I never thought that I would find myself in a fight with an insurance company. In fact, if you’d asked me a year ago if I was more likely to fight an insurance company or jump out of a plane, I would have asked to borrow your parachute. Today it’s a whole new ballgame. I haven’t mentioned anything about my fight with Blue Cross Blue Shield on my blog ‘cuz I just haven’t wanted to go there yet. Perhaps I have a “compartmentalize” complex. I just wanted to keep the fun stuff (like blogging) separate from the not so fun stuff. Unfortunately, now the not so fun is creeping it’s way into every facet of my life and I’m finding it oozing out of every corner. It also occurred to me that holding back and not sharing my story wasn’t going to do anybody any good, except maybe Blue Cross Blue Shield. On the other hand, sharing my story might actually be very helpful to other moms and families that find themselves in a similar situation. So here’s the 411 on my new part-time job: fighting Blue Cross Blue Shield.
My daughter Lily was born at 5:05 a.m. on Monday, August 10, 2009 via a medically necessary cesarean section. After pushing for an hour and a half my doctor recommended that Lily be delivered via cesarean because Lily was failing to descend and was exhibiting non-reassuring fetal heart tones. When my doctor attempted to “perk” Lily up there were no changes in her condition. My doctor believed that Lily was in distress and even if she was able to deliver Lily’s head, it might be possible that Lily’s shoulders would get caught. The doctor suggested that this could result in Lily being born with a “bum” arm. My husband and I agreed to follow our doctor’s recommendation and proceeded with a cesarean section.
We are now in the process of appealing Blue Cross Blue Shield of Arizona to cover Lily’s c-section on August 10, 2009. BCBSAZ no longer considers “fetal distress” as a complication of pregnancy and therefore has decided that they will not cover my c-section. My husband and I paid out-of-pocket $8,000 for pre-natal care and a normal vaginal delivery. We understood that our health insurance policy with BCBSAZ did not include maternity but we believed it did cover a cesarean section if it was medically necessary.
According to BCBSAZ our policy was changed on October 1, 2008 to no longer cover cesarean sections due to fetal distress. While we did receive notice in the mail from BCBSAZ that our plan was changing we did not understand that if our baby was in trouble they wouldn’t cover a cesarean section. We believed that if our doctor deemed it “medically necessary” it was medically necessary and our insurance would “kick in”. Boy were we wrong.
We now have approximately $30,000 in outstanding bills that we are appealing, including approximately $17,000 for the cesarean section and resulting hospital stay.
I’m more than happy to pay my “fair share”, I just want my insurance company to step up to the plate and do what I believe is the right thing. The only reason I can see for the change in the BCBSAZ defined “complications of pregnancy” is monetary. I understand that Blue Cross Blue Shield is in business to make money. Every business is in business to make money. But shouldn’t health insurance companies be in the business of insuring our health too?
Taking on this fight is costing me oodles of time and significant amount of money. It’s taking me away from my business and impeding my ability to make money as a freelancer. Most importantly and most upsetting it’s taking me away from time that I should be spending with Lily.
If you’d like to know more about my fight with Blue Cross Blue Shield of Arizona you can visit the website I’ve set up at www.lilysmom.com. Please share my story with your friends and family and be sure that you understand your own insurance and what is and is not covered. You can send any questions about my fight to elizabeth(at)lilysmom.com… you can send parachutes to me too, since I’d really rather be jumping out of a plane than having to fight an insurance company.
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