Mike and I showed up for my OB appointment yesterday anxious and excited. Excited to possibly discover Binky’s sex, check growth, and see little fingers and toes. And anxious because…well, I have just been an overwrought mess lately.
It’s hard to describe the terror I feel before every appointment. I wake up with lumps in my throat and an elephant on my chest. I am always scared that TODAY will be the day we find a blood clot. TODAY might be the day I have protein in my urine. TODAY might be the day one of my blood tests come back abnormal. The only thing that keeps me from having a complete panic attack every week is my ultrasound. It is just as important to my mental health as it is to the baby’s and my physical health.
When I was called back yesterday, I was taken into a different room than usual. Then Dr. Risky’s nurse practitioner came in with a Doppler (a high-tech microphone used to hear the baby’s heartbeat). After she located the heartbeat and left, I turned to Mike and said, “I’m not getting an ultrasound today. Something is up.” I started to freak out a little. Mike talked me down, saying that I didn’t know that for sure, and I shouldn’t panic. I calmed a bit but I just had a feeling.
Dr. Risky came in, did a quick exam, gave me some test results, and then wrapped up the appointment. I looked at Mike frantically, so he asked if I was going to get an ultrasound. Dr. Risky sighed, and said, “No. Your insurance won’t pay for weekly ultrasounds anymore. Because we thankfully haven’t found any abnormalities, your insurance will no longer accept that these ultrasounds are medically necessary.”
That’s when I had a full-blown panic attack. Dr. Risky kept looking from me to Mike, clearly wondering where her somewhat-rational patient had gone. I tried to explain to her through my tears that the one week we DIDN’T have an ultrasound with Madeline was the week my water broke. And that while I understood this pregnancy was totally different and everything was looking SO much better than the last time, that didn’t keep me from being utterly terrified. Dr. Risky tried to comfort me while Mike asked questions and I took giant hiccuping breaths. I hate crying in public, I HATE crying in front of doctors, I hate losing control of the situation. Dr. Risky said next week she’ll “sneak” me an ultrasound if she has to.
I don’t care about not knowing Binky’s gender yet, that’s obviously going to be known at some point. But having to go another week without knowing if there are blood clots, or how the placenta is doing, let ALONE the baby, is going to push my already fragile mind to its breaking point. It helped a bit that we heard the heart beat, but it would have helped a lot more if I’d gone into the appointment knowing I wasn’t having an ultrasound. I would have been able to prepare myself a little better. I was booked for an ultrasound appointment, and Dr. Risky’s office thought I’d be able to have one until I showed up that morning.
We have health insurance thanks to COBRA. I was laid off in October, and Mike’s company didn’t offer him health care coverage. COBRA is astronomically expensive – for our family, it was costing over $1300/month for health insurance. Because Madeline and I both had pre-existing conditions, we were both impossible to insure, so COBRA was our only option. Luckily, I qualified for a cut in the price of COBRA thanks to Obama’s stimulus package, and it came at the perfect time as Mike was laid off in June. I say all this because I KNOW I am lucky to have insurance. Mike and I freelance right now and pinch pennies and we make it work, because this insurance is the only option I have and I HAVE TO be insured.
But. This is where I get so supremely annoyed. Based on my medical conditions and my previous pregnancy, I am classified as extremely high-risk. I know that ultrasounds are expensive, but it’s so frustrating that my health insurance is choosing to hold back on an ultrasound at the potential risk of my child and myself. Sure, they saved $1500 this week, but what if there was a problem that could have been detected and PREVENTED this week that was missed? That $1500 would turn into hundreds of thousands of dollars – just for me! My medical bills from my first pregnancy were astronomical, and Madeline’s bills? Well, she was a million dollar baby in more ways than one.
I understand that in this country, health insurance is a business. I understand that, for them, I have proven to be an astronomically bad business decision. But they’re stuck with me for now. I think a better business decision for them would be to allow my doctor to provide me preventative care. There are thousands of other women in the same position as me. We don’t like being thought of as business decisions, especially when our children are the unwitting victims. We’re people who have been through a lot. We’re more than just a dollar amount.
Kelly says:
Oh god, how distressing, frustrating, so many other descriptives and generally just FUCKED!
I am so grateful that I live in Australia at times like this. You guys get it really good in my field of work, but health-wise gimme here or the UK any day.
I hope that she sneaks you the ultrasound next week. I hope that you can maintain some level of sanity between now and then.
Love and hugs… To all of you. Keep safe, Binky!!
.-= Kelly´s last blog ..Lounging around =-.
Katrina says:
I don’t blame you for crying and hiccuping back your sobs of disappointment and frustration yesterday. You went there expecting to see your Binky! You needed to see that all was okay!
And to be denied that, without warning?
No wonder you fell apart.
Ugh. Insurance. So frustrating!
Well, at least you have the understanding of Dr. Risky, who will sneak you in for an ultrasound next week.
Here’s hoping the week passes quickly! Hang in there:)
.-= Katrina´s last blog ..What is with this DAMN computer, anyway…. =-.
Chrissie says:
UGH!! That is totally ridiculous! I am so sorry! I know I would be FREAKIN out and extremely dissapointed to say the least if I was expecting to have an ultrasound and was told at the last minute that I wouldnt get one. I will keep hoping that this is 1500 dollars that the insurance company saved and it never turns into a loss, but not for their sake, for you and Binky. ((HUGS))
bokker says:
Jesus. That’s shocking and unfair.
I’m with Kelly- I feel like punching people who whine about our free healthcare in the UK.
.-= bokker´s last blog ..Not content with one blog, I’ve selfishly bagged myself two. =-.
Krissa says:
First of all, I like Dr. Risky. Second, I wish people would talk to you more when they start doing things out of the ordinary with you. They know that you notice that and they should say something to you about what is going on! I’ve had anxiety problems off/on throughout my life and I have had panic attacks so I can sympathize with what you are feeling at those moments. You don’t need that now. And while of course you probably are going to have those moments, there are things that the staff at your appointments can do to lessen the severity. If you have been able to start yoga, that will really help you relax. It is a short term fix when things are as stressful as what you live through daily, but it really does help. … As for insurance, don’t get me started. Many years ago I worked for a company as an “Underwriter Communicator”. My job was to call applicants and ask questions that the underwriter had based on answers they had given on their applications. The answers they gave on the phone were going to determine their coverage and whether they got declined, or a rider, etc. If you only knew how twisted and evil that industry is. I won’t go into it all in these comments, but I finally one day did not go back after I couldn’t take it anymore. The last straw was when I spoke with a single mother who was currently pregnant. Her agent (her local guy selling our insurance) had done what they all do and let her believe that as soon as she sent that premium check with the application she had coverage. WRONG. And being pregnant is an automatic decline. I broke the rules and told her everything in as soft and easy a way as I could and tried to help by advising her about public assistance as best I could. Her situation was heart wrenching and to be part of an industry that was so dishonest and….well, that was just one horror story. Yes insurance is necessary, but the policies in that industry need to be totally rehauled. The way they are now, it’s all about making the industry heads rich. It is disgusting. … Sorry for the long rant on your comments. I hope you can do yoga and get as many moments of relaxation that you can. And I’m glad Dr. Risky is taking care of you. Hugs to you and Mike and Binky and Rigby. And remembering Maddie with love.
Momcat says:
Maybe your doctor could also give you a special rate on the ultrasounds especially since you are having so many of them. That would probably help a lot.
Krissa says:
I should have mentioned that the single mother had three kids already and got pregnant and her husband left her during that pregnancy. She was a responsible person who found herself in a very bad situation. That happens to way too many people – as many of us know firsthand. …
Kelly says:
Oh Heather! Damn! And once again, I am so grateful to you for telling us what is going on in your life.
Your experience today with short-sighted, profit-minded insurers is the reality for almost everyone who actually uses their “health coverage”. Those folks screaming at their town hall health care reform meetings about Obama killing their Grannies have never walked even a step in your shoes or had to use their insurance for anything other than a sports physical.
Insurers are destroying our economy and lives daily. Universal Single Payer Now! is how I answer my phone these days.I can not believe there are people who actually question that wellness is a right. After all, have we not been afforded the rights to life,liberty, and the pursuit of happiness in the Declaration of Independence. And why is our health an optional “privilege” when we are all guaranteed (in fact, we are required to participate in) the right to an education? Some things are fundamental. We are such a confused nation. Penny saved, pound foolish applies to your insurer’s decision to deny you careful screening and ensure Binky’s (and MamaSpohr’s) good health. Enough with the rant. I wish that you had been able to have a good look at your child today to ensure that all is well. Thank goodness you are a writer Heather. You are making a difference as you make your way forward.
.-= Kelly´s last blog ..Don’t Touch That Thing or Pandora is Whoa! Interesting! =-.
Erica says:
Good Morning my dear sweet Heather,
I’m so sorry to read how distressful yesterday’s appointment with Dr Risky was for you and about the problems you are now experiencing with your health insurance.
We struggled to conceive our little girl and I suffered a miscarriage so I fully understand the need to see your little bean on the screen and the need for this reassurance that your little bean is still OK in there. I too was a nervous wreck before every appointment and was always sure this was going to be the day that something would not be right. As soon as I would see my little bean on the screen and the Dr. would say that all was well, I could breathe again, I would be holding my breath until then. In the UK you are only entitled to two ultrasounds at 12 and 20 weeks but my health insurance here in Luxembourg paid for monthly ones. I was always so grateful to be living in Luxembourg and to have such good care.
I’m so pleased to read that your Dr Risky will ‘sneak’ an ultrasound for you next week. You are certainly in very good hands with your Dr. Risky.
Please look after yourself, dear sweet Heather.
Please remember that you have so many people all over the World loving and supporting you from afar. You are in my thoughts today, as every day.
With love, always
your friend, Erica in Luxembourg
Haley says:
I grew up without health insurance and spent much of my elementary school years in Texas Children’s …so I know all about astronomical bills.
This health care system makes chronically ill people feel like crap…pun intended.
.-= Haley´s last blog ..For Your Information 8/18/09 =-.
JustAMom says:
Well….I wasn’t nearly as high risk as you, and I know whenever I was spotting they’d give ME an ultrasound… And I wasn’t always STILL spotting when I got to the doctor’s office…..sometimes it happened the night before, when the doctor’s office was closed…. I’m just sayin’…..
Kelly says:
Couldn’t agree more!! Spotting is definitely one of those things that they should check up on with an ultrasound – especially with high risk!! And it’s not always happening right when it is convenient for the doctor to see it first hand.
I like your thinkin’ =)
.-= Kelly´s last blog ..Nomnomnom =-.
Emese says:
I love your thinking!
Jenn says:
Excellent advice!
Chrissy says:
that’s how I always got extra ultrasounds! my dr. even encouraged me to say that at one point – in order to have one!
Amy says:
GREAT advice!!
Chris in NY says:
Wow…it took me a few minutes to understand what you were saying. It’s 6:40 am and my brain isn’t awake yet. Anyway….that’s pure genius! We moms need to do anything and everything to protect our babies…even if it means stretching the truth. Good luck with your “spotting”.
Jenn says:
OOhhh Heather!!!
