Symptoms, Questions, Concerns 11/16+

anewadventure

Oof, that thread was OLD! 

Start over below.

Lately I've been thinking of the "I'm so pregnant" spoof of Iggy Azalea's song "Fancy." Which then reminds me that I'm glad Iggy Azalea doesn't still seem to be a thing, here. 

anewadventure

anyone else doing lovenox injections? i seem to recall there were a couple?

no questions really. i'm just so OVER IT and want to whine about it. my stomach is a mass of bruises and nodules and is getting really over-sensitized. LO also starts to flip his shit when i try to pinch my abdomen to administer my dose. he's like, "STOP CROWDING ME, MA"

MJDsquared

BLESS YOU! I've been getting notifications on that thread for eight pages. I refused to start a new one on principal because I was still going to get the notifications. I was just waaaaiting for someone to start a new one!

Question: RH- moms: was your Rhogam shot covered under insurance? I seem to recall that @ktcakes87's was not. When I Googled, I found a wide variety of answers. Mine was not covered at all and I'm just wondering if my OB's office can code it differently or if I should appeal to the insurance company. It seems ridiculous since it's a preventative measure and part of my normal prenatal care so I feel like something should be covered... (I know insurance plans vary so answers to this won't necessarily help, but if anyone else had to have their OB change their billing or appeal to the insurance company that would help at least!)

Also, it's only like $150 and it goes to my OOP max...so if I deliver in December it really doesn't matter. But if I deliver in January I'm going to be dealing with a giant bill and feel like I shouldn't pay this $150 on top of it.

babytimeagain

@anewadventure Ugh. That song has been stuck in my head for the past two weeks because of the "I'm so pregnant" spoof. Make it stop!

anewadventure

@MJDsquared oh. you've done it now. you brought up one of my PREGNANCY RAGE TOPICS O' THE WEEK.
i just found out my insurance denied the entire claim for my 28 week rhogam shot. i did not have any problems with this my first pregnancy, but it was a different insurance. 

anyway. the claim was denied because the rhogam shot HAD to be administered outpatient at the hospital lab. except apparently all labwork that is outpatient from the hospital must be preauthorized. (i'm supposed to know this...how?) so because my OB apparently did not do their leg work, and the hospital ALSO did not do their legwork (they should absolutely know better), the claim was outright denied. 

the kicker? normally, the insurance would say "well we're not paying this for ___ reasons but this is the negotiated rates and this is all you're allowed to charge for this service." this time? denied outright, did not go through the process of negotiated rate smackdown. the charges for the shot total nearly 600 freaking dollars because labwork billing is absurd. 

icing on the cake is that i had to jump through 100 hoops just to get the shot. first the lab was closed unexpectedly. then they had a staffing issue. then they had a paperwork issue. then i had to get my blood retyped for liability purposes even though it's been typed 1000000 times and i'm not a mutant that can morph or something. so finally, one week later in the process, i go back to the hospital for a FOURTH TIME to actually get the shot. in all that time, the lab couldn't process the paperwork with my insurance? this wasn't exactly a lightning-fast timeline. 

TLDR; i'm angry. this is a routine item of prenatal care. it is REQUIRED if your blood type is negative. i still haven't figured out any recourse. i assume this will be a thorn in my side for quite some time to come and i'm pessimistic that i have the ability to avoid paying this ridiculous set of charges. at the VERY least i would like my insurance to say "these are the negotiated rates, we still won't pay" so i can pay 100 bucks instead of 600. ETA: oh yeah! AND! it wouldn't even count towards my OOP maximum. my insurance ignores the claim like it's a sack of rotten potatoes. 

your insurance absolutely should cover the shot, and there should be zero question for the one administered directly postpartum while you are inpatient in the hospital. 

mdcd44127

@MJDsquared My Rhogam shot was covered by my insurance (BCBS of NJ) like a vaccination. I just went back and found the bill for it, the hospital charged my insurance $750 for the shot and they covered it 100%, all I had to pay was $30 for the bloodwork they did during the same visit (antibody screen and glucose test).

FX you deliver in December and don't get hit with a huge bill!!

kyrwyn

@anewadventure What state are you in and which carrier? I know an insurance broker and an attorney here in CA who both spend all day every day dealing with shit like this. I can ask them again what the magic words are to say on the phone with the "denied your claim" asshole... apparently some phrases inspire fear and generate better responses. I didn't get to use them, because my OB's nurse went postal on UHC for denying my diabetes test strips before I could get on the phone.

skc040512

Holy breast leakage...I've had a bit off and on since like 28 weeks or so, but randomly yesterday it decided to ramp up. Anyone using breast pads? I hated them with DD so I've been putting off wearing them, but I think it's about time I'm gonna have to suck it up.

anewadventure

@kyrwyn i'm in maryland with their version of BCBS, it's called Carefirst BCBS

kyrwyn

@anewadventure I'm emailing the friends now... I'll let you know what I hear back. Hopefully they can give you some effective ammunition to get your claim processed.

babybison

I don't need the RH shot but I had a similar problem at the beginning with part of my prenatal panel. And the ins girl on the phone told me it was something that had to be pre-certified which usually takes 30 days. and I was like, wft, 30 days ago I wasn't even pregnant how could I know to get this pre-certified?! 
It was like a $7,000 sticker shock. But I'm not sure we've ever received the bill....

