Thursday, July 8, 2010

July 8, 2010

I had my doctor's appointment on Tuesday. The baby and I are getting better at non-stress tests. This time, it only took us an hour instead of our previous 3 1/2 hours. This week, he has been very active. Tuesday was no exception. Perhaps they can invent a multiple monitor system for babies that do not like to stay in monitoring range!

The reason this post is late is that we have been spending every free moment trying to figure out our newest insurance mess. Did you know insurance companies can go out of business? They can! We got a notice a couple of weeks ago that our insurance company (American Community) was in financial difficulty and was being "rehabilitated". The State of Michigan worked out an agreement with Golden Rule insurance to accept American Community's individual policy holders. When we got the notice, I looked online to see if all of our U of M doctors participated with Golden Rule. They do participate with one network within Golden Rule, so I thought we would be all set.

Friday we got our information from Golden Rule with the details on our possible policy. We were gone all day Friday, so it was evening when I was able to get online to check the information. From what I found, we were ineligible to be part of the network that accepted our doctors. Because of the holiday, I was unable to talk to a person until Tuesday. After a little meltdown Friday night, I was doing better on Saturday. On Sunday, I taught Ella and Sam's Sunday School class and told the kids the story of the Israelites wandering in the wilderness for 40 years because they did not trust God that he would take care of them. I realized that God has taken care of us so far, and I had no reason to doubt he would this time. Sometimes you really do learn all you need to know in Sunday School!

On Tuesday afternoon, I called Golden Rule to determine if our doctors would be partipating. The woman on the phone told me that they weren't and that we should ask the surgeon (the same amazing man we were so impressed with last week) to refer us to another doctor at another hospital that would be in the network. The fact that we have already met with U of M and gone through all of the pre-surgery preparation (and paid for it with our own money) was irrelevant. I asked if we could shop other insurance companies and she told me that other companies would consider the heart defect as a preexisting condition and it would not be covered. She informed me that this kind of surgery would be "very expensive". You have got to love a system like that! Tuesday night resulted in a second meltdown.

On Wednesday, I called the old insurance company, the new insurance company, the U of M social worker, and the State of Michigan office in charge of the rehabilitation. Other than the U of M social worker, everyone said that we should just give up on U of M and move on. The only other hospital I can find that is capable of performing the surgery is the children's hospital in Detroit. Phil and I don't feel this is an acceptable option (and neither does anyone outside the insurance industry that I have talked to).

To be part of the agreement the state has worked out with Golden Rule, we have to be on their insurance by August 15th. My induction date is August 16th. We were told by one person (after he told me we couldn't ten minutes earlier) that we could keep our old insurance until it runs out or until the company is liquidated and be on the new insurance at the same time. We have paid our policy up until September 4th, so as long as this information is correct and the company does not fold before this date, at least the first surgery should be covered and my maternity care deductible should still be in effect. By the way, when you are forced to switch insurance because the company is going out of business, all of your previous deductibles are ignored and you start over.

After more research and phone calls, we found out that we could be part of the network that our doctors participate with if our zip code was Clarksville. The next mailbox approximately 300' to our east is a Clarksville address. When we built our house, we were given the option of an Alto or Clarksville address. We picked Alto. We are now trying to find out if we can change our address to Clarksville or convince the insurance company that we should be able to be waived into the proper network. I tried to get an exception when I talked to the company on Wednesday, but had no luck. As far as I can tell, other than the fact that we don't fit their arbitrary rule, there is no difference to the insurance company which network we are in.

The social worker at U of M has been helpful. There may be a program that will allow us to go to the U of M because some genius realized that insurance companies pay less when patients are treated in the best hospital available. They get better care and get out of the hospital sooner with fewer expensive complications. U of M is a "Center of Excellence" for Congenital Heart Defects. There is also a state program that can help with some of our costs if we have to go out of network to go to U of M.

So far, nothing has been determined and all of the information we have is based on someone's opinion. We feel like we are making some progress, but it would be nice to have this all solved before the baby comes and have some reassurances that the costs will be covered. We really appreciate your prayers at this time. We have decided that if given the choice of having a baby with a good chance of being healthy and growing into adulthood or having good insurance coverage, we would still rather be where we are now!

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