I’m so sorry this is happening to you. Isn’t it enough you had Maddie in her 29th week of gestation? Isn’t it enough to know she was hospitalize several times due to a consequence of a medical condition they choose to “ignore: the week before you went into labour? Isn’t it enough for them….someone, anyone on higher ground in your polictical office to know we loss our sweet. beautiful Maddy without warning/way too soon b/c of consequences way out of your control? And now, someone who doesn’t even know your name, decided you should be “JUST FINE” without the major tool to assist the doctors in knowing EXACTING what is going on inside of you? I’m so sorry!!! Saying this is so unfair lacks the passion I feel for such a shitty, cold and uncaring decison by people who have no idea what you’ve been through, who you are, let alone your name?!?!?!?!?.
I do take solace in truly believing your baby will be born without complications….on time when he/she is suppose to. Please don’t think because I am ranting and raving I feel otherwise. I am just so mad and upset FOR you!!!!
At times like these I realize how lucky I am to be Canadian. I’ve lost 5 babies. The consequence for that was an ultra sound weekly for each of my Earth Babies as well as non stress tests. I understand your fears and your tears….I would have been the same way. I wish we could bring you up here!!! If I could Heather, I’d put you down as a dependent so you could have as many Ultra Sounds as YOU felt YOU needed!!!
I am sorry but, I really do think everything wil be Okay and you will see your baby next week. I know you can’t wait…..and too be honest Heather?!….I can’t either.
Praying & Thinking of you during this stressful time. And sending you lots of comforting hugs!
My Best,
Your Canadian Friend;
Jenn
Amy says:
Another Canadian raising her hand, all necessary ultrasounds and weekly doc appointments covered by our employers. Bless them and our system here.
catherine lucas says:
Dollars against lives. I do not understand the American Health care system, but am afraid already for the time we come to the States and will have to rely on it. How totally unfair from that insurance to not wanting to cover. I also wonder why an ultrasound has to be billed at 1500 dollar. They use what, twenty minutes? A bit of electricity and a doctor who is working there anyway already? If you are not allowed monthly echo’s, being a high risk patient, who will be allowed then?
It baffles me that health care has become so good yet only people with money can access it… I was a single mom with 3 kids in my previous life in Belgium, had the third baby four months after hubby left me for another woman, I had insurance for god sakes, Insurance companies suck… If only we would not need them as much as we do. They are getting richer on the backs of people who have to penny bite every dime..
My goodness, guess your post from today Heather will bring out all the ranters amongst us who had bad experiences with health care…
.-= catherine lucas´s last blog ..Ferrets and Pink rabbit ears… =-.
Katie says:
Exactly! I don’t get it either! I was in the US for a while and could not understand how certain ‘services’ could be so expensive!! Why should an ultrasound cost that much??? It makes no sense and therefore must mean that somebody is making big bucks out of people! But that is so unfair! Here in central Europe an ultrasound (if you were to go privately) would cost no more than the equivalent of 50 bucks and we have very good doctors here. For godssake, all the doc has to do, as Catherine said before me, is to plug that machine in and interpret the image before him, and how long does that take? 10 mins tops!! God, how bloody annoying… Sorry you have to go through this!!!!!!
Amy says:
So agree. Believe here in BC Canada an ultrasound tech is paid about 25 dollars an hour. No doubt a fair wage considering in my experience an ultrasound was done in 15 min or less. So how can a hospital/doctor charge $1,500 a scan? Criminal if you ask me.
Kate in NZ says:
What a horrible day, and a horrible situation. Poor you, poor Mike, and poor Dr Risky! Good on her for being so understanding, it must be a terrible situation for her as well. Binky, we know you value your privacy, but be nice to mommy, ok? She’s had a hard time. Next time there’s an ultrasound, give her a wave, maybe blow her a kiss – and uncross those legs!
Lots of love and hugs to you Heather.
.-= Kate in NZ´s last blog ..Unpacking =-.
Megan (mommyesquire) says:
Oh Heather, that is just awful. Insurance companies can be really difficult. We had to take my 18 month-old to the hospital yesterday, and I had to call my insurance company. A woman answered the phone and said that she would take my name and number and that someone would return my call in 24 to 48 business hours. So my child is in the ER and it may take you 6 days to call me back? Un believeable.
Could Dr. Risky use a different diagnosis code which would get the insurance to pay? Will you get a 20 week scan? You are close to 20 weeks, right?
amanda says:
Amen girl – totally with you. I hope they sneak you in next week -but so stupid that they have to sneak you in at all. Ugh.
xo from CT,
Amanda
.-= amanda´s last blog ..weekend. update. =-.
eden says:
Hi …. ummmmm, I was waiting to get to the end of that post, where you would write, “And so I totally got an ultrasound.”
But, you didn’t and that SUCKS, man. I used to freak out, go to my doctor, and he’d just fill out a frickin’ form and I’d have an ultrasound. I wish I could pay for one for you, realz. I would LOVE to do that.
I wonder what Tom Cruise did with his ultrasound machine, and if you live near him.
MATE. I swear to God, if your life was ruled on all of our love and support, nothing bad would EVER happen to you again. Really hope the days til your next appointment pass really quickly for you.
XOXOXOXOXOXXO
Rebecca (Ramblings by Reba) says:
Doesn’t make much sense, does it? Ugh…
.-= Rebecca (Ramblings by Reba)´s last blog ..It began with a park, two dogs & a pile of poop. =-.
Karen says:
Insurance is a curse and a blessing. It makes no sense that an US would cost $1500, for starters. Don’t we all deserve the best possible care, esp if you have to pay so much for it. And you’re right, preventative care is much more cost efficient in the long run.
Maybe Binky needs another week to get over the bashfulness and show his/her stuff. Silly baby!
Continue to be strong, you’re such a rockstar!
.-= Karen´s last blog ..The New Vacation =-.
Jen says:
Heather, I am so sorry you had to deal with this.
I work for a Dr. and we write letters to insurance companies all the time describing the situation,(your condition and also what happened in your last pregnancy, the reason behind the(in your case..the ultrasounds) and what what it could mean if these US are not done weekly and how it could end up costing them more in the long run. There have been cases where something was not covered was changed due to a letter from the physican. It is worth a chance. Good luck
nic @mybottlesup says:
heather- during the last 3 months of my pregnancy with jackson, paul was deployed. he missed my entire third trimester and was lucky to be home for the birth. my obgyn happened to be a military brat herself, and every time i went to see her, she did ultrasounds…. (and didn’t note them on the chart) so that i could have a pic of the baby to send to paul.
i’m sorry you didn’t experience that yesterday. so so sorry that instead you were forced into a full blown panic attack and now have the burden of that anxiety for another week.
i’m sorry for it all.
.-= nic @mybottlesup´s last blog ..my heart… continued… =-.
Machelle says:
I am incredibly sorry to this happened to you. I am sure that while I say I understand your frustration, I am sure I don’t understand the depth of that frustration. I can not imagine what you are going through, and even know I don’t know you except through your blog, you and your family are in my prayers.
Those of you that believe this is wrong need to protest this kind of incident to your congress people. This is health care now, it will get worse. I don’t mean to take Heather’s blog to state this, but people need to work together now so that these things can be prevented
Again, pardon me for my comments in this form, but i DO NOT want to see things like this happen even more down the road.
Heather deserves the care she needs, not what some medical director somewhere, who doesn’t know her, decides she needs.
Sheila says:
Ditto Jen. Talk to ur dr about appealing the decision with the ins company. He can explain the $$ they will spend on the back end compared to the amt of weekly u/s. Cobra or not you have INS and there has to be an appeal process for this. Good luck
cj says:
This is just infuriating! Our health care system MUST change.
I am so sorry that this happened to you and hope that you get to have that “sneaky” ultrasound next week.
I know that it would not be a medical ultrasound but I have heard of the 3D ones that are done by private companies, maybe you could sign up for some sort of deluxe package that would allow you to have them really often…..and you could ask all of us to donate to pay for them?!?!?! I know that I would be happy to help donate what I can to help.
Again, i’m sorry and I’m thinking of and praying for your family.
Vicky says:
I know it might be even more stressful, but I think I would call the insurance company myself. It seems like sometimes they just turn things down as a matter of course and then when somebody raises a fuss, they relent. Just an idea.
Vicky says:
I think cj’s idea about us donating towards a package of ultrasounds is a great idea. I know I would do it and I bet a lot of other people here would too. Seriously, think about it.
Charlene says:
heather~~having “discovered” i had the breast cancer gene and having chosen to have a double mastectomy, losing my insurance and being unable to get insurance for several years, i understand your frustrations~~insurance companies can really suck~~i even worked at one for several months, hoping i would be able to get their coverage~~no, they even wouldn’t cover me~~just because i had a surgery 10 years earlier that saved my life {i choose to have a preventative double mastectomy when i was 37} even though i didn’t have cancer~~but because i was tested and had the breast cancer gene ~~i couldn’t get insurance coverage~~it really sucks sometimes~~but try not to freak {and that is a joke coming for panic attack me} but *i* just know ya’ll are going to be okay~~i’m a long time lurker and this post made me comment~~i’m 51 now, and a decision i made when i was 37 that saved my life, that i would do again in a heart beat~~still makes me unable to get health insurance~~hopefully things will change in this country~~it’s long over due!
.-= Charlene´s last blog ..and still no recipes =-.
Kristen McD says:
When I was pregnant with my first, I had to be on a medication that kept me out of the hospital. Only my insurance company wouldn’t cover enough pills per month to really… keep me on it and out of the hospital.
Until after the third time. Because my doctor fought for more, and won.
Dr.Risky could appeal this decision. A lot of things – the default answer is no. Until you make a stink. Not enough people do.
Kristen McD says:
I mean that generally – and not a dig. I’m sorry. Came off bossy and mean. I know you’re a fighter.
Anna Marie Hinnant says:
I’m so sorry you had such a rough day. It sucks.
Health insurance is more than a business – it’s a racket. And I agree with Kristen D – you need to call the insurer and put up a fight – the default answer is “no” but an appeal might get somewhere. Emotional arguments don’t work, but clearly explaining the economics to them sometimes does.
Megan says:
Oh Heather, I am so sorry. I work in a hospital and hear these kinds of stories every day. It is so f’ed up that health care in our country is a business.
Are there any free clinics in your area? Or Planned Parenthood? Since you were both laid off relatively recently and since your insurance won’t pay for something that is medically necessary for the health of your baby, you may be able to get free or significantly reduced-cost ultrasounds.
Also, I like Dr. Risky more and more every week. Good for her for helping you out. Would she be willing to help you appeal to the insurance company?
Ugh, now I am all fired up. But I will take my political rants elsewhere I’m keeping my fingers crossed for you.
Heather says:
I can’t believe the insurance companies in the States, I’m from Canada, and I like you, have a preexisting condition, so I was a high-risk preg for both pregnancies, seeing perinatologists for both of them. Baby no. 2 developed into the problem with first an arrhythmia, then polyhydramnios, requiring every other week ultrasounds and eerily the same, I get to 29 weeks, and am told to come back in 2 weeks for just an appt, but no ultrasound, this passes without event, then like you, I had PPROM, at 33 wks, 5days. So while in no way does this compare to what you went through with Maddie, I feel for you, if i were to ever get pregnant again (in all likelihood no) I’d feel the same way, you expect somethign and it doesn’t, all for money. So while Canada may suck in some aspects, it did pull through for us in terms of my pregnancies/healthcare. I am so sorry that you have to experience this, and I would fight this if I were you, you have extenuating circumstances ! DAMN IT !! I HATE the U.S. insurance systems !!
