I feel I need to give a little rant and rave lately about our insurance situation. If you’ve been keeping in touch with my blog you might be familiar with our ongoing battle with our insurance company to pay for all the procedure and tests done to me in this medical condition I find myself. If you are not familiar here is a quick (I hope) recap:

Upon my regular visit to my lady doctor to get the yearly lady physical, I had a number of concerns that I shared with my doctor. She ran a blood test that tested a long list of things including hormone levels, thyroid function, and any possible infections or abnormalities that could cause my many concerns. A few hormone levels (I can never remember what they are called) came back higher than normal, similar to a women going through menopause, so she ordered to have me come in and repeat those few tests. Again, they came back higher than normal. So, I was referred to a specialist Fertility Clinic to help decipher the next step. At no point did any doctor warn me that this might cause concern for my insurance company or that I should check for authorization before seeing a specialist.

As deeply afraid, concerned, FREAKED OUT(see past blog posts from this time period) as I was at that time, I didn’t give it a second thought and went to the specialist to see what exactly was going wrong with my body. They confirmed that POF (Premature Ovarian Failure) was the cause for my non-existant periods and my other symptoms. The doctor ordered another blood test, again without authorization, to find out if the condition was caused by molecular level. Thankfully, the results were negative.

It was shortly after this that I got the complete bills from my first tests at the OBGYN. My insurance claims that the POF diagnosis was a “pre-existing condition” and would not cover it. Of course, it was more than we can afford. Of course, it is not a pre-existing condition, so of course, we fought it. They reviewed the matter and found that I had not been to see the doctor for anything relating to this condition for 6 months prior to the hire date, and they opted to pay 70%, still leaving us to pay approx $208 for the lab fees.

Recently, and what you may not know about, they sent us a bill for the complete lab and doctor’s visit to the Fertility Clinic. The total came to somewhere in the $700+ range. I called the insurance company to have them explain why none of this was covered, since I was referred to see them for the same condition that I was seeing the OBGYN. They explained that tests were considered “major” and therefore needed authorization from them before proceeding. I had the option to send the matter to get authorization. “Yes, send it! I should not have to pay for this when a good 20% of what we make goes to your insurance company every month!” I yelled to the representative on the phone.

Yesterday, I received notice from dear old Altuis Health Insurance, my good friend (sarcasm). They informed me that they declined authorization and that the “molecular labs take at the Fertility Clinic were not a necessary treatment, and therefore not covered under our insurance”. I have the option at this point to appeal that decision. Of course, I will.

It is not a wonder to me anymore how many Americans are now going the route of not getting health insurance. Why pay so much a month to a company that doesn’t do it’s part when you need them most? Had we saved the money ourselves and told the doctor that we don’t have insurance, they would have billed me for a lot less and I could have paid it myself. Health-care reform needed? Yes, but who is going to really know what it will take to fix it? If I had it to do all over again: I still would have gotten the diagnosis and treatment recommended by my doctor, because not knowing what was going on with my body was surely killing me. At the same time, how heartless are these insurance companies that they can undermine the disaster that this whole process has been for me personally?