Chit Chat Mom» Lily’s Mom http://www.chitchatmom.com One first time mom that can't stop blogging about it! Wed, 31 Mar 2010 14:43:42 +0000 http://wordpress.org/?v=2.8.6 en hourly 1 Just Because It’s Your Policy, It Doesn’t Make it Right http://www.chitchatmom.com/2010/01/28/just-because-its-your-policy-it-doesnt-make-it-right/ http://www.chitchatmom.com/2010/01/28/just-because-its-your-policy-it-doesnt-make-it-right/#comments Fri, 29 Jan 2010 00:47:33 +0000 Chit Chat Mom http://www.chitchatmom.com/?p=834 I received an email from BCBSAZ this week regarding my appeals. They wanted to let me know that after an in-depth review of my case, “Unfortunately, we are unable to provide coverage in this case, as our contracts for individual policies exclude maternity coverage except in very specific circumstances.”

Just because it’s your policy, it doesn’t make it right.

Interestingly enough, it seems that if I’d needed a cesarean section prior to October 1, 2008 it would have been covered. The revision to Blue Cross Blue Shield of Arizona’s definition of “complication of pregnancy” to no longer include cesarean sections “during labor” seems to be a decision driven by the bottom line, not what is best for their patients. If Lily hadn’t been delivered via cesarean it’s a definite possibility that BCBSAZ could be paying for Lily to have physical therapy right now. Hmm… which is better for the patient, a cesarean section to avoid future complications or physical therapy for an infant?

BCBSAZ has offered me a meeting with their Medical Director. That should be interesting.

]]> http://www.chitchatmom.com/2010/01/28/just-because-its-your-policy-it-doesnt-make-it-right/feed/ 0 Next Step in My Insurance Fight: A Hearing with the Office of Administration http://www.chitchatmom.com/2010/01/13/next-step-in-my-insurance-fight-a-hearing-with-the-office-of-administration/ http://www.chitchatmom.com/2010/01/13/next-step-in-my-insurance-fight-a-hearing-with-the-office-of-administration/#comments Thu, 14 Jan 2010 01:57:51 +0000 Chit Chat Mom http://www.chitchatmom.com/?p=812 My husband and I came home today to receive a letter from the Department of Insurance that stated that the services related to my cesarean section are not covered under the terms of my policy.  The Department of Insurance found that the services I received were “not related to a complication of pregnancy as determined by BCBSAZ.”  So our next step is to request a hearing with the Office of Administrative Hearings.  We have 30 days to request a hearing and the office then must notify us of the hearing date at least 30 days prior to the scheduled hearing.

This is of course not what we had hoped for, but we’re going to press on.  In addition to the more than 30 letters I have already sent to my local and state representatives I will now also be writing to Speaker of the House Nancy Pelosi and First Lady Michelle Obama.  I’m thinking for good measure I should also write to Oprah.

For more information about my fight against Blue Cross Blue Shield of Arizona, please visit www.lilysmom.com.

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