Love, prayers and peace,
Another Heather in Canada
Midwest Mommy says:
Oh I am just so frustrated for you right now.
.-= Midwest Mommy´s last blog ..Totally Ticks Me Off Tuesday =-.
Lindsay says:
I am right there with you. I am ecstatically and terrifyingly expecting my second (first was a 27 wk preemie)and am also high risk, but for different reasons. My insurance will not pay for some of meds or for me to see a perinatologist unless my OB refers me and he said he isn’t going to, because he can handle things. And the only hospital in our town with a NICU is out-of-network so we are paying much higher costs just to be able to deliver there. We keep arguing that by paying the comparitively small bills now they could save hundreds of thousands in the future. Unfortunately, this is a different insurance company than handled all our bills with Julianna.
Good luck with your insurance issues! And a healthy pregnancy!
.-= Lindsay´s last blog ..Sweet Corn…It’s an Ohio Thing… =-.
AnnD says:
First, I just wanted to say you must be psychic or something. Or just really sensitive to medical personnel’s behavior to have known based off of the nurse’s behavior that you weren’t getting an U/S. Amazing Heather!
Second, I hate insurance companies. They can be so worthless!!! And I’m so sorry this had to happen to you this week of all weeks when it marked such a stressful time in your pregnancy with Maddie. Sometimes you can call them (insurance companies)….if you have that emotional energy and try to explain the situation. I had a “normal” first pregnancy, but I had a miscarriage in Feb. and lost a little girl to Trisomy 13. I began bleeding with my current pregnancy with a subchorionic hemmorhage and placenta previa at 8 weeks, 3 days and got weekly U/S’s (sometimes twice weekly) from 6 weeks until 12 weeks and then the doc decided they weren’t needed because the placenta was looking as it was moving up and out of the way. It about killled me to have them suddenly ripped from me without being cleared of the condition and having been so used to them. I invested in a home Doppler (It was about $90 on Amazon) and I use it 2-4 times a day to check the baby’s hearbeat. It has been such a lifesaver! I highly recommend one.
Colleen says:
I will NEVER for the life of me understand the USA health care system. I can’t believe they would deny somebody so high risk the care that they MUST have! It’s sick and should be a crime. Then again after some of the stories i’ve heard about the health care system there, I guess i’m really not that surprised.
At times like this I thank God for the Canadian health care system. Granted it has its faults, and wait times have been extremely exaggerated by alot of people in the media, but i’ll forever be thankful that we get the help we need, when we need it, we don’t pay out of pocket for it, and NOBODY that is NOT in the medical profession can say “OH, no problems to date, no more ultrasounds for you”. It’s disgusting.
Hang in there Heather. It sounds like Binky is doing awesome!
The Grown Up Teenager says:
Man, the more I read about the American health care system, the less I take the Canadian one for granted. And we completely take it for granted.
I can’t imagine paying 4 figures a month for health care and then being denied an ultrasound during a high risk pregnancy. I pay nothing. Between our provincial plan, and my parents plans, I’ve never paid. And I’m 22 and still covered.
You can always come bunk with me. The OB in town is a friend of my parents. I’ll give her a call. Seriously though, this isn’t fair to you and I hope it gets fixed soon.
Amy says:
Amen. (And I am in no way religious). I live my life not worrying that a major illness with bankrupt us. As frustrating as the Canadian system may be at times (long waits in ER) I know they have my back and as a family we will NOT suffer financially should one of us become very ill.
I cannot imagine facing a life threatening illness WITH the possibility of bankrupting a family. Just too sad, too barbaric and trying for all involved.
Beret says:
Disgusting all the way around. I hate our system for so many reasons. I am lucky to have good insurance (through my husband’s work) but that’s all it is, dumb luck. People who work just as hard as my husband have no insurance. It’s insane
You know what’s the craziest part? That an ultrasound costs $1500 in the first place. Or that an overnight stay in the hospital costs in the tens of thousands of dollars.
WTF is going on in this country??
I don’t blame you for being inconsolable.
Colleen says:
It’s horror stories like this that make me even prouder to be Canadian! $1300 A MONTH for health insurance and then they are going to deny you? It would be cheaper to get dual Canadian/USA citizenship, live in a border town and come to us for your health care! How on earth can situations like this not be considered a crime when your PAYING (through the nose) for a frickin service they are refusing to supply? There is something seriously wrong in the good ole US of A!!!
Angie says:
I’m proud(?) that you’re speaking out w/your concerns and being heard. It’s frustrating for me to hear/read of others that work in healthcare or have family that do…and ultrasounds are ‘snuck’ in for giggles and grins. I hope you have some comfort/peace this week knowing an upcoming look is on its’ way.
With my daughter Meredith, my Dr. did not provide any u/s views other than a dating u/s (which confirmed what I already knew and was unnecessary,imo), and ordering a 12w nuchal scan b/c of my age. No typical 20 week scan… I kept having unusual spotting that was getting the “Spotting is not unusual” response.
On the day I hit 28w, I woke up an hour after I went to bed, went into the bathroom, and covered a good portion of the bathroom with blood. I spent a week in the hospital, then another 6.5 on full bedrest at home (which ended w/another coating of blood for the bathroom) with complete previa…which could have been discovered w/a simple, ‘typical’ u/s.
Your situation is much different of course; and I’m relieved your Dr. is willing to work with you; but as I mentioned–so much more relieved you’re making yourself be heard and doing what works for your well-being this time. Go you!
Anxious to read your progress, and can’t wait for you to have a baby back in your arms. Praying for you, Mike, Maddie and baby…
HeatherScent says:
Ugh. Health care should not be a business. You cannot put a dollar value on a person’s life. That is so gross to me. Our system in Canada is far from perfect, but at least a family never has to worry about going bankrupt during a time of medical strife.
I think of you and your Binky every day, and I pray to whomever it is that listens to prayers that both of you remain healthy.
.-= HeatherScent´s last blog ..Hi! Remember Me? =-.
Aunt Becky says:
This is what I used to do, I don’t know if I told you, I worked for an insurance company. Which would TOTALLY make people hate me.
Until I told them that I proved that things like hospice care (I primarily worked hospice) were cheaper at home than inpatient. I wrote grants to come up with alternate funding for hospice patients. Or patients with chronic issues.
And shit, Heather, had I worked OB, I’d try and put you in touch with someone. Man, I feel like punching something.
.-= Aunt Becky´s last blog ..Sadder Than A Paint-By-Number Sad-Eyed Black Velvet Jesus Clown =-.
Deborah says:
Healthcare in our country is a disgusting, expensive sham. I wish more people could be exposed to your story, putting a real human face on a problem that so many people find so easy to sweep under the rug. It absolutely enrages me that you aren’t able to get your weekly ultrasound. I’m not a huge fan of offering advice to strangers (my friends are a TOTALLY different matter, ha!!), but have you considered writing an editorial for your local paper? I feel like your story in particular could really sway some people’s minds.
I will be thinking about you today, as always.
.-= Deborah´s last blog ..Delighted =-.
Martha says:
I am so sorry that you have to deal with this crap. When I was pregnant with my first child, we had to move to MN because my husband had an internship there. So he had to leave his job and we went on COBRA paying over $1000 a month. When I went to the Dr. in MN they told us that the insurance did not cover outside of Florida. We were going through a lot of things At that time too, we where also in the middle of buying our home in FL too, which 2 weeks before closing the bank pulled the loan. Bad times. Anyway, we tried to sign up for medicare we did not qualify, and we weren’t covered with my husbands job because he was an intern. My husband had to sign back into the National Guard to get insurance, it took us a almost two months to get insurance. Luckily Tri Care covered for the time we weren’t covered, I had a panic attack and I had to to to the ER. We are now back in FL we have insurance with my husband employer but we still have a couple of issues because they changed companies recently. In June my son got really sick with a high fever, we had to take him to the Dr. twice in 1 week because he had a 103.2 degree fever. We got the bill recently and it was for over $300 for just ONE visit. The insurance company will only pay after we pay our $600 a year deductible. I don’t understand why we can’t all get Tri Care (what the military have) we never had any problems at all with them and we did not have to pay a dime. I hope that everything works out for you.
((hugs))
Martha V.
Alexandra says:
My thinking exactly. Our 3 children were born premature, because there were no “medical reasons” to order an ultrasound. So, 3 boys born early, in NICU, and I “told ya something felt funny.”
Jen says:
being from canada, I dont understand how your health care system works. Is there not a free clinic, or something along those lines?
I would be harassing the insurance company for sure.
Please try to stress to much, I dont want you to get upset.
Take care of Binky and your self.
I am praying that something will come through for you.
.-= Jen´s last blog ..Review your Product =-.
Jeanie says:
I’m so sorry, Heather. I remember all too well I and other mothers talking about how we were told we were getting a US only to come in to the appt. and have it not even be mentioned until we mentioned it (as if we could forget or something!). It’s REALLY bad in the military, where we SUPPOSEDLY have 100% coverage (HA!). I had 1 US of our baby after my nurse practitioner (the mil’s excuse for a obgyn) lied on a form for us. Mil moved us in my 7th month and refused to give me a new doc, told me to have the baby on my own, they couldn’t help b/c nobody was on staff, etc,etc. On top of all the mil-stress I thought I was going to have my baby under a tree somewhere!
You’re ninja for handling all this as well as you have been, I think. I’m proud (and have been for a while now) of you all the way from Okinawa. You will make it through somehow and you’ll be amazed at yourself once the dust is settled. I’m amazed at women’s strength in general and yours in particular.
*HUG*
courtney says:
Heather,
I hate insurance and I am a doctor. I have a small doppler that I used to listen to my pregnancies with. If you want it I will send it to you. If you think of it you can send it back when your precious baby is born and I can lend it to someone else, if not no big deal. I let myself check quickly once a day and it reassured me so much. Email me cmarkhamabedi @yahoo.com and Ill send it your way if you want it. Hugs and prayers as always
courtney
Amy says:
Courtney you are a sweetheart :))
Lisa says:
Oh, that makes me so mad. I don’t get these ridiculous “business” decisions that insurance companies make. Don’t they get how much preventive care really saves them.
I hope Dr. Risky is able to sneak you an US next week and that she fights for you to get back to your regular weekly US.
Hugs
.-= Lisa´s last blog ..Teaching Your Toddler or Preschooler Their ABCs and 123s =-.
Michelle Pixie says:
It’s moments like this that I wish I lived in France! Insurance is such a racquet and frustrates me to no end.
You hang in there & I am sure you will get your peek at Binky next week.
.-= Michelle Pixie´s last blog ..Work It Girl =-.
Courtney says:
Perfectly said, I can’t believe that they wouldn’t cover this as a preventitive measure!! God Bless.
Courtney in New York
.-= Courtney´s last blog ..What do I want to do? =-.
stephanie says:
Are you eligible for the AIM program? You may have already looked into this.
http://www.aim.ca.gov/Home/
.-= stephanie´s last blog ..We’re home… =-.
QF says:
Argh….
I am upset and in ranting mode so this might be hard to follow.
It is so frustrating to hear this story yet again. It seems that this sort of thing happens more often than anyone is willing to acknowledge.
What really gets to me is the fact that the insurance company decided that since “they haven’t found any abnormalities” they won’t cover other more ultrasounds. The reason why this pregnancy is going much better is because of all the preventive care you are receiving. Didn’t they find the problem with your placenta through the ultrasounds? What would have happened had the insurance denied the ultrasounds before? If the insurance company is looking to save money, making sure you are healthy is the way to do it.
