Friday, May 7, 2010

Think this is too blunt?

So today I get a claim form in from my lovely insurance company. The font is suppose to express my dripping sarcasm. I'm obviously use to dealing with them. They'd previously covered the ultrasound for my fetal echo & such, but now they are telling me they are NOT paying for anyone to review them & decide if our baby was OK or not.

Yes, seriously.

Upon calling, they tell me in no way shape or form on screening test covered unless I was having a medical problem. But me having a medical problem doesn't really relate back to our baby needing a fetal echo, & other screenings, which she agrees with so she is basically telling me there is no way that it can be billed to have them cover it, so I ask if experiencing a full term stillbirth less than a year ago would be a medical reason to cover the screenings for this baby. The response?

"You can appeal it, but no, we really don't care about that."

*blink blink*

OK. Fine. Thanks for being honest, I had to hang up to go cry then.

I wasn't going to appeal because honestly I'm just so beyond done with all of this. Just done. But I decided I might as well. So I wrote this little lovely letter. I look forward to the rejection to see if they address my question.

May 7, 2010

To whom it may concern:

I am writing to appeal claim number 264544 for the date of service of 3/11/2010 for the total amount of $742.

These were “screening test” for our unborn child. The actual ultrasound portion was fully covered, but the doctor looking at our unborn son and ensuring his health was not. So I guess the ultrasound itself is covered, but we are responsible for the cost of having it read? I’m not exactly sure I understand the point of covered of the actual scan, which was more expensive, if no medical professional reading it was covered.

The code used to bill was a family history of heart conditions. On top of that issue, I also experienced a full term stillbirth less than a year ago that is not full explained to this date, minus a possible kidney issue which can sometimes be related to heart issues as well, which is why my doctors & specialist this pregnancy wanted to have these test done. Simply put, these test were ordered to ensure the health of the baby I’m currently pregnant with. Not to mention my and my husbands own well being, to help diminish our fears and worries of this child dying as well. I’m already being treated for depression and other issues related to my last stillbirth, including being on medication, so I’d obviously like to prevent any in the future if possible.

If these screening test are not covered, I’d like to know how many dead babies WV PEIA would like us to have? Is there a certain number that we must experience before testing will be covered for future children to ensure that we do not experience another dead child, and I myself have to go through labor delivery, & the emotional pain I’ll have to experience each time? I'm curious about how many maternity and delivery charges PEIA is willing to pay out before they assist us in preventing a dead child instead of just paying maternity coverage out over and over again that has the same negative end result.

I’m asking for your company to provide my unborn child with the medical care he deserves so he can have a chance to experience life. And so my family can avoid having another life taken from them.


Jessica Culver

Blunt? Maybe. Unprofessional? No more than them & I really don't care anymore.


  1. I love it. Seriously. Great job and I hope it opens their eyes. I'd punch them for you if I could!

  2. Straight to the point! Hope they finally get the message.

  3. It's definitely not too blunt. Personally, I'd send a second letter to the VP of Customer Service with a Cc: to the CFO (or whatever they have) to relate that the service representative said that they "didn't care" that your baby had died. I'd tell the VP, "Regardless of whether I agree with your company's decision to deem these services as ineligible under the terms of my contract, your service representatives should be trained to have a suitable level of compassion to your members. To be offered anything less than basic human compassion is inexcusable and unacceptable."

    But that's just me.

  4. Gretchen (again)May 7, 2010 at 8:48 PM

    I also understand that may be an easier said than done thing. I'm sure by now you've had your fill of writing letters to your carrier.

  5. Hi! I just found your blog! Congrats on your pregnancy and I am crossing my fingers and thinking good thoughts for you! Wow, I'm really full of exclamation points! Anyway, I totally sympathize with you about the insurance thing. I just had a root canal and I had to shop around to find an endodontist to do it, but then after it was done I learned that insurance doesn't cover the crown that has to go over the tooth at the end which is about a thousand bucks. Hey insurance, thanks for paying for half a procedure! Really appreciate it!

  6. I think it's perfect.

  7. I'm sure Sarah doesn't mean to be equating your experience to a root canal...

  8. Pretty certain she was merely relating her understanding of messed up insurance claims.

  9. I don't think it's too blunt!

  10. Hi Jessica-
    I commented on an older post but wanted to do so here as well because- I don't know because I am so close (right down the road in Charleston), part of that horrible club you're not until you're in and because as it turns out we have the same insurance company. I find this so horrible because I have never had a problem with them so I will be writing a letter coming from someone who is actually a policy holder- maybe that will help. I looked for an email addy for you but didn't find one so I wanted to leave one here and I don't know offer to be someone who is literally a few minutes away- or something. Anyway:
    I am a Jessica as well.



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