Saturday, October 31, 2009

Composed myself - advice needed

Hello ladies,

Well, I finally composed myself (well I did yesterday). Thanks for the wonderful comments and heartfelt prayers. I am sure you all know me by now, and know that I will always put up a fight.

On my lunch break, I called the insurance company. I spoke to two people who kept sending me to the medical department. When the medical department heard I was a patient, they immediately transferred me back to customer service. Well, by the third person I was livid! This lady K, was quite helpful. I explained my history to her and what this surgery entailed, I asked her to please take time to understand my medical needs and the limited options I have. I cited their vision to them which is "to provide the same level of care to patients as they would a family member" and asked, are you telling me that you would approve this for your daughter or sister? I said to her, I am 25 years old and have had to cremate 2 babies 8 months apart, the Dr.'s will not tie my tubes. So I am going to continually get pregnant and basically naturally-abort (that is what they call stillbirths). Mentally and physically my heart and body cannot take it.
She responded that she agreed and cannot understand why they would deny such a necessary procedure (finally someone understands). She tried to get a hold of her supervisor (who was in a meeting) and said she would call me back by 3:00pm.

Well by 3:30pm, I called her back. She said she did speak to her supervisor, who is speaking to the medical department to see what happened and what can be done. They did not call back by the end of the workday, but I will be calling on Monday morning to get an update. I am prepared to go as high up as I possibly can, and will take it to the news media if necessary.
I also wrote a 2-page grievance letter which I am planning to deliver in person on Monday as well as pictures of my babies and their Urns. Maybe then someone will listen to me.
Even if they cover it 80%, which is my out of network benefit, I have no problem coming up with the balance but to pay 100% out of pocket plus expenses is next to impossible.

This is where I am happy for "blogverse". You meet so many people from different fields. I me Jessica a few months ago who works/used to work for an Insurance company, who gave me advice then, and will give me advice now (check Facebook Jess!).
All of you come in as well. What else can I do? Who the hell makes these decisions anyway? A group of people or one person?

Where is my expected end?


  1. Good for you, Marie!!! Way to take your anger and frustration and make it SUPER productive! I will be praying that the news you get on Monday will be wonderful...and that you won't have to do any more to get it covered! Love you girl...praying praying praying!!!!

  2. I am glad to hear that you are fighting it. I am not sure who denies or approves these things. Insurance companies can be such a pain. Keep talking to them and keep going higher up if you need to. You'll get there!!

  3. Vista stinks...I know from personal experience. Keep calling until you get the answer you want. I'm praying that in the end it will all work out!

  4. Marie, I sent you a message on facebook. :) Feel free to post on here, but wanted to give you the option to do that if you wanted. :) I am pulling for you. :)