catch-22 if you will.
You see, if I had given birth to Charming in the hospital, my insurance would have happily paid my doctor $8000. Now, as most of us know, hospital births are much more than $8000, so I would have had to pay above and beyond that, setting me back a good chunk of change. I, however, chose to have my baby at home. Midwife: $1300. Circumcision in the doctor's office: $468.08. (Let's take a moment and scoff at the audacity of that, shall we? But, I do want qualified hands cutting "down there," I must admit, and I THOUGHT the insurance would be more likely to cover the Dr than the Mohel therefore....). Grand total: $1768.08. That, to me, is a bargain.
But, oh no, not to my "share program." The share program that I joined, and stayed in, not only for economical reasons, no, but because they not only support, but promote, home birth. In fact, up until about a year ago, they only paid about $3000 per birth because that more than covers what nearly all midwives will charge. (Homebirth midwives, that is. Don't get me started on the hospital midwives, who are FINE, I'm sure, but pricey.)
Fast forward. Share program decides to join a PPO to lower costs. PPO makes rules in order to be joined. Share program decides that young couples are more economical than older couples and expands maternity payouts because young couples want epidurals. Suddenly Share Program doesn't cover home birth. Oh, they say they do. It looks good on their propaganda. But the midwives they have covered for several births (mine and my sister's) are suddenly unacceptable for the PPO because they are only "certified" and not "licensed" and the licensed midwives (nurse midwives rather than lay midwives) only deliver in the hospital. (But the Share Program doesn't hesitate to educate me about the fact that "why would someone hire a midwife to deliver in the hospital? Those midwives deliver at home....(crock of hooey).)
On top of that, even though I followed all the rules, Share Program doesn't want to cover Charming's circumcision because the doctor's office coded it as "routine." Because, let's say it together, CIRCUMCISIONS ARE NOT SOMETHING DIAGNOSABLE.
Any-hoo.
(Interesting. The tornado sirens are blowing. They match my mood.)
So, I have a couple people at Share Program that are supposed to be "trying to find a creative way to cover this." If they do, I'll happily tell you who Share Program is and tell you to join. If they don't? I will be smearing their name to kingdom come. You don't sign off every phone call with "God bless!" and not follow through with what you say you will do.
Oh, and the tornado sirens were the weekly drill. The weather here is sunny and hot.
2 comments:
I'm irritated right along with ya. They should be fined for the hours they've made you waste...ugh.
that sucks. i'm still trying to get my insurance co to acknowledge my home birth from november. i've sent them the claim in the mail twice and faxed it once and it's STILL not showing up in their system. it's so frustrating. i don't know if they'll reimburse me at all, but could they at least acknowledge me? blah.
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