Tuesday, December 29, 2009

Word to the Wise - Insurance Woes

I thought I was very thorough in my insurance coverage investigation while I was preggo. My main concern was to make sure that all of my monthly, bi-monthly, and then weekly prenatal visits were covered, along with my ultrasounds and any other unforeseen issues. Thank goodness that as long as my doctor wrote up the order of whatever needed to be done, it was covered, even if I had to go on bedrest or get to the hospital before delivery time. That was all a relief.

However I didn't investigate too much on the pediatric side of my insurance. And now the nightmare begins. I delivered WEB at a hospital in my network. The pediatrician that we chose is not in my network, but I didn't think that would be a problem since WEB would have his own insurance card with his own primary care doctor on it. We just picked a pediatrician in my network to see him when I delivered him in the hospital. Well, there were a few small issues that WEB needed to get 2 follow-up visits for days after his delivery. I hadn't changed his primary care doctor yet, so we just went to the same one that saw him in the hospital, since it was covered.

Once these 2 visits were done, I called and switched his primary care doctor. For whatever reason, they made it retroactive for the 1st of the month. Which basically meant the visits that he had already been to, were magically no longer covered. Here I am, 9 months later, still battling with the insurance that it should be covered and I'm not paying the pediatrician's bill.

So word to the wise: Be very careful with what you choose and when you choose it. Make sure you get your "Evidence of Coverage" (EOC) and read through all of the prenatal and postnatal stuff. And call your insurance company a couple of times to get all of the answers you need. I called my insurance at least 3 different times to make sure that everything was covered, and since I was pregnant over a new year, I wanted to make doubly sure nothing changed after the new year. Plus, I was getting closer to my due date and had major preggo brain, so I forgot what they had told me and needed to triple check. Ha Ha.

I would do the same with your HR department at work, and with your doctor as far as disability/maternity leave/paid family leave benefits. I was basically my HR department at work, so that made my job easy. But, I made sure to have my doctor's office staff go over my disability paperwork early so they had it on file, just in case. Momma's gotta get paid! She's gonna have diapers and other fun stuff to buy!

You're going to have enough to do with a new baby, the last thing you want to be doing is calling your insurance to work out a grievance and appeals claim so you can get your appointments covered. Those are precious minutes that you could be sleeping while your baby sleeps!

If you live in CA, here's the link for more info on what's covered for your maternity/disability leave (6 weeks for vaginal delivery or 8 weeks for c-section) and the paid family leave (6 weeks).
Check your state's website. They should have information there. Not all states have a Paid Family Leave Act, but I think it's the going trend since there are also a lot more adoptions. Everyone deserves some time off with their new baby. Depending on your state, the new daddy might be able to take some paid time off too!

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