This whole thing with the preexisting conditions makes me angry. So yeah, some people might “cost” a bit more to insure. At the same time, there are people who are insured that never need it. They can balance it out if they wanted it to.
I am amazed at the cost of the ultrasounds. I paid cash for my pregnancy. My ultrasounds cost between $125.00 to $180.00 depending on where I went and what needed to be done. I don’t know about your case, but maybe you might find a place where you can have ultrasound done if you feel a bit anxious. I know the money is tight, but this might be an option.
Hang in there! Ask Dr. Risky to appeal the decision over and over. Try to stay calm. I wish I could help you in that department, but I suffer from anxiety attacks and I am still trying to figure it out myself.
Just hang in there. Everyone is rooting for you and Binky…
Okay, enough ranting.
Jen says:
Well said, Heather. I’m sorry that you have been affected by the messed up healthcare system we have in this country.
My thoughts are with you, Mike, and Binky that everything else goes smoothly from here on out.
.-= Jen´s last blog ..This is going to be awesome =-.
Meg...CT says:
Oh Man, NOTHING pisses me off more than medical insurance. Damned if you do, damned if you don’t. My husband is self employed and I only work part-time, so we know how expensive health care is. When you pay these astronomical prices, you expect your needs…both mental and physical, to be well taken care of. I completely understand your need to “see” and “make sure”…so should the medical community, doctors and insurance companies alike.
I will say an extra prayer for you and your family today…Prayers of health and well being.
Peace.
Corinne Cooper says:
ugh…so sorry you had to deal with that. Insurance companies can be so shitty to deal with. I was diagnosed with sever pre-eclampsia (sp) and had my daughter 6 weeks early. We too were on Cobra because my husband quit his job when I was 7 months pregnant (long story). Sienna was born 8/27/07 & they denied her the synagist shot (sp) for the upcoming flu season in order to prevent RSV. Luckily her doctor did not take no for an answer & sent back the request with some “additional info” and she was approved. Hang in there Heather. All seems good so far with Binky. Prayers & Hugs to you & Mike.
Middle-Aged-Woman says:
I am so confused when insurance companies opt of the relatively inexpensive preventative care, and cross their fucking fungers hoping for the best. Their gamble is what’s wrong with our damn system.
.-= Middle-Aged-Woman´s last blog ..Life Changing Books =-.
Tracy says:
Have you thought of looking into Medicaid? It might help with your share of costs. {Hugs}
Liz says:
I’m another Canadian coming out of the woodwork to say that I so don’t get this. I know there are huge debates going on in the States right now over health care but I haven’t been following it very closely.
I’ve watched those birthing shows on tv and I always think how lovely and modern and fancy those Amercian delivery rooms look compared to what’s available at my hospital. But my doctor has ordered ultrasounds for no other reason than my mental health demanded it (after 3 consecutive miscarriages and a premie), and he hasn’t had to justify that to anyone. So I guess I’d say that I’d put up with the lack of artwork on the walls or a tv in the room in exchange for humane health care.
Like everyone here, I’m just hoping like hell for a healthy, strong baby Binky at the end of this pregnancy.
Lisa from WV says:
I don’t know if anyone else has mentioned this, as I have not read all of the comments, but it might possibly help if you write your insurance company a letter explaining all of this. I once worked in a doctor’s office, and we have had patients who were denied for certain things, only to write a letter explaining their situation, and then they were covered. Sometimes it takes two or three letters. No guarentees, but it’s worth a shot. Good luck, and once again, sending prayers from across the U.S.
Lisa
Heather says:
I hate insurance companies..
.-= Heather´s last blog ..yaaaaawn =-.
Mary in AZ says:
Heather,
I am so sad for you right now. What a miserable appt. I am praying that you will be able to have that u/s next week and that everything will be straightened out SOON with the insurance.
Hugs!
Mary
Gina says:
Don’t post much…but read all the time.
Heather, I hate, hate, hate that you are having to deal with this. This just plain SUCKS!!!
I agree with another poster: have your Dr. office write the Ins. Co. and explain the situation. I’ve had to do that in the past and it has worked.
Best of luck to you….thoughts and prayers your way, always!!!
Lindsay from Florida says:
OH Heather!! I hoped that the worst thing I could read on here this morning would be that Binky had been “shy” again, and we didn’t know the gender. This really makes the old “We don’t care what the gender is, as long as the baby’s healthy” cliche take on new meaning.
I am OUTRAGED on your behalf. Is there anything at all we can do? Start up a fund for ultrasounds? Deluge Cobra with letters of indignation? Storm their offices? (I’m only partly kidding on the last one…you know we’d all do that in a minute if you asked. We’ll all make the evening news…)
Stay strong. You’re a fighter as a Mom, and you always will be.
Jodie Brooks says:
This should be the last thing that you have to worry about. It’s so sad that doctors and patients have to manage their own healthcare and decide the things we can do without to save money. I’m sorry that you are going through this. I would want the peace of mind that everything is ok. I’m praying for you and will keep you in my thoughts!
daisybv2 says:
Heather, I am so sorry that is happening. That is really crazy I can’t believe they are doing that is there anyway you can have them call and fight it.
It makes me soo mad you pay all that money and they tell you “can’t have something done”
Hugs to you! I am so sorry you had to go through that
.-= daisybv2´s last blog ..Cops =-.
Holly says:
I had a similar experience with my 2 high risk pregnancies. I had to go through multiple, exhausting phone calls but it was worth it. I had paid for ultrasounds at every doctor’s appointment and there were a few that I declined because I knew the baby and I were ok. You have an advantage since you are paying cash each month for your policy and you are not receiving a negotiated rate like a corporation. I know it’s stressful to think about but you might want to consider arming yourself with a copy of your OB medical records and an afternoon on the sofa with the phone. You’re obviously rightfully upset about it but I promise you, not all insurance companies are bad and sometimes all it takes is a phone call. Good luck!
Linds says:
ive been kind of on the fence all along about the whole universal health-care debate, but my concerns about the government trying to handle something as delicate and ethically complex as health care are outweighed when i hear stories like this.
we need SOMETHING different. this current system is outrageous, truly.
how is mike doing? ive been saying lots of prayers for you both.
lindsey says:
They thought my daughter had down syndrome and those extra few ultrasounds really helped keep me sane. I can’t believe they aren’t covered thats crazy. I hope it all works out for you. I agree with the others often times a phone call is all they need to be reinstated.
Kate C says:
Hi, Heather —
I have only commented a few times before, but this post really got my hackles up. I am SO ANGRY that your insurance is doing this to you. I was covered by COBRA for a while, and it was a nightmare.
I have a debilitating, progressive illness, which, as you know, makes finding good insurance coverage nigh impossible. My premiums are sky-high, and I still end up paying tens of thousands of dollars a year out of pocket.
I have been so enraged and hurt by this insane fight against healthcare reform going on in this country right now. I realize that universal healthcare coverage is not perfect, but it is just, and would take us one step closer to making sure that everyone has a fair shake in life. The people protesting reform right now have so clearly never known true need and true health crises, and it makes me absolutely insane.
I’ve followed your blog since hearing about your beautiful girl’s passing, and when I read that you were pregnant I absolutely balled. I am so thrilled for you, but at the same time I truly can’t imagine the anxiety you’re feeling. You are handling it beautifully. Every part of me wants nothing but joy for you, and it breaks my heart that our broken healthcare system is now getting in the way of that.
Stories like yours need to be shared with Americans right now. I’m so glad you’re so open and honest, and I hope that your experience will make people sit up and take notice of the reforms that are so desperately needed.
Thinking of you!
Marnie says:
Insurance companys irritate me, but so do dr’s offices. Don’t get me wrong, your dr sounds great, but how is it that a wand going over your belly for 5 mins and showing pics on a screen, cost $1500?
It reminds me of when a few years ago we had an insurance that had a $500 deductible instead of our current $15 copay, and my husband was in the process of switching insurances. My daughter needed her well baby visit, and with the deductible her appt was $90. I wanted to pay cash instead of using the ins, and they said, “ok, then its $35”. Wha-Huh!?! Even at the time, I couldn’t believe that it was cheaper to pay cash, than use the ins.
Its crap like that (drs overcharging ins co and ins co justifiying the cost of their premiums to us) that has this stupid healthcare system all screwie. All the while the people that suffer are the patients.
I hope you are able to get your ultrasounds from here on out. Sorry for my ranting. We all just want the best for you and Binky.
Summer says:
I couldn’t agree more about the high cost of insurance. But one of the reasons that doctors charge insurance companies so much is because they don’t get paid for everything they bill for. If you ever look at an EOB statement from your insurance company you will see that doctors are paid only a fraction of what they bill.
I’m not saying doctors aren’t to blame for some of the high costs, but the greedy insurance companies are the ones that drive up the prices and then decline patients who are “high-risk”.
.-= Summer´s last blog ..Something in the Air =-.
Marnie says:
I agree that the ins companies are greedy. My oldest daughter has had 4 eye surgeries and reading the statements afterward were unbelievable. I didn’t mean to sound like it was all the dr’s fault for the cost of ins premiums. Unfortunately its a vicious circle, the dr overcharges so the ins co underpays, the ins co underpays so the dr overcharges. It’s like what came first the chicken or the egg? There needs to be a standard, like if the dr charges $50 for an ultrasound (or less would be nice. Yeah right, I wish), then the ins would pay $50.
I could only dream about a world where medical care/procedures/prescription meds would all be reasonably priced and the reasonably priced ins would pay for it all and there was no such thing as declining patients for being high risk or having pre-existing conditions. Not only medical fees, but groceries, gas, everything. Too bad everything has come down to making the big $$.
Talulah says:
This is just ridiculous, cruel, and yes, WASTEFUL on the part of the insurance company. I am so sorry you are being put through this. And so sorry that human beings can do this to other human beings, as long as they hide behind the excuse of “It’s a business decision.”
.-= Talulah´s last blog ..Attack of the 16 lb Toilet-Drinker =-.
Danielle-lee says:
I totally agree with you. I hate that healthcare is such a business transaction. I hate the talk of it being a privilage, not a right. We all have a right to preventative care, to that $1500 ultrasound that could save lives….it’s so maddening.
I am so thankful you have COBRA, even tho it’s so expensive it’s sinful.
I’m sorry you didn’t get the ultrasound. I know that had to be so stressful & painful. hugs to you.
.-= Danielle-lee´s last blog ..Wordless Wednesday =-.
Rachel says:
Ugh, insurance here makes me SICK. I am so tired of people being treated like commodities that can just be written off if they aren’t good for the bottom line.
I think about you everyday, and will be anxiously awaiting more news about Binky and looking forward to hearing more stories about Maddie.
.-= Rachel´s last blog ..I Don’t =-.
mandy says:
There are issues, for sure, with the Canadian medical system. No system is perfect. BUT, no one in Canada goes uninsured. No one in Canada with a medical need loses their house, goes into debt, ceases to be covered due to job loss or preexisting conditions. No one is denied serious/urgent medical care deliberately.
There’s a lot of misinformation and fear-mongering about the Canadian “socialist” system in the US right now as Americans go through health care reform. In as much as Canadians complain (it’s a national hobby), I don’t know anyone who would choose the US system over the Canadian one.
