Can anyone give me some helpful hints/tips and/or any other useful information when dealing with insurance problems with respect to adoptive children? We have a reputable company that has B's and C's and a Shield in the title....but.....they are acting like some kinda fly by night operation when it comes to Charlie's health care.
First, it took an act of congress to get him added.
Then, it was the hiked up premiums due to his "speech delay" (duh...he's lived in America for less than 5 months....)
Now, it's them not wanting to pay for ANY of his routine health care (immunizations, well baby check ups....nada....)
Our bill from his first 2 visits at the pediatrician is already over $1500! Insurance has rejected all of it. HELP! Has anyone gotten any answers regarding why our adoptive children are treated differently than our birth children? Anyone filed a grievance or anything fun like that?
We have that same shield insurance and our sucks too. We didn't have a problem adding him, and there were no increased payments for him being adopted, but it still stinks. We have to be 100% of every bill unless it is a check up or well baby visit. All our visits to the IA doc come out of our pocket. His fist visit was over $2,000 (all that blood work is pricey). Lucky for us when we reach the out of pocket max of $9,000 they will pay for everything. What! I don't understand paying to have insurance and then also paying all of the bill.
ReplyDeleteI have re-read this and decided it was not helpful to you at all just joining in your rant...hope you let it slide.
Maybe you should tell them you saved them thousands by not having all the prenatal care and delivery costs.
You should definitely speak to someone higher up. I'm not sure what state you live in; I live in MA and I've never seen any of the big 3 insurance companies (BC/BS, HPHC, Tufts) pull that on anyone--unless your entire plan doesn't cover well-baby check-ups for all your kids, adopted or no. That smacks heavily of discrimination, and I would definitely want more of a clear explanation in print. If they can't provide that, they shouldn't be doing that to you; and if they can provide it, they should be reprimanded for discrimination. Definitely go higher up on this one!
ReplyDeleteWow, we have the shield, too, and have had no problems at all. I worked thru my employer to get Marina added and they took care of that for me - just had to send in our adoption certificate. Our coverage may be different, but mine has been awesome. I've only ever had to pay my co-pay when she goes to the doctor and her OT and ST are both covered, I just pay a deductible.
ReplyDeleteSorry you are having all these problems - no fun. If you have your insurance thru a third party (employer, etc.) get them involved to advocate on your behalf.
That is so stressful! We also have the shield on our insurance cards and have had no problems. We only ever pay a copay, even for all of Grace's OT appts and IA appts. I hope you get this worked out soon and fast!!!
ReplyDeleteWe're not there yet- adding her this week. But just wanted to pipe in that it's just stinky! I would definitely ask to speak to someone's boss!
ReplyDeleteDo you have an individual/family plan? The carriers will play games on indiv policies. I work in insurance, on the broker side for corporate plans and if you have a corporate plan, ask the companies hr team for assistance. They can direct you straight to the broker and they should be able to work direct with their contacts at the carrier to resolve this. One thing... The IA dr probably won't be covered ... Just because use they normally aren't contracted.
ReplyDeleteI go through the same insurance CO. Just having them fill out the pre made form to say my future child will be covered took them over a month...and that's with me calling them EVERY week. Such a HEADACHE! Hope you can get it straightened out soon!
ReplyDeleteWe don't have the shield company and didn't have a problem adding our son, but that first appointment with blood work, etc. was a doozy! None was covered. since then, no real issues except that we have to meet our deductible first and then the copay kicks in. . .a fact that I had forgotten since Aidan has been so healthy lately but then remembered when i got the bill for the Strep Throat visit and test! Keep hounding them. I'm sure you can get them to cover at least part of it!
ReplyDeleteSadly, you must fight them. What they are doing is illegal. These companies try to play games and see if you will just pay them. For our third adoption we completed on 12/13/10 and we went to our IA dr and regular pediatrician right away. Someone made a mistake and said we were only covered starting at the begininng of the year. They tried to say they couldn't change it. I got the manager and explained this was illegal and they did change it. Best of luck and fight. Once you fix this I bet you don't have more issues with them.
ReplyDeleteI had this problem with a lot of Misha's visits too, mainly with blood samples that were sent out to the local hospital. I've gone back and forth with them and the shield a few times and it turns out it is usually about the codes they put on visits. I had to go back to my nurse practicioner and she redid the codes and they will rebill it. I think there is some type of adoption code that she used that almost automatically gets rejected because it turns into something like an administrative third party reason that they would use for something out of the ordinary.
ReplyDeleteHope this helps. I'll let you know if it works this time.
Steph