Pre-Existing Condition

DeniedI was thinking of going to the dermatologist. Should I tell my provider that I have skin? This was my reaction to a dizzying fight over the bill I received for the delivery of my baby and our hospital stay. We’re lucky to have insurance, I know that. But imagine my surprise when my provider wanted me to pay a penalty of several hundred dollars for not clearing it with them when I arrived at the hospital at 2:30 a.m. to have a baby.

“You must have known at some point that you were pregnant, and that’s when you should have told us.”

“You’ve been paying for my pre-natal visits. Isn’t that–?”

“With your doctor. This is a hospital bill. It’s completely separate.”

“Why exactly? Never mind. I did pre-register with the hospital, and we did call you to find out what would be covered months ago.”

This is really nothing compared to the nightmare my friend is facing. After severe back labor at her home for 14 hours, she went to the hospital and was advised to get an epidural. Now she’s got a bill of a few thousand dollars for using an anesthesiologist who wasn’t in network. Evidently she was supposed to ask in the thirty seconds between contractions. They would have told her that he was the only anesthesiologist in the hospital, so I’m not sure what she was supposed to do after that.

With these headaches, you wouldn’t think that women also pay up to 84% more than men for individual health plans that exclude maternity coverage. And in the individual market, only 13% of health plans available to a 30 year old woman across the country even provide maternity coverage (“Still Nowhere to Turn” from the National Woman’s Law Center). Gender rating makes being a woman in itself a pre-existing condition. And if my anecdotes are evidence of the standard, even a new mom with a plan may not be covered as well as she thinks she is.

3 Comments

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3 responses to “Pre-Existing Condition

  1. thanks for bringing more attention to this vital issue. gender rating has me outraged, it needs to be a bigger part of the current debate.

  2. cathy weingeist

    I feel your pain. I had a “transient ischemic attack” which is like a small stroke that only last a few minutes on a cruise ship. I was really scared the second time it happened so I went to sick bay (I had to go by wheel chair because I couldn’t use one leg). I called ship to shore to Bc/BS for authorization and they said “sure that is an emergency” After I got home, I submitted my bills to BC/BS and they denied it! They now said they would only pay if the service was in a hospital or in a clinic and they didn’t consider sick bay on a ship to be either one! Good thing I decided to have the recommended MRI when I got back to IOWA!

  3. Absolutely, Nicole. I’ve been thinking too about all the women who do not plan on having children and still have to pay higher premiums just because of their gender.

    Cathy, that’s unbelievable. What is the point of calling to authorize if they can rescind later? The sick bay should be considered a clinic. Had you gotten off the ship to go to a hospital, would they have paid for your transportation home?