Insurance, can't live with 'em...

Are you considering having another child after preeclampsia? Trying again after preeclampsia can be an emotional challenge. You can find support with others who share your concerns here.

Insurance, can't live with 'em...

Postby megansmom » Tue Aug 24, 2004 11:35 am

...can't afford to live without 'em.
I called the insurance company this morning to see if I could get these tests covered. They just kept telling me that they could not give me a diagnosis code over the phone...well, DUH! I went around and around and around with them. I finally got off before I started yelling. Anybody have any idea on how to get throught their thick skulls?! I am going to try to go through it again this afternoon. All I need to know is if they will cover it. I am sure it is just a matter of getting in touch with the right person. Just needed to vent a little.... Any hints, tips, ideas on how to handle this? I'm sure most, if not all, of you have had your own dealings with insurance before. Thanks so much!

~Amanda
Mama to Megan, severe PE with mild HELLP at 34 wks

Thinking about TTC later this year
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Re : Insurance, can't live with 'em...

Postby angelkat » Tue Aug 24, 2004 12:14 am

Amanda..

The only thing I can think of is to call your Peri office or OB office and ask them for the DX code. This way you will have the correct code.... Otherwise, I'm clueless when it comes to insurance companies....

Hugs
~T
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~i~ Katlyne(12/9/02-04/02/03)25 wks
Casey - 34wks Born 7/29/04
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Re : Insurance, can't live with 'em...

Postby julie f » Tue Aug 24, 2004 12:15 am

Amanda,

I can only think of two things:

1. Can your doctor's office call to see if the tests will be covered?

2. If you get your healthcare through an employer, talk with the HR/Benefits person at work to see if they can at least find the right person for you to talk to. When I used to work in HR, we had contacts at the Insurance co that could sometimes nbe really helpful in pointing us in the right direction.

I hope you get some answers soon!

Julie (27)
Zachary James, 7/22/03-7/27/03, born at 26wks - severe pe

Miracle in progress... #2 is due February 2005!!!

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Re : Insurance, can't live with 'em...

Postby megansmom » Tue Aug 24, 2004 12:36 am

T~ There is the problem, I do not have dx code because there isn't one for one I need, but I need a dx code to see if it is covered. See the problem? It just goes round and round. [xx(] I do have the names of the tests they want to run, but no code. Grrrrrr....[:(!]

Julie, My doctors office does not know if they will be covered since they can not come up with a dx code. They told me to call the insurance company to see what is covered. The insurance co says they need a dx code to know if it's covered or not. So here we go again.... [xx(] I hadn't thought about going through the hr dept at dh's place of employment. We finally did that when we had all the insurance problems after Megan's birth/NICU stay. They were so helpful and took care of most of it for us. I will have to send my dh on that mission tomorrow. Thanks for the idea!!!

Meanwhile I guess I will try once again to get back on the merry-go-round myself.[}:)] Again, thanks a bunch!

~Amanda
Mama to Megan, severe PE with mild HELLP at 34 wks

Thinking about TTC later this year
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Re : Insurance, can't live with 'em...

Postby bonnie » Tue Aug 24, 2004 01:04 pm

Amanda,
I am so sorry that you are having to go through this. I also apologize in advance if you've already said this and I am having a pregnancy brain moment ([:I]), but here's what I suggest:
1- The HR dept has someone who should be able to sort this out for you. They either have them internally, or externally, but they are paying someone to handle these sort of things (it is better for them to deal with it than have employees who are preoccupied about insurance claims instead of their task at hand). I would explain the situation to them and let them loose on the insurance company. (the hr person may also be able to override payments depending if the plan in a self-insured plan or fully insured plan. Meaning, if it's self insured, the employer ultimately can TELL the insurance company to pay the claim even if it isn't something that is normally covered. If it's fully insured, than they don't have as much pull with the insurance company in telling them to pay the claim.)

2- If there isn't anyone who can help you, then go back to your doctor. The doctor HAS to know WHAT they are testing for or the lab CANNOT run the test. SO, ask the doctor HOW they are going to ask the lab to run the particular test that is in question. IF the doctor can't tell you, then ask if you can speak with the lab. Explain to them the situation and see what they say. They can't do anyting without codes. . . so they'll have to know what the code is.

If you need any futher help, let me know and I'll delve further into my "bag of tricks" for you, but these should work (or at least they did 90% of the time for me and my clients . . .)

Yoni's ima

Yonatan 7/10/2002 (35 weeks PE)
baby girl rosenbloom 11/10/2004

CHECK OUT MY WEBSITE . . .
http://rosenbloom.homeip.net/yoni

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Re : Insurance, can't live with 'em...

Postby for faith » Tue Aug 24, 2004 04:34 pm

Lot of great ideas here, just want to say wishing you the best, I know how hard it is dealing with those situations.

Jill
mommy to:
Tyler - 4 (36 wks, PIH (just told by peri it was mild PE))
Angel baby - 1/20/03 (11 wks)
Faith Kristine - 1/5/04-1/30/04 (30 weeks due to severe PE, passed due to NEC & Sepsis(preemie complications))

trying for #2 to share our lives with since 9/02
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Re : Insurance, can't live with 'em...

Postby maxs mom » Tue Aug 24, 2004 05:45 pm

Amanda,
I just took a 12 hour urine test and the DX code was 401.0. It is for malignant hypertension or severe systemic hypertension. I would think that with your previous history, your doc just needs to come up with a code that will cover these tests so your insurance will pay for it. It doesn't sound like he has prescribed these tests many times before, so that may be the problem. Can you call insurance and see if this diagnosis will warrant them covering the tests?

Kara (34)
DH, John (36)
Max, 1/20/03, 25 wks, 1lb. 3ozs. (IUGR), severe PE
http://www.babiesonline.com/babies/m/mightymax/

#2 is on the way, EDD at 36.5 weeks is 3/24/04
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