stressed out insurance won't cover recommended stay

Discussion in 'Pregnancy Help' started by healer27, Mar 2, 2010.

  1. healer27

    healer27 Well-Known Member

    Hi everyone I havent' posted here in awhile. I found out at 12 weeks that I was having identical twins monoamniotic/monochorionic which is high risk because the babies are in one sac with no membrane between them so the cords can become easily entangled or knotted which can cause the loss of the babies. Good news is I'm now 22 weeks and so far now issues. MY high risk dr's have recommeded that I go in the hospital at 26 weeks so the babies can be monitored on a regular basis. If they see any signs of decreased heartrates or anything that looks bad they do an emergency csection. From what I've read thsi is the norm for momo pregnancies. My problem is it looks like our insurance will not cover this care, which means, there is a very high probability that because the babies arent' being monitored the way the should I could loose both of them. i'm just devasted, and stressed out, the pregnancy is so stressful to begin with you don't know day by day how the babies are and you worry constantly. I know momo's are rare but wondering if anyone else here has dealt with this or something similiar and what you did? we are no tdone fighting the insurance company but its very stressful. I know there i sa momo board here but thought i'd post on the main board here for more visiblity.
     
  2. busymomof3

    busymomof3 Well-Known Member

    Congratulations for making it this far without any complications :clapping:
    I hope that the rest of your pregnancy is uneventful. I am sorry that your insurance company is being difficult but I hope that you are able to get through to them. I know when I was off with my first son I had to call everyday for two weeks straight before they would go ahead and review my case. Then they decided to cover me. This was only for disibilty so I have no experience with you situation but I think that you should continue to push on and try not to let your self get to stressed out about it because thats the last thing you need. :grouphug:
    Best of luck
     
  3. citizenpelikan

    citizenpelikan Well-Known Member

    Oh my god, I'm so sorry. Reading this gets me all riled up about the health care system here in the US. When facing a life threatening situation for either mom or the baby/ies the concern about having enough insurance shouldn't even enter into the equation. The mom and babies should get the help they need no matter what. I will keep you and babies in my thoughts. I hope everything works out for you.
     
  4. becasquared

    becasquared Well-Known Member TS Moderator

    Are you talking about an inpatient stay? I would think that it would be covered once the doctor wrote the Rx for it/recommended it and got the proper authorization. They probably don't want to hear from you until the doctor has created the request.

    Best of luck!!
     
  5. cat mommy

    cat mommy Well-Known Member

    Contact your state's insurance department for assistance also.
     
  6. Kaffeetee

    Kaffeetee Well-Known Member

    That made me mad. I don't like to deal with the insurance.
    First of all, you need to make sure your hospital is contracted with your insurance carrier, also to make sure the pediatricians at the hospital is in the network of your insurance carrier. I was hit with a big bill after my first born, not knowing that the pediatrician attended my hospital is not contracted with my insurance carrier. Then you need to go to the hospital to do a "pre-registration", so the hospital will have all of your insurance info, and they will bill the insurance before they bill you. I see no reason that you should fight with your insurance carrier right now. If the doctor said you need to be hospitalized, and the hospital admitted you, you should be covered. Unless you have a very strange and limited policy??
    Bottom line is, insurance or not, I'd check myself into the hospital if I'm having momo twins. Fight the fight when you have two healthy babies in your arms, not now. You wouldn't want to lose the babies because of some stupid insurance companies. If, you really have to pay out of pocket (for some bizarre reasons), most hospital will work out a discount and a payment plan for you.
    Wish you and the babies the best..
     
  7. Rose Wright

    Rose Wright Well-Known Member

    I would also recommend checking into Medicaid or other insurance. I read that sometimes they will even help pay pre-existing medical bills.
     
  8. TwinxesMom

    TwinxesMom Well-Known Member

    My girls were a high risk pregnancy and we were on twice a week monitoring. Maybe he could do mwf monitoring until later in the pregnancy. Hopefully though as pp meantioned you can get something cleared thru the doc.
     
  9. lianyla

    lianyla Well-Known Member

    Someone above made a good pt. It won't be listed probably as covered til it "NEEDS" to be covered, do you know what I mean? It is like an emergency. It's not "elective" so when your doc writes it off, you should be set. Talk to your Peri about this. I have NEVER and I do mean EVER in my life heard of insurance NOT covering this.

    Seriously. I'd be knocking on the mayor's door. You'll be going to your local new's station and I'm not kidding. we'll all be right behind you too- here at TwinStuff!

    I mean it!

    Good luck and don't stress yourself out cuz I'm 99.99% sure this will work out!
     
