Is It Worth It?

That's what my husband asked me on his way out after lunch and back to work...

"Is it worth the $50 they want you to pay?..."

I have been battling insurance and doctors offices for the past couple of months... It started back on May 8th when I had the first trimester screen, recommended by my doctor,with the specialist, that also included, unbeknownst to me, a finger-prick blood test for Downs syndrome. The "positive" result that THAT test and the ultra sound combined gave me, caused my doctor to request that I consider the genetic counseling and meeting with the specialist again for a more "in depth" ultra sound. I declined then, telling him that it wouldn't make a difference, that I would carry the baby to term, regardless... I knew, by this time, that my insurance would not cover ultra sounds 100%, but only at 80%. I was confronted with THIS information when I went to the u/s on May 8th and was told I had to pay $80, that I didn't have, but had to scrape up (borrow) last minute or be charged the $25 no notice cancellation fee...

So, after my "positive" result from the first u/s, I decided INSTEAD of meeting with the specialist again I would have the basic "regular" ultra sound with the u/s tech, pay my 20%, see the baby, put my mind at rest and put it behind me. I re-iterated my decision AGAIN to the specialist nurse that called me to ask once AGAIN if i was SURE that I didn't want to see the specialist and have the genetic counseling and to make sure I understood WHAT the positive test result meant.... I scheduled my "basic" u/s for July 18.

The morning of the 18th I was feeling anxious and thankful that my husband was going with me. We sat waiting several minutes before ANOTHER nurse came and got me and took me back to her office to inquire ONCE AGAIN "WHY" I wasn't seeing the specialist and having the genetic counseling that my doctor recommended and just having the "basic" u/s? I again, reiterated to her my reasons being it not going to make a difference and that my insurance would only cover 80% and I didn't want to spend the extra $$ on something that wasn't going to change anything.

If you haven't kept up with the story, you can find it here.

So! I wait another week, and July 24th I have what i was told was the "State Program" covered u/s with the specialist and meet with the genetic counselor (that I really didn't care if I had or not, I really was focused on just wanting to SEE my baby... but was told it was all part of the deal...), and when the baby doesn't cooperate, the Specialist doesn't get all the measurements that he wanted and so asks me to return in three weeks, which I do.

So when I return on August 14 it was to COMPLETE what the Specialist Doctor started on July 24th, COMPLETEING the measurements all of which I was told would be covered under this "State Program" that I "automatically qualified for because I had a positive screening..."

"It doesn't matter WHAT your insurance covers, Mrs. P.", I was told on the 18th when I was encouraged to cancel my appointment that day and reschedule with the specialist on July 24th, the following week, "You had a positive screen and are AUTOMATICALLY covered by the State Program for EVERYTHING, including an amnio if you so choose to have, that needs to be done to monitor the baby, and will continue AFTER the baby is born if it turns out that the he or she does have Downs..."

It was shortly after this now "completed u/s" that I started getting a bill for the first session on the 24th where the baby didn't cooperate and he asked me to return. "Why" I asked the billing department...

"Well, that is your 20% leftover from your insurance"

"this was supposed to be covered by a 'State Program', why is my insurance being billed"

Fast forward to now. Now, after I have told the Doctors office for the umpteenth time that I was TOLD that it would not cost me ANYTHING and that is the ONLY reason I put off my originally scheduled u/s, I was NOT going to "eat this" and SOMEONE else would have to... and get THIS, the girl told me that the charge was for the GENETIC COUNSELING lady that I INSISTED that I really didn't care WHAT she had to say in the FIRST PLACE, but I was only interested in SEEING the baby!! It WASN'T going to matter!!!

I have called the billing office through the general line to be left on hold for over 45 minutes (both times) to receive a voice mail to which I never got a call back, twice. I got a direct number to a billing girl that I spoke with and said she would find out what was going on and she never called me back, TWICE. And when I finally got ahold of her a THIRD time she FINALLY told me that they would adjust the amount of $28.33 from the 24th appointment , but the $49-something (I haven't received THAT bill yet...) from the follow up u/s on the 14th of August could NOT be adjusted... "WHY NOT?! It was all part of the SAME "program" that I was told would be COVERED 100% back on the 18th of July when they convinced me to reschedule..." gggrrrrr....

I guess most people would say "forget it" and pay it and walk away... My husband would, at this point... Maybe to most people $50 isn't a lot of loss... But to this mom of five, $50 is a weeks worth of groceries, or medicines, diapers and toiletries for the month, gas for the van for a couple of weeks, a PAYMENT to the hospital for the emergency services I have had to take the kids in for over this past year... I can't do it... When I have to tell my kids that we can't take the trip to the zoo, or go to the movies, or I can't send them to camp or we can't go to the beach or take a vacation or even pay for sports or whatever, I just can't justify paying for something that I was ASSURED would be "taken care of" by this mysterious "state program"...

I found out when I called Miss "Blow-me-off-and-never-call-back's" supervisor this morning from HER assistant (yeah, still haven't been able to catch the one on top...) that NO "paperwork" was EVER submitted to any "State Program"... so NOW what? Do I qualify or not? No one can seem to give me a straight answer... I'll give them MY answer... I was ASSURED that I qualified BEFORE I ever cancelled my original appointment, that it would be covered and it would not cost me ANYTHING. I didn't screw this up. Someone there, did, and I'm not going to pay for it... what are they going to do? NOT deliver my baby?... maybe...*scoff*... whatever... I'm tired and this is all stressing me out...

I'm 32+ weeks in, I'm 42 years old and this is my 5th baby... I just want to crawl into a cave somewhere and let nature take it's course, at this point... Of course, I'd like to think that my family might miss me if I do that, so I guess I'll stick around a little bit longer... and wait to see if this supervisor lady is any better at returning phone calls than her supervisee... Please, God, she'll say the right thing... I told them that I go back to the doctor on the 24th next week and I really don't want to be confronted with this again... My blood pressure has been doing so well... *sigh*

So, to answer my husbands question, "Yes. It's worth it..."

It's worth it to this mom that will lay awake because she spent $5 on something that she later found she could have gotten at a different store ON SALE, using a coupon and save $4. It's worth it when you consider we already pay over $500 a month for insurance that we can't really even afford to use, when there is a $100 deductible per person ON TOP OF the 20% that you have to pay for pretty much any services that you need, but you can't really chance NOT having it... When you are a big family choosing to live on one income, "frugal" and "bargaining" becomes a way of life... a way of survival... it all counts.... It's worth it when I am able to save enough cash to take a trip or do something special and/or unexpected with the kids because it doesn't happen too often. It's worth it to see their happiness and excitement. Yeah, that's worth all of it... I'll let you know if I ever get that call back.. Rest assured, if I don't hear in the next few days I WILL be calling again... please, pray for me...