Monday, September 8, 2008

Pregnancy, Insurance and "Specialists", Oh My!!


Okay, I made an "executive decision" and cancelled my appointment with the "Diabetic Counselor" this morning. Now don't get me wrong. I think that Gestational Diabetes should NOT be taken lightly, and I won't treat it as such... but as I recall (and keep in mind that this is baby #5 for me...) that my "numbers" have always been a little "high" but the previous doctor has always reassured me that it was not significant enough to be worried about... Keeping an eye on my blood pressure always seemed to be the greater concern, and THAT has been really good! I mean, even my current doctor told me that it wasn't too bad, and I should watch the sweets, increase my protein and walk more. Simple instructions, I can handle that, thanks, Doc! But THEN it was the Diabetic counselor that accosted me on my way out to "make an appointment" (Like I have time and babysitters for MORE appointments!) so that she could take an hour of my time to counsel me on diet and how to use the glucose monitoring machine... is all this REALLY necessary?? Are my numbers SO significant that it warrants pricking my fingers after EVERY meal? When I spoke with nurse friends AND a mid-wife friend of mine they all told me that the numbers didn't seem THAT significant... "watch your sweets, eat more protein and take a walk!" They all said it!!

On top of this, I was on the phone with the Doctors billing department this morning, as well, questioning WHY I was being charged for services that #1 I was told would be COVERED by some "State program". She told me that that was the charge for the "genetic counseling"!!! I told her that I didn't WANT that in the first place!! Tate it wasn't going to matter WHAT she told me in GC. The ONLY reason I agreed to it was because THEY (the doctors office) told me that because I had a "positive" result on my first trimester screen that I AUTOMATICALLY qualified for the "State Program" and the genetic counseling was part of it, so it was covered... Now they're telling me it's not and so I have to pay for it... gggrrrrr... I don't think so!! I won't take this quietly, that's for sure!!

I try to tell these people, look, this isn't my first 'rodeo'. I have 4 previous little blessings at home so it's not like I can just drop and go for every appointment that they think I need to see a specialist for. And because we live on ONE income, and we are a family of 6, soon to be 7, 20% is A LOT OF MONEY for us to contribute for these expenses that aren't going to change the fact that we are still going to have this baby!! See?! Feed my family, or pay 20% of a bill that isn't going to change anything, but only give me more information that I may or may not want to hear...? hhhmmmm....

*sigh* So, the billing girl that I spoke with FINALLY this morning (I've been trying to contact her for 2 weeks, leaving at least 3 messages that were never returned) told me that probably 85% of the time, insurance companies WON'T cover the cost of the diabetic counselors.. great! Sorry, Doc, I don' t mean to be an obstinate patient here, but I just can't do this anymore... too much "counseling" is making me nuts! I have 4 kids at home, I'm WAY pregnant and WAY hormonal. I homeschool, and trying to potty train a 2 year old, I run errands and try to keep my home as orderly as I can and I don't have time OR patience to measure and monitor food and machines... I feel fine, my weight has been fine, no significant weight gain.. in fact I've lost 4 lbs. since this latest "find" because they have made me absolutely paranoid about eating... I WILL watch the sweets and the carbs, and I WILL eat more protien and walk more. My blood pressure is better than it has been in a long time (116/66 last night) but I just can't do it anymore... I am down to my last few weeks of pregnancy. I just want to be left alone, honestly... I initially chose this new Doctor so that I could feel confident in having a specialist if needed, in the event that I had problems with my BP again, as has been my problem with the previous pregnancies... But enough is enough.... I'm going to trust God on this one... I still like my doctor tremendously, but it's all the "extra's" that want to get their hand in the pot, so to speak...

So, now I don't know about the insurance. They are a whole other confusing problem for me... I mean, our family is relatively healthy, thank you, Jesus! So we don't use our insurance a whole lot. We pay close to $600/month for insurance that covers most things 80/20% , with a $100 deductible per person per calender year. So, yeah, we pretty much pay for insurance we can't really afford to use... They initially told me that ALL maternity was covered 100%. Now they tell me that labs and x-rays are 100% up to $350, after which it goes to 80/20. AND the ultra sounds are being billed 80/20 because they are "major medical". "But", i tell them, "I wouldn't be getting an u/s if I wasn't pregnant!". "Well", they responded, "It's not notated under maternity, so that's why it falls under major medical..." THEN they told me, "Mrs. P, you will need to refer back to your information packet as to what is covered and how..."

Now, I don't know about you, but TALKING with the insurance people over the phone is confusing enough, but they it REALLY irritates me when they want to refer to the plan book!! Talk about TOTAL Greek!! Do they honestly think that regular "Jane Doe" can actually make heads or tails of that?? Please.... That's what I told the girl, and she giggled... she knew that the request was as dumb as it sounded... Unless you deal with this stuff all the time, it makes NO sense! And they change stuff all the time!! I thanked her for her time and told her that I had to stop for now. Anymore and my brain was literally going to explode... I'm not sure what I'm going to do, because I really don't want to take the word of my insurance that "this" amount is what i owe... I need to go back and see if I can get any of these other bills re-marked and re-sent as "maternity" so that the insurance will cover them... such a pain....

Okay, enough griping... there are people worse off in this world... and I think I need a nap... : )

4 comments:

Tammy said...

I don't blame you at all Em. Like you said, enough IS enough! All that talk and info would just stress you out needlessly. You take care of you, the best way you know how. I'm sure you'll do fine.

If you ever need me to watch the kids or anything, just let me know. : )

Lee said...

Thanks, Tammy! You're a sweetie! You know NOT what you are volunteering to do! lol!!

Tammy said...

Yes I do!! hehe Your kids are great, and get along with mine just fine. Bring them over anytime!!

Andrew said...

Hello Lee -

Sorry to hear about your struggles with Insurance policy. Considering your experience with pregnancy and raising a family, I would be interested in hearing some of your tips for saving money on behalf of State Farm.

State Farm encourages (and helps) policy holders to analyze their finances prior to a new family addition. However, we are always looking for suggestions from people with tangible experience like yourself.

Hope you are able to remedy the problems and congratulations.

Andrew