We lost a baby last year, on Oct 29th at 24/25 weeks gestation through no fault of anyone. It was an “abnormal” pregnancy. I got every test, every counselling session, every specialist I needed before and after our loss. I can’t imagine paying one cent of a medical bill on top of that loss.
I feel for you and Mike and others in your situation. Belonging to a society means being your neighbour’s keeper, not being concerned with keeping your neighbour from getting what they need.
.-= mandy´s last blog ..Some Burning Questions for You =-.
Amy says:
Too true.. I have never been denied any care through our system here in Canada and it does not cost me a dime. For those who are not covered by employer/Company plans the monthly premiums are very reasonable and affordable. No one goes without and for that I am proud.
andrea says:
This is so frustrating! I had two high risk pregnancies that unfortunately both followed the same path, with some new extra features thrown in for fun the second time around! It was so extremely maddening to fight with insurance for certain drugs, ultrasounds and procedures knowing that in the long run it would avoid longer and much more costly hospital stays. My OB went to bat for me on so many occasions but it didn’t always work and those for me were the real low points.
Sending you and Binky all good thoughts!
Amanda says:
There are so many things about your post that just shock me. We may not have the best health care system here in Canada, but it’s paid for (more or less). I cannot imagine being told _at_ my appointment that this is not covered anymore because of _______. That’s just plain crazy to me.
All I can say is hang in there and keep the faith.
.-= Amanda´s last blog ..Summer Reading Round-up – Part One =-.
Tina Hosko says:
Be proactive Heather and FIGHT back. If you need to unleash your inner beast next appointment, do it. That really SUCKS! So damn ridiculous.
Sorry Heather
Jesika says:
This is crazy because my husband made me sit down and watch Sicko last night and now you wrote this blog and it really makes you sick at what the insurance companies can do here in America!!!! I am sorry if I were a doctor I would give you the ultrasound for free because peace of mind is priceless!!!
Jenn says:
I’m so incredibly sorry you are having to deal with this. It seems to me that the DOCTOR should be the one who decides whether or not an ultrasound is necessary – not the insurance company. The whole mess with health insurance makes me sick to my stomach. It is just more proof that greed comes before humanity and that is so so sad.
I’m glad that your doctor is willing to sneak you one next week if she has to but the situation is still so disheartening. It sounds like whether or not the ultrasound is needed for the baby’s health, it’s definitely better for you to have them as far as your mental health is concerned.
I hope they work it out and you can at least receive them every other week.
Bianca S says:
Wow, and I thought the French system sucked (I’ve been living here for nearly a year and it’s been the bane of my life…!). But…wow. That sounds bad. My sympathies
Melissa in TN says:
You may already have one or someone else may have mentioned this in the comments, but my home fetal doppler was the best investment I ever made. There were so many times when I calmed myself down by finding my daughter’s and then two years later, my son’s heartbeat. It was so reassuring to be able to check on them whenever I wanted.
I am sending good thoughts your way. Hang in there.
Rach says:
I am so so sorry. My last pregnancy with my son was horrible – I wanted an ultrasound every week and couldn’t have one…even though the pregnancy before, one baby died and the other had many many birth defects.
I am not sure how everyone is thinking a single payor would be any better. There would be even MORE rationing with a single payor. More people to be insured, less money to go around. Money doesn’t just appear out of nowhere for these things…our current administration seems to think so. Hey, let’s just print money! That works, right?
The whole thing is absurd.
I wish there were a better way. We do need reform of some kind.
DITTO on the doppler. GET ONE!
.-= Rach´s last blog ..you would have arrived today =-.
andy says:
living in canada one sometimes takes for granted our “health care for all”.
i can’t imagine the weight on your shoulders on top of all else that you have endured.
your doctor sounds at least like she has empathy for your insurance situation and wants to help you as much as her tied hands will allow.
blessings for you and your family.
andy:)
.-= andy´s last blog ..even though a human head can fit through my vagina doesn’t mean I want to turn it into a magic clown car like at the circus =-.
Erin Walsh says:
oh how frustrating! Why is it that our insurance providers are the ultimate decision maker with regard to our medical care? If the doctor says you need an ultrasound, THEN YOU NEED A FREAKING ULTRASOUND! But nope, sorry, some insurance bigwig has decided that their bottom line is more important than your peace of mind and potentially your unborn baby’s health. ARGHHH!
LastGrlStanding says:
I know there’s a bit of a debacle in your neck of the woods right now regarding healthcare but I live in Canada. And as much as there may be wait times for non-emergent cases I can honestly say I’m so grateful for our universal health care (did you know it was Keifer Sutherland’s grandpa who pioneered our health care system, right here in little old Saskatchewan?). If I could give you an ultrasound I would (will an etch-a-sketch drawing help?). If I could make everything okay for you, I would in a heartbeat.
*hugs*!
-Kristel
.-= LastGrlStanding´s last blog ..See You In The Funny Farm =-.
PattiMcKenna says:
Heather,
Talk to your doctor and ask if she will help you appeal this decision. After losing our son, the insurance co. gave us an apnea/heart monitor for our next baby, but then refused for the one after that because there weren’t major problems with the last child. We appealed and won. The pediatrician wrote a letter on our behalf, stating that an error in judgement on this decision might cost a life, and also that mother and baby needed the reassurance the monitor provided. In your case, the stress of worry can significantly impact your health and the health of your baby, making an even stronger case for winning an appeal. I urge you to give it a try.
.-= PattiMcKenna´s last blog ..I Love You Enough =-.
AnnD says:
Just some other thoughts; does Dr. Risky have old U/S machines at his disposal. At my OB’s office they have the fabulous 3D/4D U/S machine that you need an appt. with a U/S tech for and then older U/S machines that the docs can wheel from room to room at their will. They aren’t as “good” as the newer ones, but they can see bleeds and the placenta pretty well.
I would really consider calling your insurance companies and explaining 1.) about Maddie’s prematurity 2.) Maddie’s recent passing which has caused you immeasurable stress and anxiety in life let alone related to the health of Binky….and if you can’t get anywhere on the phone….consider going above their heads, writing a letter stating that you have a blog that gets so many hits a day and will release the information to the media or something….
I dunno…..just some thoughts…you deserve those U/S’s girl!
If you want the link to the Doppler I ordered, email me at AnnNville@aol.com It works really well and it’s my savior!
shiduri says:
Those fucking rat bastard pieces of shit insurance companies.
This is BULLSHIT.
lilmissbridget says:
Heather,
I am so sorry to hear about this mess! I am praying for you and your family daily. This is just another example of why we NEED health care reform now!
What business is MIke in? I work for a biotech in Valencia (near Magic Mtn) and we are hiring currently for different positions…
I read this article yesterday, and it pissed me off. And now you, with your story, its just not fair. This woman has cancer and is getting free chem thankfully as her insurance denied her life saving chemo treatments!!
http://www.cnn.com/2009/HEALTH/08/18/chemo.closet/index.html
Stay strong, everything will be ok. Because it has to be!
Bridget
AMomTwoBoys says:
Grrrrrrr
.-= AMomTwoBoys´s last blog ..Birthday Boy =-.
Rachel says:
BRAVO, Heather. Well said. Health insurance in this country=FUCKED UP. It makes me so angry for you, for myself, for the hundreds of thousands of uninsured. I’m so very sorry for the extra distress and confusion that this has to have added to your mind.
Sigh. It is great news that things are progressing along well and normally, though. Here’s to that…!!!
Jess says:
This post left me in tears.. I’ve been fighting this STUPID insurance system for 11 years for one reason and 7 years for another. Pre-existing conditions are a BULLSHIT excuse… How is it our fault we are born with some random problem that couldn’t have been prevented.. I could go on forever on this subject… BUT I know you don’t need to deal with it.
On a separate subject…
You need to keep yourself calm, I know.. easier said than done.. But Binky feels it when you’re stressed or upset! Everything is going very well with Binky, don’t stress too much, Karma is giving you what you deserve … a break.
Meg says:
How horrible that something like insurance can threaten to cause harm to your mental health with something like this. What can we do to help?
Maddie says:
I am fuming, cross, annoyed, angry and above all frustrated with it all on your behalf.
One of my friends has Breast Cancer, “luckily” she has private insurance in the UK, which means she gets to stay in a private room, in an NHS (National Health Service) hospital. When she has reached her ‘limit’ of funding for the financial year, her treatment stops. Because the private and public funding systems don’t talk to each other, and as she hasn’t had consistent treatment through the NHS, such is the stupidity of it all, they can’t help her with making up any shortfall in chemo she has ‘missed’ by going private. Unfortunately cancer doesn’t stop, so she is now on Herceptin, in her last chance saloon and REALLY expensive, and being funded by the NHS when they picked up on an appointment nothing else was working because of everything stopping and starting, but because it was an NHS appointment, her insurance won’t cover any of the costs – WTF is going on?!
I live in Oz, but have only been here for a year, so don’t have much experience of healthcare systems over here, but when are people going to realise that when you are ill, you are stressed. When you are relying on experts to give you answers, you bow to their knowledge, you expect that the tests you need to be completed will just be friggin done.
Why is it so difficult for medical care to be given? Why do we pay our taxes, our insurance and why do we put up with mediocre service? ANY where else, a shop, a restaurant we would complain and give feedback, why with Doctors and Hospitals do we accept what appears to be the status quo?
I could rant for ages, but I will close now – sorry for wittering on, I hope you get your scans, I will send you money if needs be to help you get the security and answers you need. Keep working as a team, together you are stronger and can achieve anything. Much love, Mads xx
.-= Maddie´s last blog ..The times, they are a changing =-.
Whitney says:
I’m sorry but it doesn’t cost $1500 to turn on the machine and the doctor to use it. That is just them (the doctor’s office) charging because they can! Dr. Risky knows your situation and should out of the kindness of her heart hook up the machine and just take a peek. Sure you wouldn’t expect a detailed ultrasound but a peek to see Binky & make sure everything is alright! I am sure that machine has paid for itself over and over!!!!
Some Health Care systems is for the birds!
Hope you get to see Binky next week! Praying that everything is wonderful!
Melissa says:
During my high risk pregnancy and based on my previous multiple miscarriages, I was given a weekly ultrasound as well, and there were a couple weeks where they skipped them, and I have to say, I KNOW that feeling of terror, anxiety and utter helplessness you are feeling. I know that this may not be much help, but there is a service at least here in San Diego (and I am sure LA has to have several) that you can go in any pay to get an ultrasound done, and I believe it’s like $90 or something. I know, it’s not a “medical evaluation” ultrasound, but I think that you (like me) have seen so many ultrasounds in the past, that it would give you peace of mind to be able to see Binky and know that he/she is okay, and that you do not see any other “clots or such” that shouldn’t be there. (I had a massive clot in one of my lost pregnancies, so I know exactly what they look like, the image is branded into my brain, something you just don;t forget). These ultrasounds are high-level, 4D, and they also can determine the baby’s sex! They also even give you a DVD/CD of Binky to have as a keepsake. I know it’s not the ideal situation, but if it can buy you a little piece of mind and sanity to carry you into your next week appointment, it is worth every penny. Honestly, I wish I could come up to LA and pay for it myself, but I never, EVER want anyone to have to experience that feeling that you are feeling and that I know all too well, a feeling that still haunts me, even though I now have a healthy 1-year old boy.
Please consider looking into this. The link to the San Diego one is http://www.bfiultrasound.com/
Perhaps they can guide you to a facility in your area, should you be interested. Hope this may give you a little peace of mind, something you deserve so, so much. Thinking of you….