But I can't see why the RH wouldn't be covered. It's not elective. 

Edit: I think I tagged the wrong person? Tag removed.

anewadventure

@kyrwyn YOU ARE THE BESTEST!

kyrwyn

@babybison @anewadventure Yeah... few things make me angrier than insurance BS, especially during pregnancy.  The system makes sense to exactly no one, and the rules are so clearly designed to force you into failure (non-compliance).  How they expect anyone to navigate it while building a human from scratch, I do not know.  I am so effing grateful to be on an HMO during pregnancy, because it's my medical group's responsibility to make sure all my referrals, anyone involved in our delivery, etc, are in network.  

From super-friend, the attorney:

From a quick poke at the Google, BCBS not covering that shot seems to be a theme. Also, it looks like most providers tell the mom to be to get it from the pharmacy and bring it to their next visit to be administered, which would support the idea that the insurance doesn't always cover it. 

I highly recommend she files a grievance and goes through the appeals process. You can't always get the Insurance Department's attention to your individual claim until you have jumped those hoops. She can also file a claim with the insurance department, noting that this is a pattern of medical necessity review behavior that is detrimental to the Rho negative moms in the state for those with BCBS coverage, and that they may wish to investigate why this seems to be denied to BCBS members on a regular basis, while others covered through other similar insurance don't seem to have this issue as often. 

I'll keep poking at the information out there, and if I find more, I will pass it on. 

Amber_Waves

Insurance companies are such a pain. The prerecorded message when I call to check on a benefit always says that the answers aren’t binding etc etc. great, so you can just say whatever and no consequences if you’re wrong?

@anewadventure If you reach a dead end with your insurance, try calling hospital billing. We had a $1000 bill reduced to $300 by billing, just because I said, “is there anything you can do?”. I have also called my doctors office about surprise bills and they have smoothed it out. You may recall that we got a surprise $6500.00 bill for some genetics testing. I talked to the counselor that had ordered the tests and she was like, “nope, should be $99.00; call X and say Y.”

MJDsquared

So here's what my explanation of benefits looks like for the Rhogam. The RhoD and the injection are charged separately. Anyway, the "provider billed" amount is higher than the "plan allowed" amount, but "plan paid" says $0. So I'm like...does the plan putting a cap on how much I can pay for it mean they don't have to pay anything? I hate insurance.


I have a call in to my OB's billing dept to ask there first but we'll see when she calls me back...

ETA: Those bastards applied it to my deductible, which apparently means they're allowed to charge me for it. I'm just not sure why that was applied to my deductible when nothing else has been.

ETA again: Apparently they just decided to start billing me for injections and putting that towards my deductible. The more confusing one though is how the flu vaccine solution was covered in full, but then "vaccine injection" from the same day was billed to me in full and went towards my deductible... I literally only got the flu shot that day. Are they telling me that if I went to a Walgreens and got my flu shot I would've had to pay $45.60?!

kyrwyn

@anewadventure

Super-friend, broker, has weighed in:
I believe words like “Endangering at risk pregnant women” may also be helpful when talking to BCBS, along with “grievance” and “appeal to the state department of insurance for review.”

Hope your Friend in Maryland can get it sorted sooner than later.

anewadventure

@MJDsquared if you haven't met your deductible then yes, you'd have to pay for the rhogam shot, as it's not lumped in with regular prenatal care. for the flu shot, it's pretty bogus for them to charge separately for the serum and the injection but in that instance you would have to pay for the injection charge. 

your prenatal care hasn't been billed yet? (depends on the OB office whether they do it in a lump at the end or earlier on). ACA covers prenatal care and delivery but you have charges you have to pay for like copays for ultrasounds, coinsurance for labwork, copay for hospital admission, etc. 

MJDsquared

@anewadventure I've been paying for whatever's not covered for ultrasounds, blood draws, urine samples, etc. along the way, but none of that went to my deductible, just my OOP max. The first thing they put towards my deductible was the flu shot injection, then the Rhogam, then I think the Tdap.

I got a letter from my OB towards the beginning of pregnancy telling me X amount was due to them by some date (November something I think). I'm really responsible and lost the letter, lol. But basically it was their guess as to how much I would owe them for all their services based on my insurance plan. Haven't heard about that again but it should be coming up so I'm just waiting on a bill for that.

weaver15

@Skcobb I have never had leakage till after my babies were born. I like the washable pads the disposables would stick to me. I hated it. 

kyrwyn

Holy, crap, guys, it's go time. I'm past 37 weeks, my blood pressure was borderline and my fluid level was a little low today -- apparently that's the NST trifecta. We got sent home to eat dinner, pack the bag and then head in to get induced tonight. When they said "any appointment could be the day" they apparently were not kidding.

