Monday, 17 February 2014

Whatever you're selling... I'm not buying

As many bloggers have described horrific fights with their insurance companies and others have no insurance coverage at all, I feel a bit badly complaining that my insurance is too keen to be helpful. The mere problem is that I don't need their services...

While we were discussing a natural cycle versus medicated FET, I suggested to my RE that transdermal estrogen patches may be a better option for me. In addition to my blood pressure issues, I had an episode of aura a few months ago. Aura is considered to be an absolute contraindication to any form of exogenous estrogen as it increases the risk for stroke. Data on post menopausal hormone replacement therapy has noted a lower thromboembolic risk with transdermal methods versus oral estrogens  (as they avoid the first pass effect of the liver), so I figured it would be a safer alternative and my RE agreed. After five days, my blood pressure has remained normal without medications and I haven't sustained a stroke. So far, so good...

My prescription was written to dispense a supply of twenty patches, which would be enough to get me through my transfer. As I anticipated, the pharmacy tech started explaining that my insurance would only pay for one month at a time. Now, if I were truly smart, the idea would have occurred to me much earlier, so that I could have stockpiled a box of four patches each month with only a $10 co-pay. "That's fine." I informed her that I was prepared to pay for the rest out of pocket. She offered to call my insurance company to see if they could grant an over-ride. Although I had limited coverage for my IUI procedures and meds; Healthnet made it clear that they wanted nothing to do with an IUI loser like me once we started IVF. I thanked her for her offer, but advised her not to waste her time.

Earlier today, I received a call from a representative from Healthnet. My first thought: holy shit! maybe they'll actually cover my transfer meds! Then I realised that I have never received a phone when my insurance has approved anything else...actually, there was only one other time when I received a call from Healthnet... Oh, fuck me, not again... "Congratulations on your pregnancy! We would like to enroll you in our Maternity Mentoring program. When is your due date?"

Maybe I was a little more sensitive from my estrogen patches. Perhaps I was a little tender after recently seeing a patient who was at the same gestational age that I would have been. Regardless of emotions, I was justified to be pissed that for second time, my insurance was offering me enrollment in a prenatal program when I am not pregnant. In a very angry tone, I informed the agent that I had a miscarriage over two months ago. As the representative started to issue an apology that nearly sounded sincere, I was tempted to hang up the call in a huff; but then I decided to do a little investigation.

"That's okay. I understand you are just doing your job. Can you tell me how you received information that I was pregnant?"
"We must have received a referral from your doctor..."
"That's bullshit. I miscarried very early and never made it to an obstetrician's office."
I also know that we never make such referrals to any insurance companies.
"Our computer generates a list of particular diagnoses. For patients who have been diagnosed with diabetes, they would be referred to our diabetes program..."
"So, you picked up that I was pregnant with the diagnosis code from my beta draws."
"I guess so..."
"No one noticed my diagnosis of a 'missed abortion', a CPT code for a D+C, or the fact that there haven't been any claims for prenatal care..."
"No, I don't have any access to your records. I just have your name on a list."
"Approximately one in five women will miscarry. Women may chose to terminate the pregnancy. I can't be the only upset phone call you'll face today..."
"No, you're not."
"Is it possible to opt out of this program? I'm going to be doing an embryo transfer next month, which may or may not work. I could miscarry for the third time. I don't want to be having this conversation again in another three months..."
"No problem. I'll remove your name from our database. If you do become pregnant, it will be your responsibility to enroll yourself in our program."
"That's fine. Thank you."

As I hung up the phone, I tried to determine if it is creepy that my insurance company is trolling through claims looking for certain diagnoses. I suppose it is benevolent that they are offering programs that help their members take steps to better health, but it also seems a little intrusive. I never asked specifically what this maternity mentoring program offered, but I feel I have no need to join. I shared this story with Co-worker, who started to chastise my pessimistic thinking. "Jay-ane... don't say that..." Then she stopped herself. "Oh. You don't need their program as you're already smart..."


  1. I've never heard of insurance companies doing this but I'm not surprised. Ugh! I'm sorry you had to deal with that call! XOXO

  2. Wow. I think I would also take issue with the fact that my insurance company was accessing my personal info so they could sell me stuff (I'm assuming that this maternity program would cost you something in terms of more coverage?). Anyway, good for you for setting them straight, although I definitely don't envy the call person for having to make a bunch of calls to women who could potentially no longer be pregnant.

    1. Actually I don't think it would cost anything extra to enroll... I was really struggling to think up a title...

  3. I have HealthNet, too, and I received a call about their pregnancy what-not program a few weeks after my babies died... after they had approved hospital procedures that should make very plain what had happened... The guy on the phone didn't even apologize, he was just like, "Oh, you already delivered." Sigh.

  4. That is creepy. And annoying. Hopefully you're really off their list for sure now.

  5. Oh, that would annoy me to. And I absolutely not surprised that they're doing this. Insurance companies have contacted me about my diagnoses--asking if it could be a worker's comp issue (no, just acupuncture for fertility (not covered) and "back pain" (covered)). They offer discounts on our premiums if we enroll in "get healthy" programs. It feels a little big brother-y to me. But I keep thinking that if it keeps health care costs down by encouraging people to get/stay healthy it can't be so bad; although I'm not 100% convinced that it's driven by anything more than corporate greed. However, if they took 10 more seconds to look at a consumer's file and they could probably pretty easily figure out if a woman does actually still qualify for a pregnancy program.

  6. This is ridiculous yet not surprising. Obviously they want pregnant women to enroll in prenatal care programs ASAP because it is good for their bottom line. Early and frequent prenatal care = better outcomes = cheaper bills for the insurance company. They upset some people in the process, but that dosent necessarily effect their bottom line, so they will keep doing it. Grr.

  7. I canNOT believe that this happened...AGAIN! Maybe it's time to launch a formal complaint with your health insurance company. Like you pointed out....a significant number of early pregnancies end in miscarriage. There MUST be a way to at least inquire with patients besides a "congrats on your pregnancy!". SHEESH!

  8. That's crazy. Good thing you spoke up.

  9. It's annoying when info. is shared with anyone, even our own health insurance companies, when we don't directly provide it to them. It just feels like a violation of privacy.

  10. Ugh, I'm so sorry that happened. Good for you for speaking up.

  11. I am so glad the patches are working out well!

  12. I'm sure it's probably a decent program, but really. They should dig a little deeper before making phone calls like that. Horrible customer service. I'm glad you said something to her, although I doub it will make a difference