perinatal loss-insurance won't pay - Health Insurance Issues Message Board

angelb49 · 09-22-2003, 12:05 AM

Hi, I have a question for anyone out there who may know what to do. Here's my story:
I became pregnant in December of 2002 after only 1 month of trying-we have a 2 year old and decided it was a good time to try for another child. The pregnancy progressed to 4.5 months with regular prenatal care. I was then told my AFP results came back high for a neural tube defect. We were devastated, but had heard of children who had had operations that were successful in repairing the damage, allowing them to lead almost normal lives. We went to our 18 week ultrasound and were told everything was fine, and it was a boy. However, when we arrived home 2 hours later from baby shopping, there was a message from our OB telling us to meet her at the hospital right away. They did another ultrasound and my worst nightmare came true. Not only did my baby have spina bifida, but he also had a chiari malformation of the brain, missing septal wall of the brain, kidneys that didn't work which was causing him to constantly vomit the amniotic fluid he swallowed back up, malformed intestines, a keyhole bladder, hydrocephele, the list just kept getting longer and longer. At the end they told us our baby was dying, slowly, and that he would most likely be dead by the beginning of the third trimester. I had twice the amount of fluid I needed already, and they were worried about my health as I had already been horribly sick throughout the entire pregnancy. I asked if there was any possibility for me to carry the pregnancy to term. I was told that even if I did, he would die hours after birth. My husband and I had to make the hardest decision of our lives, and so we set our son free. I gave birth to him and we had him cremated and put in a little urn for us to keep. There is no way this baby was ever not wanted, but that's exactly how the insurance company is making us feel. They consider the whole thing unethical, so they are refusing to pay for a dime. I was told if I became seriously ill due to continuing the pregnancy, my hospital bills would have been paid for. If worse came to worse and I died, the funeral would also be covered-I thought they have got to be kidding! No. I just need to know what to do with all of this. I haven't even had much of a chance to greive for my baby, and I have to deal with this! They even sent me a notice saying I needed to collect more information before they would consider paying for a follow up bill-and I have to get it back to them by a certain date-his due date-is that just a coincidence? I'm having a hard time not going off on these people on the phone. My child is dead and all they care about is money! Please, someone give me advice. I'd sue them if I had the emotional resources at this point.

------------------
Angela

MJFrog1 · 09-22-2003, 10:29 PM

Hi Angela,

I'm so sorry for your loss.

What type of health insurance coverage do you have
that is denying this care? Blue Cross/Blue Shield, Aetna, etc.?

I'm wondering too why the company is considering this non-covered. I'm assuming what you had done was a therapeutic abortion (Therapeutic abortion is defined as the termination of pregnancy before fetal viability in order to preserve maternal health) and not an elective abortion.

Has the insurance stated specifically, either through a letter or verbal that this procedure is non-covered? I know it's a pain to read, but is there anything in your coverage benefits book that states this may not be covered?

If this is totally denied, you can file a written appeal with the insurance company stating why you feel this should have been a covered service. Most insurance companies have multiple levels of appeals, so don't give up if the first one says, 'no.' It would help if you could get your doctor invovled in the process, too. Also, is the insurance through your workplace or your husband's workplace? If so, enlisting the human resources or 'insurance person' help would benefit as well.

I'd like to suggest those avenues first instead of going directly to the department of insurance for the state of Alaska or perhaps legal action (I'd consider that last absolutely last resort!).

Unfortunately, this will be a struggle and I honestly don't think you should have to go through this AND have to deal with the death of your precious baby.

The insurance company thinks the whole thing is unethical??? Wow, that isn't their place to decide. I know of many insurance companies that PAY FOR elective abortions!!! They say it's unethical. That's crap!

I'd really like to continue this discussion. I'm very interested in learning more about this insurance company and how they explain this denial.

Again, I'm so terribly sorry for your loss. I will say a prayer for you and your family.

Sue

angelb49 · 09-23-2003, 11:21 AM

Hi Sue-
Thank you so much for writing me. I am insured through CIGNA, and I work for Providence AK medical Center, a Catholic hospital. It does state in my insurance policy that abortions are not covered under the plan, but special circumstances have to be considered, and I cringe everytime they call what I did an abortion. I can't believe these eople can force their beliefs onto you to the point where you are forced to choose to carry a dying baby to term. It's insane. I am working with the benefits team right now, but getting nowhere. Thank you again for your interest.

------------------
Angela

KIDINSANITY · 09-27-2003, 09:59 AM

Hi Angela, First of all, I would like to say how sorry I am for your loss.

I also have CIGNA, and have had many problems with them covering lots of stuff also. My suggestion would be to file an appeal with them, enclosing copies of the medical records from your OB and geneticist if you had one. This will document the medical need to end your son's suffering. Then, just keep on them to pay the bills. From personal experience, the more I hound them, the more they seem to get sick of me calling and they end up paying the disputed charge. Of course, I only do this when there is a viable reason (like yours) that something should be covered.

Also, I would suggest grief counselling for you and your husband, either through professional means or your clergy, if you feel comfortable with that. It might help you finally be able to let out all your pent up emotions.

Good Luck
Sue

angelb49 · 09-28-2003, 11:55 AM

Sue- Thanks so much for your suggestions-I have given the benefits manager a call and she said she will see what she can do, but I'm still waiting for a call back. Counseling sounds like a very good idea, I just wish we would have done it sooner. Things are just too hectic. Thanks again, and God bless!

------------------
Angela