Thursday, October 8

Lesson #3 - Pregnancy Does Not Require Immediate Attention AND It Is A "Pre-Existing Condition"

Oh baby...LITERALLY! Now, before you get distressed by the title...don't!! As with everything, there are pros AND cons. Pregnancy should really be considered another full-time job. After I found out that I was pregnant, 10 home tests later, I called my ob/gyn for an appointment (apparently I felt that a nurse doing a pregnancy test would be far more accurate than the 10 I took at work). So, I got on the phone with the receptionist at the ob/gyn office - whom I had just seen for my yearly appointment a few weeks prior. She sounded a little shocked on the phone - and who can blame her?! My doc's wonderful receptionist was able to fit me in for an appointment - in 5 weeks!!! I'm sorry, but 5 weeks?!?! Apparently my pregnancy isn't considered something that needs immediate attention.

Well, five weeks came and went and finally it was the morning of my appointment. Them man and I walked into the office - part excited, part concerned - and I proceeded to sign-in. The receptionist opened the window, looked at me and said, "Didn't we just see you a few weeks ago?" I wanted so badly to bark back, "No, it was almost 2 months ago because apparently my being pregnant isn't a matter that needs to be confirmed right away." Alas, I held back and just laughed quietly to myself.

When my name was called, I walked back to meet my fate. The bubbly nurse was almost too bubbly...and honestly, I wanted to punch her in the face. Again, I felt it necessary to keep that to myself so - against my better judgment - I did just that. I was directed to pee in a cup and even though I told the nurse, a number of times, that I had already taken 10 home tests - she forced the cup on me anyways.

After getting my weight, blood pressure, I was whisked back to an exam room and told to put on the gown. On the way to the exam room, the nurse asked if the man wanted to come back as well. "Can he take my spot," I asked...unfortunately, her answer was no. The doctor finally came into the room and - surprise, surprise - the test was positive. A quick, and VERY intrusive, exam later and off we went. The man and I were equipped with a prescription for pre-natal vitamins, numerous supplements and the ever popular - first ultrasound!

Fast-forward a few weeks when I get the statement from my insurance company. The statement hadn't even fully loaded on my computer (I get them via email - how green of me!) before I was on the phone with my ob/gyn's office. As I was reviewing the document I noticed that the "patient responsibility" for my most recent ob/gyn appointment was an un-godly amount! I requested (read: demanded) to speak with a billing specialist to get this issue solved. "It looks like your claim was denied by insurance," the billing demon said to me. I asked how that could be since my insurance covers 100% of pregnancy costs (which is awesome compared to most plans). The demon said she wasn't sure what the mix-up was, but they did submit the paperwork correctly. After politely telling the demon that I would not be paying the bill at this time, I quickly got the insurance company on the phone to give them a piece of my mind. I spoke with a very pleasant insurance goddess whom I gave permission "to view my records" so that this misunderstanding could be cleared up. She opened my account and began to rattle off billing terms and words that were far beyond my wealth of knowledge on the matter. She confirmed that my insurance covers 100% and then decided she would transfer me to an insurance guru who would be better equipped to solve this misunderstanding. The guru took seconds to get on the line before saying that the reason my claim was denied is because my pregnancy was considered a "pre-existing condition**"...I'm sorry, did you say "pre-existing"?!?!

** The definition is as follows: a health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy.

Never mind the fact that my newest insurance policy began on June 1st, but I didn't get pregnant until November!! That is SOME pregnancy...and lord knows something should have been done about it by now!! The guru then informed me that the ob/gyn paper-pusher had filled out the form incorrectly. Wait a minute...I just spoke with the billing demon, who ensured me that the forms had been properly filled out on their end. Turns out - the demon misspoke. The paper-pusher had listed my pregnancy as a "secondary condition"...not sure how a pregnancy constitutes a "secondary" as opposed to a "primary" condition, but in her mind - it did.

So, back on the phone I was with the billing demon at the ob/gyn to sort out the paper-pusher's mistake. The billing demon finally (after 35 minutes on the phone) conceded to the paper-pusher's mistake and said the form would be filled out - correctly - and re-submitted to the insurance company. Finally, 2 weeks later, I got an updated insurance statement which reflected the company paying for my ob/gyn fees. Thank goodness!!


Kmama said...

I work in HR, so I understand benefits more than the average joe. I cannot imagine what the average joe goes through and pays when they shouldn't have to. It's ridiculous!

The Princess of Sarcasm said...

Oh dear Lord! If I had to deal with that when I was pregnant I woulda been a ball of tears!!! Morons......

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