Some health insurance nightmares

Double your fun if you have twins.

Last year I interviewed two witches whose babies arrived before they got to the hospital. A part that stuck in my head was that one mom still was billed for labor and delivery, even though she neither labored nor delivered at the hospital. And that’s not even what really bugged her:

“What seriously pissed me off was that I got charged a big copay for my 12-week ultrasound, which is a standard ultrasound that had always been covered before, because the doc had checked off on my chart that I was 36 years old. Therefore, instead of being coded as standard care, it was coded as being due to advanced maternal age. I didn’t have to pay for that same ultrasound with my other two kids because I was 32 and 34. I pleaded with everyone about that but never got it changed and ultimately had to suck it up and pay.”

So today let’s talk health insurance shenanigans. I asked some witches about their most infuriating, expensive, ridiculous interactions with insurance.

Here are a few:

• I was induced with my twins on June 28. They were born at 2 a.m. on July 1. July 1 was the start of my new plan year. So I had to pay for an entire twin vaginal birth out-of-pocket.

• I had an approximately three-year-long era known as the Lexapro War. It involved "proving" that the generic didn't work for me. I feel pretty lucky to be alive. 

• Our insurance wouldn’t cover our 3-year-old’s speech therapy for stuttering because they claimed it was a “cosmetic issue.”

• Our insurance wouldn’t cover our son's twice-weekly speech therapy for apraxia because we didn't have evidence of a traumatic brain injury, even though that is only one cause of apraxia (and not even the most common one).

• We were told, about two weeks before my daughter's third open-heart surgery, that her heart surgeon was no longer in network. Heart surgeries cost around $500,000 and also, there are maybe 20 people in the country who do the procedure she needed to stay alive. It was an epic fight, but we (and our surgeon and our hospital) just kept calling and writing emails to every insurance company executive we could hunt down. They finally agreed the day before she was scheduled that they had to cover it under "continuity of care." (Because yes, it turns out, three open-heart surgeries in one child ARE ALL RELATED and you have way better outcomes if one person does 'em all!) 

  We are 95% sure the reason this heart surgeon was suddenly "out of network" with our insurer is because we'd already racked up $2 million in claims by this point. Our employer was dropped by United Healthcare right after they paid out her first million, and the employer was told it was either that or raise everyone's premiums an astronomical amount. Then Cigna took over, we racked up another almost million, and suddenly the surgeon we needed was out of network. It's a shady backdoor way of getting around covering people with expensive preexisting conditions. Like babies who are inconveniently born without all four chambers in their hearts.

• When I had my son I had severe preeclampsia/HELLP syndrome and went into kidney failure. They rushed me in for the obviously unplanned C-section to save our lives. The anesthesiologist on-call was out of network. Insurance ruled it was non-emergency, and I guess I should have asked if the anesthesiologist took my insurance and then waited while the hospital called in a different one? It cost me $8,000, which I paid on a payment plan after getting regularly harassed by an aggressive collections agency.

• My husband had to have an emergency appendectomy in Uganda while there for work. The health insurance company fought us over our sparse documentation (because Uganda), including that we didn't have anything to show that the surgery was necessary. Doesn't everyone get elective appendectomies in Uganda these days??? Also, the entire bill for surgery and hospitalization was like $3,000, which is so much less than it would have been in the U.S. So they were really being stingy bastards. But, we did win! It took almost a year.

• We have “good” insurance, which refused to cover the rental of a commercial breast pump for me when I had mammaries full of milk and three premature babies in the NICU. I suppose they’d rather pay for a postpartum woman in the ER with a severe breast infection and three preemies with necrotizing enterocolitis from surviving on formula. In his spare time (with infant triplets), my husband spent months fighting for coverage of a few hundred dollars because on principle it was the right thing to do. This was obviously before Obamacare.

• One annual dermatologist appointment cost me $275 because I mentioned a concerning mole, which my insurance deemed was out of scope and therefore counted as a consultation. After I fought it, they still billed me because "That’s what you talked about...." What ELSE should I talk to my dermo about, for the 6 minutes I'm in her office once a year? So fucking annoying. All of it is a scam. I am very convinced that the insurance CEOs are decrepit old white men Scrooge McDucking into a pile of money. All I can hope is that they get an infected paper cut from all that dirty money and die a horrific, festering death.

• The hospital where I had my twins was contracted with my insurance, so it covered the actual stay and the nurses. But the doctors who staff the NICU—who have been hired to do so by this hospital—work for a practice that is not contracted with my insurance company. So despite the fact that I don’t get any say in which doctors staff the NICU (which I had to use in order to keep my sons alive), I had to pay for those doctors and anything they wanted to do.

• I started using chemotherapy about 14 years ago to suppress my immune system. After several years, our insurance company deemed this treatment experimental and denied coverage of the drug. To make matters worse, they sent me a bill for several rounds of chemotherapy that I had prior to this decision, totaling well in excess of $100,000. So the message was: We want you to die and we want you to die broke.

• I had twins, and for a good year after they were born, whenever we took them to the doctor, insurance would deny one of the claims because they thought it was a duplicate claim sent in error. Every. Single. Time. WTF.

• I have a funny old-timey insurance story. When my cousin was born, 55 years ago, he came faster than expected and was born in a taxi on the way to the hospital. But for some reason the insurance reimbursement was for a full labour delivery, and it was sent as a personal cheque to my aunt for her to pay the much-less-than-expected bill. She spent the remainder on a mink coat.

Now your turn—share in the comments or on Twitter. Sadly, I know you won’t let us down.

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I hope you enjoyed today’s issue of Evil Witches, a newsletter for people who happen to be mothers. Did you know that tomorrow this newsletter will be one year old? If Evil Witches has made you smile or nod or or forward or share or given you a good idea, please consider becoming a paying subscriber to support the work (and get extra member-only content!)

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