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Healthcare Penalty for Epidural

bazingaabazingaa member
in May 2014 Moms
Wondering if I'm the only one....

I had grand plans for a natural childbirth, but we ran into complications and I ended up getting an epidural. It was a hard decision at the time and I admit I was disappointed. But now? Whatever. LO arrived safely and that's all that matters. However, last week I got a $500 bill from my insurance company for having a medical procedure done without pre-approval. That's right.... they sent me a $500 penalty because I had an epidural during childbirth!!! Are you f-ing kidding me?!?! Considering I had wanted a natural birth, getting that penalty was like a slap in the face. We talked to the insurance company and they stood by the penalty, but agreed to send to the claims department for "re-evaluation". We haven't heard back, but it didn't sound promising that it would be dismissed. 

I can't be the only one that ended up having an epidural when initial plans were to go without. Did anyone else get charged a penalty or is my insurance company just extra special? 
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Re: Healthcare Penalty for Epidural

  • mrsbtobe20122mrsbtobe20122 member
    Kimbus22 said:

    I've had two epidurals and just had to pay my normal 10%.  But my insurance company doesn't require preapproval for most things.  If they did, I would have had it authorized ahead of time even if I didn't think I was going to need it.

    This.

    But it sounds pretty ridiculous.


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  • bridetobe9132013bridetobe9132013 member
    @comicsans‌ same here. Along with morphine.
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  • lfleming84lfleming84 member
    edited September 2014
    @bazingaa‌ I would totally argue that with the insurance and submit an appeal. Did you pre-register with the hospital? I did that and called my insurance to let them know my baby was going to be delivered there soon and wanted to make sure all authorizations were in place. You don't know what you will need going into labor and if you were registered with the hospital they should have been ready for anything. Did you take any birthing classes? I am a broker in CA and have dealt with appeals many times. What state do you live in?
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  • spinsoffresonancespinsoffresonance member
    That sounds ridiculous, what if you had ended up with a c-section would they have charged you the whole $50k because it wasn't preapproved?? You went in for childbirth, shouldn't everything that falls within usual childbirth procedures be covered?
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  • bazingaabazingaa member
    lfleming84 said:
    @bazingaa‌ I would totally argue that with the insurance and submit an appeal. Did you pre-register with the hospital? I did that and called my insurance to let them know my baby was going to be delivered there soon and wanted to make sure all authorizations were in place. You don't know what you will need going into labor and if you were registered with the hospital they should have been ready for anything. Did you take any birthing classes? I am a broker in CA and have dealt with appeals many times. What state do you live in?
    Yes, we pre-registered with the hospital. I also talked to my insurance ahead of time to make sure the hospital was in network. Did take birthing class, not associated with the hospital though. We switched to my husbands insurance this year as I knew I would be changing jobs and there would be a lapse in coverage if we went with my employer.  Never had to deal with pre approvals before, so it never crossed my mind that it would be an issue. We live in ohio. 
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  • bazingaabazingaa member
    lica001 said:
    That sounds ridiculous, what if you had ended up with a c-section would they have charged you the whole $50k because it wasn't preapproved?? You went in for childbirth, shouldn't everything that falls within usual childbirth procedures be covered?
    That was the first thing I said to my husband... Thank God I didn't need a csection!
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  • bridetobe9132013bridetobe9132013 member
    @comicsans... I loved the morphine while it worked. I also had diladid (sp?), which was nice!
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  • britabbritab member
    That's crazy! So sorry! DD and I were on different insurance plans. My family doctor delivered her and then checked on her the next day. Since my doc wasn't in DD's network we had to pay $500. What? We should have called a different doctor to come instead of the one that was there and delivered the baby?
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  • bazingaabazingaa member

    britab said:
    That's crazy! So sorry! DD and I were on different insurance plans. My family doctor delivered her and then checked on her the next day. Since my doc wasn't in DD's network we had to pay $500. What? We should have called a different doctor to come instead of the one that was there and delivered the baby?
    Ridiculous! But from the insurance company's perspective, maybe you should have kept your legs closed until your doctor came in. 

    Totally joking, obviously....
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  • lfleming84lfleming84 member
    Okay in that case you did everything in your power to prepare and get the necessary approvals in place. Please reach out to me if they do not waive the $500 pre-auth fee after the review. I am not licensed in Ohio but most of these practices carry over from one state to another. This is definitely something to appeal and you have a great case for it in my opinion.
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  • Nikkipal82Nikkipal82 member
    I'm sorry this is happening. Years ago, I got charged thousands of dollars for an ambulance ride, because they said rides over 50 miles required prior approval. I was in shock, fighting for my life at the time, and I had to be transported 90 miles emergently. I called and complained, and they removed the charge. Sometimes I wonder if they just put in these charges because most people wouldn't think to look at them and argue about it. I hope your appeal goes through.

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  • ladywolf1313ladywolf1313 member
    I would think it would be covered for it being a medical emergency. It's not like you could have stopped in the middle to call them to get it approved a head of schedule. 
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  • usernewnameusernewname member
    That's silly. Because you can pre plan your complications you know.
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  • pistolpackinmommapistolpackinmomma member
    Are you required to get the pre-approvals? I know one of our health insurance options was to "self manage" it and in turn we would have been responsible for calling ahead of time for everything. If your dr was to do it then I would be shocked that they didn't get pre-approvals for any possible scenario including an epi. Definitely read your policy and see what you are personally responsible for and fight it.

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