  10. healer27

    healer27 Well-Known Member

    Hi everyone, thanks for your input and SUPPORT. To answer some questions the hospital I'm planning on going to is coverered both the mfm group I go to as well as my ob are covered/in network providers as well. The doc is saying she will admit me 4 weeks from now. the ob nurse at the insurance co. thinks it might be denied because they are saying techincially there is nothing wrong with me or the babies, I'm not preeclamptic, in preterm labor, babies are growign normally BUT they are not normal they are supposed to be in 2 sacs of there own and they are not. Because this doesn't fall under the normal stupid flowsheet they have to deny approve it looks like it will be denied. I have talked to my mfm and told them to write a extremly strong letter outlining the risks of not having intensive fetal montioring; risks being fetal death. There have been studies done supportingthis as well which of course if denied we will fax and you can be sure as you said I will be contacting my local representitive, the state insurance company and the local news if it is denied. I know I probably sound like a nut but the lives of my future children are at stake. With this type of pregnancy I'm lucky they even survived this far. I Really can't stand insurance either.


     
  11. Heathermomof5

    Heathermomof5 Well-Known Member

    I would think that if your dr orders it, it will be covered. Your dr is not sending you to the hospital for the fun of it, there IS a reason. When it comes down to it, the lawsuit they would be facing if they prevented you from getting the recommended treatment for mo mo twins and heaven forbid something happened would be far greater than had they just paid it. I imagine this is a case of mo mo twins being pretty rare and some one somewhere in the communication chain not knowing what they are talking about. I would not stress. If the dr recommended me to go to the hospital in 4 weeks, that is what I would do.
     
  12. lleddinger

    lleddinger Well-Known Member

    I'm sure you are connected with monoamniotic.org and I know this comes up as a topic a lot. I think what some others have done is had their dr. provide the studies that support inpatient monitoring. Typically, your physician would need to have a peer to peer review with the medical director for your insurance company.
    Just as a side note- and this in no way reflects my opinion on health care reform, while inpatient monitoring is the standard of care for momo twins in the US it is NOT the case in the UK. Momo moms are monitored outpatient and delivered c-section at I think it's 34 weeks.

    Good luck! I think in most cases the insurance company gives in and covers the early admission.
     
  13. citizenpelikan

    citizenpelikan Well-Known Member

    You do absolutely NOT sound like a nut.
    I wanted to say that I have never heard of mo/mo twins who's mother was NOT admitted to the hospital at some point in the pregnancy. I think it's usually done by week 28 (at least). So that would be considered common medical practice for these sorts of pregnancies.
    I hope you get this sorted out.
     
  14. emp59

    emp59 Well-Known Member

    I would be going crazy if I was you! Somebody mentioned going to a local news station if you don't get it sorted out with your insurance and while I know that sounds crazy, do it! My SIL had a ridiculous insurance problem and she went to our local news station and they harassed the insurance company, and it worked wonders. It's worth it if your insurance won't help you. Being a twin mommy will also help you because its interesting news :) Good luck and congrats on making it this far. YOU CAN DO IT :)
     
  15. shj52429

    shj52429 Active Member

    It sounds like you are on the right track with your insurance company but as the others have said, I wouldn't accept no for an answer. I am a nurse and deal with insurance companies on a daily basis and they are SO frustrating!! Also just because your doctor says so/writes the order, doesn't mean they will cover it. They basically dictate what your doctor can and can't do based on a a diagnosis code. So what the nurse is saying is that you have no diagnosis code other than mono-mono, which I agree, should be enough to qualify but again, getting out of paying for anything is the name of the game with insurance companies. I would call every week, sometimes it is a matter of getting someone who is more willing to help than others. Good luck, I hope it works out, we have mono-di twins and I couldn't imagine the stress of mono-mono twins and worrying about insurance.
     
  16. Mel1012

    Mel1012 Member

    I am so sorry you are having to deal with this. I had momo twins in August 2007. My OB admitted me to the hospital for in-patient monitoring when I was 24 weeks. But I think up until the actual day I was admitted, the insurance did not "officially" approve me. My memory now is sketchy (no more good sleep!), but it seems like every appointment I asked the OB if insurance was all set and it never was until I actually checked in. I don't know if they stalled, or denied it until they got to a certain point in the pregnancy or what. So there is hope. Is your OB on board for in-patient monitoring? There are lots of resources at monoamniotic.org too. If insurance does not work out, I would still demand to be admitted, and work out the details of insurance/payment later. Your ultimate goal is healthy babies! FYI, I had mine at 30w5d and they are wonderful healthy girls!

    Melissa
     
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