Melissa
Momma Uncensored says:
my husband was laid off in june.. it scares the crap out of us to look at the cobra price. it feels wrong. morally wrong.. that health care is big business. wrong. this isn’t an automobile.. your value doesn’t decrease because you got a scratch.
.-= Momma Uncensored´s last blog ..witch =-.
Amy says:
So well said. Bless you!
Issa says:
I’m so sorry honey. Truly. This just shouldn’t happen. I hope next week Dr. Risky will just sneak you one, even if the insurance won’t pay for it.
The next time someone rants at me about health care in this country, I am going to send them here to read this.
.-= Issa´s last blog ..Our new normal =-.
april in NJ says:
What crap the American health care system makes people put up with. These same a&&holes will be pissed when/if (not that I’m wishing anything is wrong) something does go wrong that could have been prevented with the damn ultrasound in the first place!! How frustrating for you. I feel like seeing Binky weekly was the only joy you had… and they’re taking that away. I like what someone posted above… perhaps you had some light spotting the day before your appointment… or had some odd cramping and waht you thought was spotting… maybe not every week… maybe once a month… sock it to them for all its worth and get to see Binky Heather!!!!!
tara says:
screw insurance companies. i hope your doctor hooks you up regardless. always thinking of you. xoxo
Melissa says:
Sorry, I wanted to send one more post. I called the San Diego 4D ultrasound place, and they informed me that they have two (2) locations in LA, one in Glendale, the other in Santa Ana. The website for this one is http://www.sono4d.com
On their website, they offer the basic package at $83 with the coupon printed from their website. Check out the website, what amazing pictures they have of these little precious miracles. The staff are medically trained professionals that are certified for these ultrasounds.
Abby says:
That is one of the most ridiculous things I’ve ever heard. I love it when insurance companies decide what is and is not medically necessary. Who are they to overrule your doctor? It’s maddening.
My advice to you as a lawyer is this: don’t take this lying down. Call your insurance company, and have Dr. Risky’s office call as well. Call every day if you have to, and keep asking to talk to a more senior person. The squeaky wheel gets the grease. And if you know any attorneys who might be willing to make a call on your behalf, go that route. I find that often the mere mention of an attorney can get things moving. I would offer to call for you but I’m not licensed in your state.
Fight, girl! You are the strongest person I’ve ever “met” and I will be praying for you, Mike, Blinky and always for Maddie.
Rachel says:
I always feel like insurance companies should realize that PREVENTATIVE care is the key to saving money.
Heather, I am so sorry, I know that you are feeling terrorized right now by the idea of waiting a week. Please know that I am thinking of you and Mike and Maddie and Binky (even little Rigby) and I hope that everything goes great in the next week.
.-= Rachel´s last blog ..The Evil Tongue =-.
Notesfromthegrove says:
This post gave me the chills because you are SO RIGHT. Wow. Sometimes the way people think is so backwards. It’s like never giving your car a $30 oil change every few months, JUST to save those payments of $30, only to burn up the engine and have to buy a WHOLE NEW CAR! Ugh. So frustrating. I’m sorry you have to deal with all that.
.-= Notesfromthegrove´s last blog ..X-Fest 2009! =-.
jana says:
This makes me so angry for you on so many levels; the whole idea of a pre existing condition blows my mind; they don’t refund people who don’t end up needing their premiums and they shouldn’t charge people more for needing their insurance—-wtf is the definition of INSURANCE ??
I am so sorry you are going through this; I hate hate hate how silent things are and how intuitively, you knew about the ultrasound situation before they told you—I am exactly the same way—my situation is different, but I had some similarities and send you tons of support–I am so glad you have Dr. Risky saying they will sneak one if need be—they get your panic, and yes you deserve preventative care.
Sending tons of prayers and support, you are doing the shots and doing all that you can; I had some bad experiences that resulted in loss(es), but ended up with two babies without incident; for what it is worth. I am sending you all the support that I can muster as so many people are and hope you get what you need to ease your mind from a medical perspective; do not give up on that
hugs.
.-= jana´s last blog ..Fashion, style and growing up =-.
Leslie says:
Ooh, I’m so PISSED for you. This just isn’t right. There is something majorly wrong with the “system” when insurance companies are deciding what is appropriate health care instead of doctors. I’m so sorry that, on top of everything else, you have to deal with this crap. I hope next week Dr. Risky can sneak a peek…
Jenn says:
This is such crap!!! The preventative is sooo much cheaper than having to deal with an emergency b/c they (aka assholes) didn’t want to pay for an ultrasound!!
Total B.S.!!! This is such cap and infuriates me! I can only imagine the rage you are feeling!! I know that the U/S are keeping your sanity and I truly hope the insurance company pulls their heads out of their asses!
On the positive side…I am soo glad that everything with Binky is going sooo great! That is awesome news! Go Binky!!
Much Love, Jenn in CA
Meghan Carroll says:
So sorry that they changed this on you and didn’t tell you! Insurance in America is killing people. They do everything possible to try to not pay something. I keep your family in our thoughts daily.
.-= Meghan Carroll´s last blog ..A hot and tired weekend! =-.
amy d says:
This is going to sound stupid, but try to keep calm. I told you…don’t roll your eyes at me!
Don’t let your mind wander into those dark corners of “what ifs” It will only make you crazed with anxiety and nervousness. Neither of which is helpful for you or the baby.
Don’t panic, love. You and Binky are healthy and everything will be perfect. I have faith in that!
Much love to your family,
Amy
.-= amy d´s last blog ..And A Prince Shall Save Us…. =-.
Badass Geek says:
Health insurance is such a bitch. It sucks when it costs so much to just make sure that you are healthy.
.-= Badass Geek´s last blog ..In Which I Get A Dog =-.
Jaclyn says:
I am sure it was terrifying to not get your ultrasound this time. I love that Dr. Risky was willing to sneak you an ultrasound next time to calm your fears. I can only imagine how hard it is to go every week and be so terrified they will find something. I am somewhat high risk too due to blood clots in my first pregnancy, not the same as yours but still clots and I am SO terrified it will happen again. Hang in there! Maybe we could all start up a donation fund to get you your interim ultrasounds?? They arent that much, I think a previous poster mentioned $90 or something. Thats 9 of your peeps giving $10 bucks! Lets do it!!!! Yay! Oh wait, I gotta research how we do that. Gimme a minute.
PS I dont read all the comments so if someone else already mentioned this let me know.
.-= Jaclyn´s last blog ..The lake =-.
Jaclyn says:
I am not super familiar with LA county, only SanDiego etc. Are you close to Glendale? I think I am going to play my nurse card and see if we cant get you some discounted ultrasounds at a place, then we can set up a donation box. Shhhh, dont tell anyone, I totally should be working right now.
.-= Jaclyn´s last blog ..The lake =-.
Jenn says:
I’m totally in! You tell me where to send my donation too!
Colleen says:
If you get that donation link set up please let me know! I’ll be one of the first in line!
Jaclyn says:
I found one through paypal but I would need Heathers information to do it. So, Heather, if you are interested let me know! I also want to make sure we all know this donation button would in no way take the place of donations to Maddie’s Friends. Please, donate to Maddie’s Friends first, this one second. I also emailed a couple facilities to see if they would be willing to discount some ultrasounds for us. I will see what they say. Crossing my fingers.
Melissa says:
Count me in as well – let’s make this happen so Heather and Mike can have some sense of peace of mind. Priceless.
Tina Hosko says:
I would love to help also
Melissa says:
It is so maddening, and confounding… I work in insurance and so I deal with healthcare reform everyday, and the reality is, no one knows the right answer. The fear-mongering has reached fever pitch (at one conference I attended, a man actually exclaimed to the group that Natasha Richardson WOULD HAVE LIVED had she not fallen in Canada, with their inadequate, universal care.)
I agree that preventative care will provide some relief from all this, so fight back. Once you gather your thoughts, you can formulate a strategy with Dr. Risky to appeal. There really are some compassionate people in the industry, and I hope this will all work out for you.
(Also, as an aside, glad you are taking full advantage of the COBRA subsidy… It is slated to end in December, but most people in my field think it will continue. Hopefully you won’t need it by then, but just in case.)
.-= Melissa´s last blog ..Digging Out. =-.
Insta-Mom says:
Amen, sister. A-freakin’-men.
Molly says:
Oh, Heather, it sounds like you are having a downright awful week. I hope next week is much, much better and that you can get your ultrasound!
(Also agree with everything re: health insurance. Ug.)
Leslie says:
I know how reassuring ultrasounds can be. I always looked forward to seeing that Austin was okay in there. What I don’t understand is why ultrasounds are so expensive? The machine is already at the doctor’s office and it takes no time at all to do one. I also don’t understand why people with preexisting conditions are denied coverage. They are the people that need insurance the most! We all deserve proper health care.
Marti from Michigan says:
I’m wondering if the State of California has a type of “Medicaid”, which is the State of Michigan insurance for both poor people and disabled people. Sometimes high risk pregnancies fall into that category. If you trust Dr. Risky, and it sounds like you do, perhaps you can talk to her about reduced payments for weekly ultrasounds, or ask her if there is a State program that would help you.
If Octo-Mom can get special help for her kids, so can you. She also lives in California.
I currently have no health insurance at all from being downsized from a very good job 3 years ago. I am a type 2 diabetic and having to try to control this on my own. Not easy. All 4 of my siblings are also type 2 diabetic, and they give me advice thank goodness!
There has to be something to help a high-risk pregnancy in your state. There is here in Michigan, so there just has to be something.
Prayers continue for this beautiful growing baby in your belly. I pray for protection of Binky, for no blood clots, for peace, and love for your entire family.
Rachael says:
I’ve never understood why they have to make these rules and then insist they apply to EVERY SINGLE SITUATION. You guys obviously have a unique situation, and you deserve that peace of mind. The thing that gets me so much is that anyone working for that insurance company is condoning this. I could never do it. I don’t understand why they can’t have a little bit of compassion.
.-= Rachael´s last blog ..Behind the Library =-.
Melanie @ Mel, A Dramatic Mommy says:
Healthcare is one of the great mysteries of our time. It’s a necessary evil. I think people in that industry have to leave their hearts at the door when they go to the office. Yes, it’s a business but it’s a business about people. Squeaky wheel get the grease! Much love to you and Mike!
Erin says:
Amen – what insurance companies need to understand is that preventive care for pregnant women (and for all women who are of child-bearing age) truly prevents complications. But again, it’s a business so they’re looking to save money.
Sara Joy says:
You are WAY more than a dollar amount. What a craptastic thing to happen, your reaction is completely understandable.
You’d think the insurance company would recognize that exactly because you are a “bad investment” preventative care might help keep them from further losses. I really hope you get your ultrasounds back. Like now. And for the next 20 or so weeks. Until your full term Binky is born, because I am a well of optimism on your behalf.
.-= Sara Joy´s last blog ..Cheaper By The Dozen =-.
Katherine says:
I just found this company that claims to let you “buy” your ultrasounds for a lot less than $1500. Caveat emptor and all that, but might be worth checking out…
http://www.remakehealth.com
and an article on them: http://stanford.wellsphere.com/healthcare-industry-policy-article/shopping-for-radiology-tests-online/680092
.-= Katherine´s last blog ..Who are you and what have you done with the real Bill O’Reilly!??! =-.
