This freaking sucks: fighting for in-network insurance coverage!

It sucks so bad…it will suck the life our of you. I have found myself in a new area of frustrations, one that is hard not trickle down into my family’s life. I knew it was coming, from the moment I signed that first paper…it kept popping back up and now it is becoming a reality.

I am so scared. I am so petrified. I fear for my family’s wellbeing. I am just scared. 

As I log into the insurance portal, I see the massive amounts of dollars being attributed to George and Henry’s birth and stay at GHS’s NICU. Right now it is totaling around $260,000.00 for all the services and I am sure there are more to come.

The morning the twins were born was one of the biggest whirlwinds of my life. I had no idea which side was up or down. We were sent by Sarah’s OB with direct orders to bypass AnMed Health to go to GHS; Dr. Henry Hearn knew that if the twins were born at 32 weeks 5 days, they would have to go to the GHS’s Level 1 NICU.

After the delivery, I followed the boys into the NICU. Tubes were being attached, people coming from all parts of the NICU to continue their initial assessment the boys, it was organized chaos, and I was trying to make sense of this developing normal. As I looked at my new baby boys, I see bubbles coming out of their mouth from the CPAP…I wondered, how did we get here yet excited to see them healthy and alive.

As I stood looking at my new family, so many people passing by, introducing themselves, explaining what is happening, and I was trying to make sense of it all. I was working off 2 hours of sleep and wish I had an audio recorder, someone collecting information for me, an assistant acting specifically on my behalf. I was wondering if I was gong to make the right decisions.

Then it happened, a lady asked me to sign a piece of paper, among many other pieces of paper. I had only been standing in the NICU for five minutes after the twins were born, it was time to sign papers.

  • Release forms
  • Patient information forms
  • Lewis Blackman form
  • A form to appeal to insurance that Pediatric Obstetrix should be considered In-Network

But this one was crucial and I did not realize how crucial it was until now. The lady, whom I do not remember her name, asked me to sign a piece of paper asking to appeal our insurance’s out-of-network policy for the physicians that work in the NICU at GHS to be considered in-network. She explained the importance and then explained they that these physicians are the only physicians in the region to provide this level of care.

This moment happened amongst all the other moments during that morning of June 10, 2017 and now I wish I could hit the rewind button.

Fast forward and now I am receiving claims letters showing that the physicians’s billing is not covered. These are the physicians that provided all the care for George and Henry from the moment they were born until the moment they were discharged 28 days later. These are the physicians of Pediatric Obstetrix, physicians with privileges at GHS Children’s Hospital. These claim amounts are now totaling around $60,000.00 and I could be responsible for these charges.

At 3:30am on June 10, 2017, I had no idea that I should ask Dr. Henry Hearn if we should go to GHS because the physicians might not be considered in-network. I had no opportunity while Sarah was bleeding really bad during that 30 minute drive to GHS if the physicians in the NICU were in-network? I did not even know if we would go to a NICU? How do I plan for in-network physicians for a NICU during an emergency? All I know…I was told by Sarah’s OB was to go to GHS immediately!

WHO HAS $60,000.00 LAYING AROUND????

As I begin to start my plan, I wonder…what if I cannot appeal this unknown situation? How will I come up with $60,000.00 to pay for the tremendous care provided for the twins.

I spend lots of money each month for insurance through UnitedHealthcare. I work in healthcare. I am surrounded each day with my healthcare clients. Yet, I cannot figure how this happened, being caught in a place where there is a looming $60,000.00 price tag on services that might not be covered.

As a single income family of five, that number can be a devastating number. As I begin to research, log into GHS’s and AnMed’s MyChart to pull transcripts of dictations to show we had no choice, no option, no idea…that this emergency situation with Sarah’s placental previa would take us to a place where the hospital is considered in-network yet the physicians that provide the care are considered out-of-network.

Devastating anticipation for this family…that is trying to put the focus on family, not the looming insurance uncertainty.

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