My insurance has decided they are not going to cover my pregnancy?

Question

My son was born on May 21st and we just received a notice from our insurance company saying that we "may owe" around $10,000 for a pregnancy that we thought was covered (we have been paying for maternity coverage and were never told throughout my entire pregnancy that we weren't covered). My husband spoke with a representative on the phone that said they basically decided on July 17th that they were going to deny our coverage- 2 months AFTER my son was born. If we had known this before we could have gone with a different insurance and had coverage, but now we are stuck with a huge bill and have been paying almost $600 per month out of our own pockets for the last year and a half for basically nothing. Has anything similar happened to anyone else and if so, what did you do about it? By the way, we have Anthem Blue Cross insurance.

Answer 1

You must meet the waiting period. If you have not and submit a claim, most insurance companies drop you entirely. If you were denied for some other reason, and feel it was wrong, submit an appeal request in writing with your documentation stating why their decision is incorrect.

While this is taking place, you are still within the window to apply for state medicaid to cover the delivery if you apply this month. If the decision goes in your favor, the money that medicaid pays will be returned when your insurance pays.

Answer 2

I'm sorry this happened to you, but you wouldn't have been able to obtain insurance after you were pregnant so another insurance company may have not been an option.  

What was the waiting period for this policy and how long AFTER you got the policy did you get pregnant?  Some of the waiting periods will not cover an entire pregnancy if you become pregnant during the pregnancy.  Others just won't give you coverage during the waiting period.

http://www.InsurancePickle.com

Answer 3

I would talk to an lawyer if I were you!

Answer 4

You've been paying the maternity rider for approximately 18 months and your son was born on May 21st?

Sounds like you may have gotten pregnant before your maternity waiting period was over.  If so, there's nothing you can do about that.

If it makes you feel any better, any other insurance company would have probably denied the claim too.  Virtually any private insurance policy with a maternity rider is going to have a maternity waiting period.

Go look at your actual policy and read the maternity rider info...it should be spelled out pretty clearly what the length of your waiting period was.  And if you got pregnant before that...well, congratulations on your son, but if you wanted the birth to be covered you should have waited longer to conceive.

(Note - if your claim is being denied for anything other than the waiting period, post an update here and maybe we can help.)

Answer 5

i would consult an attorney. That is srewed up. There has to be something you can do because that is just not fair. Most attorneys will give you free advice for a consultation. Goodluck

Answer 6

Yeah, they're famous for that...see the link below, regarding a suit against them that was just settled here in CA.

I would start by calling them again, and letting them know that you plan to not only have them cover the pregnancy (per the legally binding agreement), but that you also plan to have them cover your legal expenses in the upcoming trial.  

In case they don't respond positively to this new bit of information, you should contact the office in your state that handles issues like this.  In CA, we have the "Department of Managed Health Care", and also an Insurance Commissioner...not sure what they'd be in your state, but I'm sure it's something similar.  The people in those offices should be able to help by providing information - including the contact information for lawyers who specialize in this type of case.

DO NOT let them get away with it.  They CAN'T decide after the fact not to cover you - just like you can't get insurance for a pre-existing condition.