ShyTonia

Omg @kyrwyn !!!!!!!!
Good Luckkkkkk ❤️❤️❤️

Marley629

@kyrwyn yay!!! Good luck!  We'll be thinking of you! Can't wait for an update!

cenzosmomma

@MJDsquared @anewadventure I am in NY, also have BCBS and have received EOBs for both of my rhogam shots showing they weren't covered, but was never billed by my Dr.'s office... one of which was just about a year ago (TW- they gave it to me after m/c) and the other was at 28ish weeks this pregnancy... I'm not sure what happened between the denial and my office though...

babybison

@kyrwyn Go baby go!

whiska

@kyrwyn How exciting!!!  Good luck and we'll be thinking of you!!

sjis

@kyrwyn yay! Good luck! 

I cant believe some of us have delivered and are on the verge of delivering! time has flown by!

failuretofly

I was so crampy with strong BH at work last night... I hope that's a good sign that the end is near! Though I am having major anxiety about what to do with DS if I do go into labor before MIL gets here... I mean I have some loose plans, but I'd rather not have to call in a friend for help!
Is anyone planning on having their older kids with them for labor and birth? 

babybison

@failuretofly I'm sure your MIL will be in time, and it's super stressful to not actually *know* but someone somewhere will be able to watch your DS. Other than that, I have no advice.

I on the other hand am having enormous hip? pain. Right where my back dimples are. And if I stand up after lying or sitting down for too long, I can barely use my legs. I have 3 more weeks...and I need to use my legs. 

whiska

@babybison Sorry for the debilitating back/hip pain!  Look up SI (sacroiliac) pain and see if what's described fits how you feel.  Maybe some of those exercises will help. 
My SI experience

I had it really bad around 30 weeks (I couldn't walk or do more than shuffle without severe pain!) and realized it was because I had started sleeping exclusively on my left side and didn't have good support between my knees - wide hips over here!  So I got a thicker pillow for between my knees and started alternating left and right sides whenever I got up in the night for the bathroom, and the pain totally subsided within a few days.  

If it's not SI maybe you need more support behind your low back when sitting?  Just an idea.  Hope it goes away soon!

evreka

Morning ladies. Some help and advice would be great thank You. I am 34 weeks and experiencing really bad lower back ach where I can not walk at times and where I can sometimes go blind or vision goes blurry. Now and again You can hear it click in and out I would assume. Other wise it's a really loud clicking sound that happens.  Is this normal..

Thank you in advance. 

balletnerd

@evreka my OB said that if I have any vision changes to contact them ASAP as it can be a sign of blood pressure changes. I would go in and get checked.

evreka

@balletnerd thank you for responding. I'll ask Mr if he can take me. I'm hoping that he does and not say just wait for your appointment for Monday. 

tmk0325

@anewadventure I did not do Levonox however I just finished my once weekly progesterone injections (Makena). A one month supply was roughly $3000. A very nice lady from the company told me to call the manufacturer directly, they ran some magical numbers thing in their computer and I ended up only having to pay a $75 copay each month. My insurance picked up half of the cost and the company did something with the rest. I don’t really know for sure. Either way, Insurance sucks if you do have it and sucks if you don’t!

also. I was waiting for a new thread to start too. The pressure below is real. At my appt on a Tuesday they did the strep test and another swab and my doc said, you’re really swollen down there. I’m like you don’t say?! I’ve been telling you I’ve felt a lot of pressure for at least a month now!

failuretofly

Omg the feeling of baby trying to move while you're having a BH contraction   
Not fun!

PoeMasque

The last few days ive been having actual, painful, timeable contractions at night, meaning I’m no longer really sleeping at all (ugh), but they come and go and never get worse. I would like to think this means we are super close to meeting baby, but I know this could continue for weeks. If these are just the “mild” version of contractions I am definitely getting an epidural. 

And yes! @failuretofly baby moving during BH or any contractions is awful! At this point baby moving at all isn’t exactly pleasant! Haha. 

jlemons-2

@PoeMasque good luck with your contractions. I hope they either feel better or turn into something! 

cait5413

I feel like I am back to 1st trimester smelling issues. Not sure if I didn't notice it for a while because of the colds I've had, but the past few days my daughter's diapers make me want to vomit, and the smell from the Sharpe (labeling freezer meals) also seems soooo strong. 

failuretofly

@PoeMasque sounds like prodromal labor from what my midwife described... she said it can go on for weeks    I really hope that's not the case for you!

oldersis

@cait5413 I am right there with you. My husband was eating something in the car the other day and I had to roll the window down in 40 degree weather to get fresh air.

skc040512

@cait5413 @oldersis glad I'm not the only one! Everything is making me sick these days...

wabash15

@skcobb have you tried bamboobies for the leakage? they are very soft and low profile. I loved them. 
@cait5413 +1 to the return of the first tri nausea and being set off by smells. I nearly vomited changing DS's diaper this morning.