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October 2015 Moms
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WTF . . . Insurance Rant

MamaOwl15MamaOwl15 member
in October 2015 Moms
I've mentioned a couple of times in here about my Medicaid coverage got terminated and I had to reapply . . . Well the good news is that I got my coverage back. The bad news is, if I understand the letter I received correctly, it doesn't become effective till September 1.

I'm like WTF? The reason I qualify for Medicaid is because I am pregnant. And I'll be 30 weeks on Tuesday, so I'm supposed to be starting the every two weeks OB visits. I sti haven't had the GD testing because I was waiting on my insurance situation to be straightened out. In fact, this Wednesday marks 6 weeks since I've seen my OB.

Thankfully my baby girl seems to be doing OK, but what if she's not? I have this fear I'll go in for an appointment in early September and they'll take my cup o' pee and find protein in it, or they'll measure my BP and it'll be high and I'll be sent to L&D. I have a higher risk for pre-e because I had it with my son.

I can call around and get more info on Monday. Hopefully the whole third trimester of pregnancy thing means I won't have to wait till 9/1 to have insurance and see my doctor again. Or maybe my OB's office can wait till then to bill for services.

I can't afford to pay out of pocket as DH and I had to use ALL our extra money to pay for repairs on the car, and then DH had a couples low weeks at work. So there's no wiggle room in our budget right now.

If anyone else has insurance-related frustrations to vent, feel free to share them here. We can use this thread to commiserate about healthcare costs.

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Re: WTF . . . Insurance Rant

  • anorthroanorthro member
    Do they retroactively cover anything?
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  • JaqiDec04JaqiDec04 member
    Medical in California will retroactively cover for 90 days.

    Also, call your doctors office. My doctors office global bills at labor and delivery, so the appointments aren't even billed to my insurance. So as long as I have insurance when I go into labor, I'm good.

    I'm sorry for all the hassle. I went through it with DD and it is so rough.
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  • smlowe9311smlowe9311 member
    I'm so sorry for what you are going through! My (minor) insurance complaint is because I work for the school district our open enrollment/new start date for costs of things (I don't know what it's technically called) starts over October 1st. Dd2 is due 10/4. If she comes on-time or late it will cost us an extra $1,000 out of pocket on top of the almost $1,000 we already had to pay the OB/GYN office. I know I can always induce but I just don't know if I want to do that and risk all the other complications that can come with it. I mean, she is more important than $1,000!
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  • MamaOwl15MamaOwl15 member
    smlowe9311 said:

    I'm so sorry for what you are going through! My (minor) insurance complaint is because I work for the school district our open enrollment/new start date for costs of things (I don't know what it's technically called) starts over October 1st. Dd2 is due 10/4. If she comes on-time or late it will cost us an extra $1,000 out of pocket on top of the almost $1,000 we already had to pay the OB/GYN office. I know I can always induce but I just don't know if I want to do that and risk all the other complications that can come with it. I mean, she is more important than $1,000!

    That sucks. Maybe she'll come 4 days early on her own? :-)

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  • MamaOwl15MamaOwl15 member
    JaqiDec04 said:

    Medical in California will retroactively cover for 90 days.

    Also, call your doctors office. My doctors office global bills at labor and delivery, so the appointments aren't even billed to my insurance. So as long as I have insurance when I go into labor, I'm good.

    I'm sorry for all the hassle. I went through it with DD and it is so rough.

    I plan to contact DMAS and find out for sure when my coverage starts, and also call my doctor to see what they can work out. When I got Medicaid before, it wasn't retroactive. I don't think . . . But I applied that time in August and was covered for a Sept 21 ER visit and a Sept 23 OB visit when I had a miscarriage.

    Just the thought that they'd delay coverage for a pregnant woman, especially in her 3rd trimester, for any length of time is baffling to me.

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  • Rachel623Rachel623 member
    I pretty much hate my insurance. It's going to cost $3500 out of pocket to have the baby. I pay about $600 myself and my office pays another $1200 or so every month to cover me, my husband, and my daughter. Healthcare is way too expensive and it seems like insurance companies make way too much money.
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  • smlowe9311smlowe9311 member
    MamaOwl15 said:

    smlowe9311 said:

    I'm so sorry for what you are going through! My (minor) insurance complaint is because I work for the school district our open enrollment/new start date for costs of things (I don't know what it's technically called) starts over October 1st. Dd2 is due 10/4. If she comes on-time or late it will cost us an extra $1,000 out of pocket on top of the almost $1,000 we already had to pay the OB/GYN office. I know I can always induce but I just don't know if I want to do that and risk all the other complications that can come with it. I mean, she is more important than $1,000!

    That sucks. Maybe she'll come 4 days early on her own? :-)
    Haha I'm hopeful. Dd1 was 10 days early and perfectly happy and healthy so maybe we'll get lucky ;)
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  • MamaOwl15MamaOwl15 member
    Rachel623 said:

    I pretty much hate my insurance. It's going to cost $3500 out of pocket to have the baby. I pay about $600 myself and my office pays another $1200 or so every month to cover me, my husband, and my daughter. Healthcare is way too expensive and it seems like insurance companies make way too much money.

    Healthcare is absurdly expensive. I used to pay $400/month for my employer-sponsored coverage for my family (double what I paid for just DS and me before DH turned 26!). When I left my job, my former employer told me COBRA would be over $1200/month! At that time, that was almost our entire income. And this was the most basic level of coverage offered, with somewhat high deductibles - we just didn't go to the doctor unless it was absulotely necessary.

    However, health insurance is a necessary evil, if you will. The cost of an ER visit, before you're even seen by a doctor or given any X-rays or tests, is upwards of $10k. I came very close to finding this out the hard way several years ago when I was hit by a car. Fortunately the COBRA coverage I had then was retroactive to the date my previous insurance ended, so I was covered.

