September 27, 2007
Fun with health insurance
Now, on Aug, 29 2007 my husband and I suffered a devastating miscarriage. Being near midnight we went to the ER. The hospital was very compassionate about our loss and was able to get us in quickly and expedited our treatment. The following day I called BCBS and informed them that we had made a visit to the ER, and was told it wasn’t necessary to call them just for ER visits, but only when we are admitted. Believing that BCBS would never make the mistakes at they did the previous and only time we have used our insurance I thought everything would go smoothly. Boy was I wrong!
On, Sep, 21 2007 I received a statement for BCBS that they were denying all of the claim. I called them and asked why they were denying the entire claim, and was told by Jane, “We do not cover ELECTIVE abortions. If you chose to terminate your pregnancy for non-health threatening reasons, BCBS will not cover it.” WTF!!!??? I asked her, “Are you saying that my records state that I had an ELECTIVE abortion, in an ER at 12 o’clock in the morning?” It was then, I think it clicked in Jane’s mind what she was dealing with and told me how sorry she was. I lost my cool and even started crying. I had a miscarriage not an abortion, and being treated in such a condescending way by BCBS really ticked me off. Thinking what an incredibly huge screw up, BCBS will be right on it trying to fix this, well you would be wrong. I was told to call the hospital and have them fax over my records stating I didn’t have an elective abortion. Who the heck can get an elective abortion in a busy ER at 12am, anyway?
And an update, with clarification:
I just got off the phone with the hospital and was told that the claim was not miscoded. The billing clerk told me that the wording clearly stated that I had had a spontaneous miscarriage and not an elective abortion. I was also informed that this is common practice with BCBS of Kansas City to deny miscarriage clams as an “elective abortion.”
On one hand this story leads a number of commenters (and readers, I imagine, myself included) to conclude that universal health insurance would be an improvement over this garbage. Others suggest that what we really need is a more competitive marketplace, with doctors and surgeons (etc.) competing for customers via price wars (because when someone’s cutting me open, cost should totally be more important than the surgeon’s track record [/snark]), and insurance should be more like car insurance, where it’s used for emergencies only, rather than preventative maintenance along with emergencies. Some people said the woman in question obviously should switch insurance companies (like we usually have a choice?); others suggested that she should be sure her policy actually covers expenses related to miscarriage (because it would be acceptable if it didn’t [/snark]).
I don’t really have anything to add; I just wanted to call attention to the story. It’s a fairly extreme example, but as you can see from the comments thread, this kind of thing happens all the time.