Lynn from For Love or Funny says:
Thinking of you, Heather. I agree; it would have been so much better if you weren’t hit broadside with the news that they weren’t going to do more weekly ultrasounds. I’ll read anxiously to hear about future developments. Until then, keeping you in my prayers.
.-= Lynn from For Love or Funny´s last blog ..Mom, What is flirting? =-.
Sunny says:
Thank you so much for sharing your struggles. While I believe there are a lot of unnecessary tests run every day, someone with a preexisting condition like yours certainly should qualify for a weekly ultrasound. You are right in factoring in what a complication would cost compared with the benefit of trying to save a few dollars up front.
.-= Sunny´s last blog ..Sick =-.
valeri says:
COBRA is awful. And I hate that they act like they are doing us a favor by charging us obscene amounts of money every month and then denying care. I wish the people who are fighting against health care reform could read stories like yours and understand who they are actually hurting. It shouldn’t be like this.
Susan says:
For the record: I don’t know squat about insurance. However, someone I was talking with gave the advice that you should contact the insurance commissioner about this and explain that your doctor thinks weekly ultrasounds are needed (if your doctor does, which I assume), and if the commissioner says the insurance must cover it, they have to. Again, that’s only what I’ve heard from someone else, but I guess it’s worth a shot?
joy says:
How frustrating. I hate insurance myself. Its big ICD9 game….
.-= joy´s last blog ..On Warrior Parents =-.
Glenda says:
Ughhh! How frustrating! It’s ridiculous that after everything you’ve been going through and being high risk they will bounce you around like business. They definitely shouldn’t be putting a dollar value on you and Binky! Sending you hugs XX
StrongRhetoric says:
I’m so sorry, Heather. I totally get what you’re feeling. I am only allowed ultrasounds once a month as a high risk pregnancy with what my Dr. considers “great insurance,” and every time I walk into an appointment I’m waiting for them to tell me there’s a clot, or growth restrictionk, or no heartbeat. And within a day of a healthy ultrasound I’m back to thinking that way again, every day, for an entire month.
Hopefully your doctor can figure something out for you…especially as you get further on. And soon you’ll be feeling those reassuring bumps and kicks that let you know Binky is present and accounted for.
You’ve been through so much so I feel selfish saying this, but I’m so comforted that you are going through this along with me. And I can’t imagine how many other readers feel the same way, thanks to how much you’re willing to share.
.-= StrongRhetoric´s last blog ..Oh, it is ON! =-.
Marcela says:
Hello Heather,
My name is Marcela and I’m 23 years old. I came across your site and from that day I open it every day to see how you’re doing.
It’s good to see that you have many people’s support and love. I just wanted to leave you a comment to tell you I’m one more person that hopes that with time you find a little bit of sunshine after a terrible storm. There is a phrase I like that says: – We are not human beings having a spiritual experience; we are spiritual beings having a human experience. It helps one think there might be a possible answer for life being the way it is… unfair sometimes. But as humans, our minds are not capable to understand the actual answer of happenings. I think of Maddie as a beautiful soul who probably needed just a little bit of time in this earth to fully become a perfect spirit; and she did. I believe somewhere somehow she is watching over you and hoping you are strong; hoping you keep in mind one day you’ll see her again, just not as quick as your heart wishes. Binky needs you to stay calm, be positive (I know it’s hard). But say to yourself “everything is going to be alright” and believe it. Do breathing exercises to relax, talk to your baby, tell him/her stories, teach him math, history, art. Do things that bring you peace, Heather
I am sure you will be fine! I will continue reading your posts; and I can’t wait to know about Binky!
Love,
Marcela
.-= Marcela´s last blog ..Animated Movies =-.
Julia says:
Heather,
Do you or your husband have any friends who are radiology or OB residents, medical students, or radiology techs? If so, they might be willing to sneak you an ultrasound after-hours one night. They need practice doing/reading ultrasounds; you need ultrasounds for peace of mind. (Clearly, this may be crossing an ethical line on their part, and you don’t want to risk getting more freaked out by a student’s interpretation of what may or may not show up on your ultrasound image, but it might be worth a shot)
Also, you might be too far along in your pregnancy for this, but are there any research studies going on in which you can participate and get free ultrasounds? For example, I’m participating in a study (at a research hospital in another state) on fetal growth that entails ultrasounds every month– I’ve had numerous, free ultrasounds because of this. Your OB might know of research studies you’d be qualified for at your hospital…?
Sending good thoughts to Binky!
Michelle says:
Delurking.
Fight you insurance company. I pay $130 every other morning to my RE for an ultrasound. They aren’t that expensive. There is no reason for your insurance company to deny such a small amount ESPECIALLY considering your history and condition. Point out that your attorney will file papers the moment even the hint of a complication arises.
All that said, you shouldn’t have to do this. I live in Colorado. I have self paid health insurance and a woman in Colorado canNOT buy a policy that provides standard prenatal care. If I worked for a large corporation I’d have maternity coverage, but other than that you’re on your own. The insurance company’s response every. single. time? “It’s far more cost effective.” The catch? They are required by state law to cover “complications of pregnancy.” So. They won’t pay to prevent any complications, but they will pay to clean up the mess after the fact. It makes me ill. Not ill enough to skip trying for a second, but pretty freaking ill.
I’ll continue to pray for you and Binky.
Lora says:
I hope something can be done to change the healthcare system in the US. I’m Canadian but currently living in the states for work, and the system here frightens and angers me. As other have said, our system isn’t perfect but we are, for the most part, cared for without being billed. Also, it’s so simple compared to what americans have to go through. We go to any hospital, any walk-in clinic at any time and just present our health card (no money). I wish your story and others like yours could get out there so that more people are convinced that the current, ridiculous (from what I see and understand) health care system in the states needs to be reformed. Thinking of you and hoping your pregnancy continues to go well.
Mindy says:
yep, i agree with the other people about some spotting/light bleeding…
Personal story: I had a dr. “mistakenly” remove the wrong bone (2 and a half inches) during surgery to remove a tiny bone chip…so, basically no bone there….the insurance company denied me the surgery to have it replaced. Um, ya, there’s no bone there…what do you expect me to do???
Three days before the surgery they decided to cover it. What panel of people get to judge these decisions?
Hope you hang in there!!!
Amy says:
Effing insurance companies. Never fails. I am sorry Heather…hang in there:)
Alana says:
I haven’t read all the comments but this is exactly why we need to look at health care reform. I realize the cost of the ultrasound isn’t just for the equipment, but I can’t imagine that it actually COSTS $1500 a pop. Ridiculous. Then there are jack-holes like Tom Cruise out there buying ultrasound machines for HOME USE!!! Does that make any sense? Someone contact Tom Cruise and ask him to lend you his!! There has to be a six degrees of separation between him and at least one of your readers!
Sara says:
Oh dear…I so feel for you having been there on so may fronts.
Hang in there
xx
Angie [A Whole Lot of Nothing] says:
Makes me ill thinking of people who don’t know the pain & frustration they’re causing by not reforming.
.-= Angie [A Whole Lot of Nothing]´s last blog ..On top of the Sears Tower, or the Willis Tower, or Old Smokey, or whatever they wanna call it =-.
Margaret says:
While I’m writing , I’m snorting & crying.
How aweful!
I used to work in a vet clinic, did ultrasounds all the time. What does it cost to turn on the T.V.? These clinics could do this stuff on the sly, like your Dr. said she’ll sneak one in. It’s not gonna cost them anything, a techs time??? The machine is paid for… sorry it’s just such a small thing to ask in the mist of all your sorrow, it makes me cry.
sending peace and strength always.
Margaret
Mangopuppy says:
I get ultrasounds as part of my IVF treatment (all out of pocket) and they cost $150 each. I’ve never been blessed enough to be pregnant so please forgive my ignorance, but are these different from pregnancy ultrasounds? I know they use the same machine on the women whose treatment is successful. Wonder if you can just get some ultrasounds elsewhere (somewhere cheaper) in the meantime?
Sorry you are going through this, Heather. I would’ve had a panic attack, too.
mythoughtsonthat says:
really, really sucks.
Faith….Hope….Love….Peace.
.-= mythoughtsonthat´s last blog ..A Day For New Shoes =-.
SarahB says:
Please consider sending this blog post to your Congresspeople, as an example of why we need health care reform.
If you’re up to it, of course! I’m so sorry you’re going through this.
damaris says:
my husband asked me what I was going to do now that I have decided to be a stay-at-home mom (actually I’ve been looking for a job but because I’m 9 months pregnant no one wants to hire me)
As long as I don’t have a job I will be organizing in my community to get health care.
My doctor needs to induce me 2 weeks early because my insurance ends in the beginning of september and my baby is due september 11. How horrible is that?
.-= damaris´s last blog ..Pizza for Dessert =-.
Karen says:
Oh I am so grateful to live in the UK! Our NHS might be barely capable of coping but I know I can call an ambulance, take my kids to the docs and have critical illness without worrying that I am going to have to pay any bills.
I will point out at this point that one child is ADHD and ASD and had nocturnal enuresis until 12 yrs old for which he had 3 yrs treatment.
BUT if you have some very severe or complicated illnesses we often dont have the facilities to deal with it in this country. Often the best treatmetns can only be found in the USA. How ironic, some of the best diagnostic and surgical treatments in the world and most of the country can not access it.
Andrea's Sweet Life says:
WHY on earth does it cost $1500 for an ultrasound, is MY question. I had to pay out of pocket for my ultrasounds (which is a whole other story for another time) and they cost between $200 – $500, depending on where I went, and that includes when I was seeing a Dr. Risky of my own. Seems to me, the insurance co needs to take the cost of it up with someone who does the billing, instead of cutting YOUR (and Binky’s) benefits. Hells NO.
Also, do you have a doppler at home? I rented one for the duration of my pregnancy with Blythe and the cost ($35/mo) was well worth it for my peace of mind. Love ya, girl. Big smooches.
.-= Andrea’s Sweet Life´s last blog ..Back to Life, Back to Reality =-.
Noelle says:
Heather, I’m so frustrated for you. I can’t believe after everything you’ve been through that they’re denying you coverage YOU PAY FOR and medically deserve. Please try to appeal the decision. There’s NO way an ultrasound should cost $1500, that’s insane. Thanks to corrupt insurance companies only concerned about the bottom line, “healthcare” in this country has turned into a despicable business. A desk clerk with a HS education who is forbidden to think outside of the box should not be the one making YOUR healthcare decisions. Sorry to rant on your blog but this is such a hot-button issue and it gets me all fired up! THANK YOU for using your voice to speak up about this…maybe it will get some deserved attention.
Good luck and wishes for a healthy, safe pregnancy!
.-= Noelle´s last blog ..20/100/5000 Contest =-.
Laura says:
I’m so sorry that you aren’t getting the care you need to get through the pregnancy emotionally! I just can’t imagine.
Please, please–readers of this blog, write your Congresspeople and Senators and state your support for health care reform that includes a robust public option.
Caela says:
Well said!!!! I work in a chiropractic clinic. Our job is preventative care. We have to fight and fight and fight to get paid even 25% of what we bill insurance companies. They’d “rather” pay for our patients to go have million dollar surgeries than come to us first. We have very low visit limits and very low payment rates. You hit the nail on the head- insurance in this country is a BUSINESS! If it weren’t for insurance companies health care wouldn’t be so expensive! Anyways, stepping off my soapbox now. I’m glad everything is going well and I hope you get your ultrasound next week!!!!
