Came on to hear about your appointment and am so happy to read the good report! I hope you can relax and enjoy!
I’ve never been able to figure out why I get charged for things I shouldn’t. I mostly call to complain and am told to ignore the bill—I ask them to send me something in writing showing a $0 balance. Mostly they agree but never send anything—no bill and no $0 balance.
No luck on the gym/swim coverage. They offer a deal at partner gyms but none of them have a pool ?
And they ruled that my appointment where I went in for pregnancy-related nausea isn’t considered a pregnancy related claim and therefore have to pay a copay. huh??? (All of my pregnancy related costs - literally everything - is supposed to be covered.)
So now I get to play phone tag between my PCP’s office and the insurance. It’s only a $25 copay but it’s more the principle of the thing.
In other news, we’ll be telling Mr R’s parents tomorrow. My MIL already knows why we’re coming up and she’s smugly bragging to my siblings-in-law that she already knows. She’s completely taken the fun out of the reveal. (She did this to my SIL too)
Your MIL sounds fun. I’d be inclined to reveal that you’re debating adopting a puppy.
@austinmshauri omg. Don’t give me ideas. (I’m definitely running this by Mr R after work tonight.)
The puppy should be named Mr.R’s surname!
Romani how awesome he’s going to be your doctor! This brings back all the happy memories for me (some scary moments too, but ultimately happy). You and the baby are going to do just great!
@romanigypsyeyes – You might want to take another look at exactly what your insurance covers (without a copay) for “prenatal”. The “All” pregnancy costs is unlikely – because there is a difference between routine prenatal care and care needed for complications, which can get to be quite expensive in some cases. Given that you have a high-risk pregnancy, you might want to sort this out early so you understand the limitations you are operating under. Obviously you do have insurance that is going to cover the big costs in any case, but you may have copay’s or coinsurance that you need to plan for, up to whatever the maximum cap is on annual out of pocket.
I know that I was confused way back when, before the birth of S1, about what was being covered — I didn’t realize at the time that the there was one set of costs for the prenatal care & OB’s charge for delivery vs. hospitalization costs. At the time I had a policy that covered only 80% of hospitalization, and of course I had planned all along to give birth in a hospital. So no surprises from the OB… but a big surprise from the hospital – I had to work out a payment plan and it took me years to pay it off. (Though in terms of medical costs today, it was a trivial amount – but back in the 80’s when I was a new mom I just didn’t have the funds available).
I’d think that a prenatal visit for nausea would be covered in any event, given that nausea is more of a characteristic of pregnancy than a problem. But the issue could have to do with timing of the visit – for example, the “all” that they are covering might actually be limited to a certain number of visits within a time frame. I found this on the BCBS website, describing “normal pregnancies without significant complications”:
https://www.bcbsm.com/index/members/health-wellness/staying-healthy/pregnancy.html
So it’s possible that your plan gives 100% coverage for the “normal” stuff but requires copays for everything else. So if the visit for nausea was separate and in addition to “first prenatal visit” – you might not be getting any ore free prenatal visits until week #14 (when the “every four weeks” kicks in>
Understanding the rules the insurance company is operating under could help avoid unanticipated costs – that is, if “all” means according to the “normal” schedule, then that’s a factor to keep in mind when there are non-urgent matters.
Calmom, I did extensive research into this before getting pregnant because I knew I would be high risk and require many more ultrasounds and other tests than a regular pregnancy. Everything is covered. It’s one of the benefits my union fights hard for.
Here’s our coverage book.
https://hr.umich.edu/sites/default/files/gradcare-certificate-coverage-2019.pdf
My 8 week prenatal, 8 week scan, and 6 week intake were already covered.
Baby ?Jedi… Go Blue! ??
I don’t know – but “covered” doesn’t necessarily mean that copay is waived – if you look at the definitions section of the handbook you sent me, it has this definition: “Copayment or Copay is a fixed dollar amount you must pay for a certain Covered Services”. I can see the section on maternity care that says prenatal visits are “covered in full” which implies that the copayment is waived …but you may need to talk with someone at BCBS to clarify. It is possible that in the eyes of the insurance company, the nature of a visit can be changed depending on what happens during the visit.
That is, maybe they think if a patient is pregnant and goes in for a prenatal visit and brings up an additional medical problem separate and apart from the “how is the baby doing” stuff, even if pregnancy-related – the visit then becomes an “office” visit.
As I’ve already noted, I don’t think pregnancy-related nausea should trigger that
switch … but who knows? Maybe they are defining “prenatal” very narrowly.
Insurance companies do work that way – they will say that procedures A, B, C are covered under one part of the policy, but if you go into the doctor for a single visit for A,B, C, and also get D – then the added piece changes the way the coverage is slotted.
If you feel the answer you are given is not satisfactorily explained, you might want to talk to the benefits administrator at your university.
None of this means that you won’t be covered in general-- it’s just the determination of what might trigger an “office visit” with a $25 copay and what is a “prenatal” visit.
@Knowsstuff baby got their first baby hat yesterday - one with a Michigan M on it - because I agreed to screen in for a study.
Brought it home and the dog tried to eat it ??♀️
Was the not-covered visit with your PCP, rather than your OB? If so, that may be the reason.
@Kelsmom -
When I called BCBS today, the customer service rep kept talking about an ultrasound not being covered. I didn’t have an u/s with the appointment. I went in for nausea and some routine prenatal blood work.
It wasn’t my regular PCP (who is on maternity leave) but the same hospital system and I’m wondering if that’s what caused issues. I’m going to call the PCP office tomorrow and talk to billing.
I love my PCP which is the only reason I keep her even though she’s not a U of M doctor like the rest of my doctors. This wouldn’t be the first time my PCP’s hospital system has screwed up a billing code though. (Although the EOB looks like the right code…)
I am sure you will get it taken care of. Persistence pays off with BCBS.
How did it go with the MIL?
@youdon’tsay it’s tomorrow we’re going up. Apparently they’re taking us to dinner.
Order something expensive!
You are so nice. Now, knowing what I know about narcissists, I would no doubt cancel.
Just not play along. What a self serving woman.
Let us know but no one expects you to put up with her nastiness.
Both Mr R and my SILs reminded me today that everyone’s opinions I actually care about are fully supportive of us and truly wish us nothing but happiness.
And they reminded me that my own mom has enough love, support, and everything else we need for two grandmas if needed. (Because we’re all close, both of my SILs know my mom pretty well and she’s become a surrogate grandma for the niblings on Mr R’s side. One SIL’s mom passed away while we were in college and my other SIL’s mom is just like our MIL. So they’ve kind of adopted my mom.)
So we’re going to go. Enjoy dinner. We’re bringing our dog to play with her cousin dog (her best friend) so if nothing else, I get a tired pup out of the deal ?