    I agree the insurance companies are making too much money. I know doctors charge a lot for their services, but they have to . . . Between the cost of their equipment and office space, liability insurance, and taking home enough salary to pay their loans from medical school . . . Yeah they make good money but at a cost.

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  • alinic916alinic916 member
    My insurance rant is about pediatricians!!  Our Tier 1 only covers 2 pediatrician groups, one I've heard is horrible and the other is on the other side of the city (25 minutes away!!).  So outside of wellness visits/immunizations, which are free, I will be paying a higher deductible and coinsurance because the hospital I work for isn't affiliated with the Children's Hospital!!!  Only the Children's Hospital will see kids/babies in the Emergency Room or admit them.  All of the other hospitals in the area do not offer any pediatric services, which is kind of ridiculous!
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  • SarahAnne1101SarahAnne1101 member
    I know in Georgia if you are approved for Medicaid benefits and you are pregnant, it is retroactive for 3 months prior to the date that you applied. Hopefully there is a loophole for that. 

    @aprosch - I understand your frustration. Our local two hospitals 9 one 10 minutes away and one 30 minutes away) have no pediatric services. not in emergencies even. They will stabilize the child to the point of being stable enough for ambulance transport, and then they have an ambulance take the child the hour drive to the closest Children's hospital. I've had to go through that so many times, when my son wasn't stable enough for me to get him to the Children's hospital, so had to take him to the local hospital to have them do an Er to Er emergency transfer. There was even one time when he started to deteriorate quickly in the ER and they had to call an ambulance to come to the hospital because they didn't have a toddler sized intubation tray... 
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  • JessicaS0914JessicaS0914 member
    Rachel623 said:

    I pretty much hate my insurance. It's going to cost $3500 out of pocket to have the baby. I pay about $600 myself and my office pays another $1200 or so every month to cover me, my husband, and my daughter. Healthcare is way too expensive and it seems like insurance companies make way too much money.


    My premium is higher, my out of pocket is higher, and I have what's considered a "Cadillac" plan. Because I'm told I can afford it.
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  • MamaOwl15MamaOwl15 member
    Anyone get insurance through the healthcare marketplace? Not to get all political, but after seeing what the premiums are, even for an individual with a high deductible, I decided the "affordable care act" was a misnomer. Thankfully, my husband qualifies for a tax credit for his insurance, but I feel bad for the families who don't!

    @aprosch, that's really frustrating, I'm sure! There's only one hospital you can take your child to? That sucks . . . I would think all hospitals should at least have a pediatric ER, even if you have to transfer elsewhere to get more specialized treatment.

    @SarahAnne1101, I live in VA, and at least in my city, Social Services is terrible about communication with clients. I don't recall ever hearing anything about Medicaid being retroactive. However, the last time I applied and received Medicaid, it was August 2014, and I was covered for a couple doctor visits in September . . . And this was after getting a letter that said my coverage under an MCO would start October 1. Based on that, I'm thinking I can probably get in to see my doctor in August.

    But this cloud has a silver lining . . . By having to reapply for Medicaid, I was able to switch MCO's. So I signed up for the one that's listed on the Medela website as covering the pump I want! (Plus it's the same parent company that my husband's insurance is through, which is affiliated with the hospital I was already planning to have my baby at and will be accepted by my current OB).

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  • rue:Drue:D member
    @smlowe9311 open enrollment is when you can enroll/make changes to your policy that become effective at the start date of the next year of the policy. So you really should clarify with your company what the date actually is. If Oct 1 is when open enrollment begins, your plan year probably won't start until December 1 or January 1 so you'll still be under this year's deductible. My company does open enrollment from the end of October through the end of November, but any changes made are not effective until January 1 when the plan year (and thus deductible) resets.
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  • alinic916alinic916 member
    @MamaOwl15 you would think the ERs would treat children, but no! I pass 3 hospitals just to get to the children's hospital!
    @SarahAnne1101 that's so scary to think about! Hope I never have to be in that situation,or any of the rest of us!
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  • intheversaintheversa member
    I really wish I could help you with Medicaid but I was strictly commercial insurance when I worked for UHC.

    See what they say on Monday, maybe given that you're in your third trimester they can work with you.

    To clarify on some other posts, you're doctor can't delay billing for a couple of days and bill for a day that's different from when you were seen. Well he can, but he could get nailed for fraud which will be a major pain for both of you. He also can't global bill since you had a break in coverage, he will have to split your bill based in when you were seen. I fixed OB'S claims all the time for splits in coverage.

    See what they can do for you. I really hope they can work something out and not leave you in a rough situation.
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  • leighann1leighann1 member
    rue:D said:
    @smlowe9311 open enrollment is when you can enroll/make changes to your policy that become effective at the start date of the next year of the policy. So you really should clarify with your company what the date actually is. If Oct 1 is when open enrollment begins, your plan year probably won't start until December 1 or January 1 so you'll still be under this year's deductible. My company does open enrollment from the end of October through the end of November, but any changes made are not effective until January 1 when the plan year (and thus deductible) resets.
    Unfortunately, because teacher contracts run from August-July for the most part, many times the health insurance plan year will begin in the fall. My district used to do this as well and just recently switched to a calendar year plan, with new plans beginning in January. We used to begin on October 1, too, though. 

    @MamaOwl15, I'm really hoping you get retroactive coverage because that is CRAZY. Prenatal care should not be a "luxury" in this country. Ridiculous. If not, is there anywhere you can go that will charge you on a sliding scale, like a clinic or something? Good grief. 
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