Friday, September 4, 2009


I submitted receipts yesterday to my flexible spending card account for a number of different things associated with my daughter’s birth. Checking today, one was denied. I looked at the receipt – it’s a charge for $147 that covers my portion of nursery / norm newborn, pharmacy, drugs/other, lab/chemistry, lab/hematology and recovery room. All the denial says is – “this product or service does not qualify under this plan.” This HEALTHCARE plan! Look, I know that you can use the FSA card for things you shouldn’t and then you have to pay it back (or your card is suspended) because the thing works like a credit card. But what part of the nursery, labs, drugs and recovery room sounds to them like I went out and bought a pair of pretty shoes with the card?

This denial is reminding me of my early insurance woes which I had not previously told you about – so let me share here. When my daughter was born we decided to put her on my husband’s insurance (as we weren’t entirely sure about my job plans). I was not on his insurance because we were midway through the pregnancy when it came time to change plans for the new year and I didn’t want to worry about what was covered / if my doctor would be included / how much that would confuse them…

So when her initial bills came – we submitted them to his (or her) insurance. They denied them because apparently newborn care is counted under the mother’s maternity care, not the baby insurance. Since we weren’t on the same plan, we needed to submit them to my plan. So we did. Well my plan denied them because she wasn’t added to my plan. My husband called. After a very long discussion, it was determined that yes, in fact, they should pay them. Awhile passed and we received another notice on the bills – still unpaid by my insurance. I called them back. After several calls and a printed copy of the page from their website that showed that maternity care includes the newborn’s first 48 hours in the hospital, they agreed that they should pay them – but explained that they were unable to because she wasn’t on my insurance, so how did they know this was my baby? Really. That was seriously their answer. So despite the fact that they’d covered my OB claims for February 12th, which included a live birth, they couldn’t be sure that this claim on February 12th for a baby girl who shared my last name was really my child. Ok, well easy enough to remedy –
Me: I’ll send you a copy of her birth certificate.
Insurance company: No, that won’t work.
[Take a minute here to factor in the time it took for my jaw to drop at the ridiculousness of that.]
Me: Why not? It’s a legal document
Insurance: We can’t accept that. She has to be on your insurance, so that her name is added to your policy.
Me: But we haven’t added her to my insurance. She’s on my husband’s insurance. And it’s too late to add her (even if that was what I really wanted to do) because it’s more than 60 days since her birth.
Insurance: That’s the only way we can do it.
Me: But how will that help? The bill is coming in as “Baby Girl” under my last name. If we add her, it’ll be her actual name – which shows my husband’s last name. This isn’t going to line up to the patient name.
Insurance: No, that wouldn’t matter. We understand that with newborns.
[So you don’t understand that via a birth certificate, but you do get the name thing…?]
Me: So how do I add her? Do I have to PAY to add her?
Insurance: That can only be done through your benefits coordinator through your job.

I’ll sum up that after SEVERAL calls and emails with the benefits coordinator, my daughter actually had to be added (luckily in name only, no premium) to my insurance for the first month after her birth so that they could pay the bills that were due under MY benefits.

Given all that, you can imagine how much I am looking forward to calling the insurance today to figure out why labs, nursery care and recovery room are not considered eligible medical expenses for my flexible spending. Because keep in mind – this isn’t an issue of what’s now covered by my insurance. This is actually MY money – the money I elected to go into a healthcare account at the beginning of the year so I could use pre-tax money for my healthcare expenses. They just aren’t counting these as healthcare. ARGH. It’s really unfair that you can’t drink while breastfeeding when you have to talk to this many insurance people in the first year…

PS – 25 minutes of hold music later… it was processed under the wrong claim code and will be reprocessed / approved. Ugh.

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