Kate says:
I work in a health law firm and we had an issue with this today. Have you appealed to the insurance to see if they can change their mind? Submitting a risk/benefit analysis of your previous issues and the cost versus preventative care saving them money could help COBRA pay for this.
.-= Kate´s last blog ..Its not sign hunting if the signs hunt you!* =-.
Ami G says:
I used to work for an insurance company calculating benefits for group medical claims…Dr Risky can appeal the ruling on your behalf…it needs to be done in writing with evidence of why she feels you still need the weekly ultrasounds…if you do not receive a timely response to her appeal you can turn the case over to your state insurance board…whenever a claim is denied the insurance company has to send you an “ERISSA” letter which outlines your appeal process…the fact that you have a COBRA policy should not make a difference here…I am guessing that they would have denied coverage for more weekly ultrasounds at this point no matter what…Dr Risky just needs to prove that the need is still there. Good luck!
Amy says:
This is great advice and I hope you take it. I am sure your doctor could make a great case on why you need the weekly ultra sounds, even if only for the mental well being of her patient, you.
All the best.
Lisa says:
What Ami said. My sister works for an insurance company. If you want to email me who your insurance is, I can have her tell you exactly what you need to do and say to appeal.
When I had a miscarriage my insurance wouldn’t cover my ER visit since it wasn’t a “medical necessity”. Due to her help, I was able to get it covered (only took a year).
.-= Lisa´s last blog ..Wordless Wednesday: Chicago Weather =-.
teki says:
I work in the health care field and there are problems with insurance companies but there are other issues not being addressed. I can’t tell you how many tests I’ve had to do on 90-some odd year old DNR patients that are WORTHLESS. Why are we doing this exam? why are we putting the patient through this procedure? Because the FAMILY wants it and the Dr is practicing CYA (cover your ass) medicine. Does the patient have a right to be treated ABSOLUTELY. But to do a $4000 test when the patient cannot tolerate any intervention after the exam is a waste.
Tiffany says:
I’m so sorry to hear about your insurance woes. I have also had troublesome pregnancies and “pre-existing conditions”. Pregnancy is even considered to be a pre-existing condition and I learned this when I tried to self-insure with my first pregnancy.
I don’t know if you have heard of this program before (and I’m assuming that you already heard about Medi-Cal), but the AIM program is excellent. It’s TONS cheaper than COBRA (based on a sliding scale) and most offices/hospitals accept it. You might want to check it out.
Take care.
.-= Tiffany´s last blog ..More on Niki… =-.
Jessica says:
I am so sorry to hear about this. Its so ridiculous. I too would have been falling apart! I am moved by all the love and support you have on here. I think about you all the time.
ruth says:
What amazing people read this blog. Hi to all of you.
And yes, I would love to donate a bit.
And we need that public option so stuff like this doesn’t happen…I know how expensive Cobra is, having been there and done that years ago. Sucks. Sucks. Sucks.
Good luck and give Dr. Risky a hug for me.
kelley says:
OMG, I have always hated the health care in America but after reading this post and what they did to you today I REALLY hate it now!!!
I am so sorry!!!!
Sounds like your doctor will do it for you anyway. I am just so sorry that happened to you!!!
thinking about you and your husband – Kelley
http://www.tutusandchoochoos.blogspot.com
Susan says:
My first confession – I’ve worked in the health insurance industry for 18 years and there are more good than bad decisions made each day.
A couple of options: call and ask to speak to a manager and find out who determined that your ultrasounds are no longer medically necessary. Ask how they made that determination, then ask to speak to the VP of Claims if you don’t like the answer.
Fax a letter to the President and/or CEO of the insurer and explain your concerns, who you are and the power of your blog.
If these things don’t work, e-mail me privately and I’ll have more suggestions.
.-= Susan´s last blog ..The Sweetest Thing =-.
Patty says:
This is so beyond stupid and rediculus that they will not allow weekly ultrasounds, ESPECIALLY with your high risk! And really, with as much as you are paying for cobra, they should give the friggin ultrasound! This in no way compares, but I work in the dental field and deal w/ insurance companies all of the time, and my point is that insurance companies suck and are in it for the business. It disgusts me when they try to get out of things they are supposed to cover! AHHH! Totally sucks! I reallly hope that you get another ultrasound soon!
.-= Patty´s last blog ..My sweet little lady… =-.
AmyJo@binkytowne says:
I”m familiar with the industry as well. Based on your previous pregnancy you should be able to demonstrate that there is a medical necessity to this. You need to put it in writing and ask for a “Medical Necessity Review”. You can file a complaint with the CA Insurance Dept as well. It takes a couple of weeks to get a response, but it’s another option to be aware of. http://www.insurance.ca.gov/contact-us/0200-file-complaint/index.cfm
I totally understand. All of it.
.-= AmyJo@binkytowne´s last blog ..That Child =-.
Lisa says:
I am so sorry they are only factoring the physical health of this pregnancy in this decision. I am happy Binky and you are doing well enough that they don’t feel you need one…but I think you do. You need it for your peace of mind and emotional health, all of which have effects on Binky. It sucks that insurance companies make these blanket decisions. You, Mike, and Binky are in my thoughts.
Sam says:
I am not sure what is more infuriating … that insurance companies are allowed to make decisions just as they see fit or that doctors are allowed to charge outrageous fees…ie….1500 dollars for an ultrasound!!!
I’m an RN and hate dealing with this kind of stuff..it’s not fair!!! You can definately call the insurance yourself……..be relentless……cry and cry………do what you have to. It may not work but from my experience the squeaky wheel usually gets the oil.
.-= Sam´s last blog ..1 shoe 2 shoe…..little shoe big shoe!!! =-.
LizzieKate in MN says:
As I started reading this post, I could feel waves of fear, anxiety and grief welling up inside of me. My first baby was stillborn at 27 weeks and my subsequent (2) pregnancies were mentally/emotionally draining. Always wondering if something was wrong. The ultrasounds were one of my only ways to stay (partially) sane. My husband purchased a doppler so we could have *some peace of mind between appointments/ultrasounds. It is not something I plan on using again and would be more than happy to send it to you! From one grieving Mom to another – hugs and good thoughts from Minnesota.
Kim says:
Holy crap Heather, I would be freaking out also. I had an easy pregnancy with Emma, but I still was a freak show when I was pregnant with Seth..well, with all the rest of my kiddos. But, if you add in the craziness of your pregnancy with Maddie. Holy hell. I’m sorry.
I rented a doppler when I was pregnant with…I don’t know, one of my kids, and it gave me a great sense of comfort.
I am glad your doc is going to sneak you in next week. That is just absolutely insane. Argh, stupid insurance.
.-= Kim´s last blog ..My Whrll Story =-.
Tara in The Fort says:
I’m mad at Dr. Risky for NOT giving you an ultrasound after seeing how upset you were. It’s absolutely ridiculous that your insurance won’t cover them anymore. I’d be writing letters are lighting up their phones all day long until someone came to their senses. Wow. Just wow.
I hope you can get them to start covering them again. You are so right–what IF there’s a much bigger bill. I hope and pray that all is well, and I think it is, but still. Jerks.
Hang in there sweetie! I hope the next week passes by so quickly for you.
plue says:
Do you think that you can ask your doctor to give you a special rate for any extra ultrasounds you want to pay for? I can’t believe that it actually costs $1500. Don’t they already have the machines? My cat had one and it only cost $150. Is the technology really that different for humans?
.-= plue´s last blog ..The Best View in Albany =-.
Jamie S says:
I do not live in the area but I have paid out of pocket for extra ultrasounds from private companies when I was pregnant. They offer 2D and 3D/4D packages. They start as low as $99! I enjoyed my experience and the peice of mind… plus end the end I had a little DVD of the baby before she was born! Might check one of these out if they are close to you. http://www.4d-ultrasounds.com/southern-california.htm
Maybe they will work with you for a huge discount if you plug their site somewhere?
Vickie Couturier says:
I worked for a OB/GYN for years before I retired due to illness,but IF we had a high risk patient,an insurance didnt cover another ultrasound,We did it anyway an ate the cost! Sometimes Doctor or Nurse has to do what they fill is necessary,an DAMN the cost! At least that was the way our office worked,of course it was a small town office in the deep south,but it shouldnt make a difference,if its needed it gets done payment or not!
Ginny says:
Hi Heather, I read this post yesterday and was so infruriated by the insurance crap. So you don’t need my heated response. I now live in Canada having skipped on up to the colder climates. All I can say is that to get an ultrasound done here, if you so choose to pay out of pocket, it will only cost you no more than $200. I get them all the time for breast cancer screening. Those cost $80. The other day, I had one done on my throat to make sure that my thyroid cancer is not back. That one cost me $100. And you know what? The insurance company we do have reimburses us. I wish you lived close enough to Canada to skip on up and get an ultrasound when you needed. You, Mike and your children are always in my thoughts and prayers. Sending some Northernly Love…
Rachel says:
I know you already posted a follow up to this post.
I am on private insurance now instead of employer provided and the full cost of an ultrasound where I live is under $200, I can’t remember the exact amount of the last one, but I believe it was $170.
I am high risk too and I understand that I know very little about your medical history, but I pay about $450 per month for health insurance to cover myself and my son. I talked to an agent yesterday who felt once I have my baby he can cut my costs significantly by increasing my deductible, it would work out to about the same amount I paid when I was employed.
Insurance costs vary a lot by state, and sometimes even counties within the state. It was going to cost $900 per month to add me to my husband’s health insurance then I found better private coverage through a company using the service at ehealthinsurance.com. I am not sure you can change insurance mid-pregnancy, but you may want to check it out once you deliver.
.-= Rachel´s last blog ..Something I learned… =-.
Molly says:
Hopefully I won’t upset anyone with this, as I mean only the best and am a huge Heather and Maddie (and now Binky) supporter, but just something to think about…
Maybe Dr. Risky is right and Heather does not need the weekly ultrasounds from a medical standpoint. We’ve all complained about the medical system here and I’m in complete agreement. I’m a physician and I agree that insurance companies working for enormous profits and extraordinary doctor fees for procedures are the major problems in our system. I’d love to see a single-payer system where the entire population receives appropriate care. But that means we define what appropriate is–from a medical standpoint.
It does add cost to the system to do tests that do not contribute significantly to medical management or diagnosis. If Dr. Risky is correct and Heather’s current pregnancy does not need weekly ultrasounds, then we’re not doing the right thing if we order them. It’s hard when you think about it from a personal story standpoint–I would love for Heather to receive weekly scans for her peace of mind. However, if you imagine a system where patients were given various tests because they (and not the doctor) thought they were necessary, you can imagine the enormous cost to the whole. One of the reasons you have a doctor you trust is that so they can guide you to appropriate testing. That said, if her doctor thinks it’s necessary, then she should receive the care.
Off my health care cost soapbox, onto my Heather soapbox. I keep cheering for you and Binky and can’t wait for my little one (due at the same time) to be a virtual playmate with yours.
Jennifer says:
Well, it seems to me that insurance runs healthcare. My son was born at 27 weeks, in the NICU for 92 days. It was very obvious that he had to come home on oxygen, 24/7 because he just needed it. Well, in order for insurance to cover such a thing, they required the hospital to shut off his oxygen until he dropped into the low 80’s, and then they were required to wait to see if he could bring it back up, then drop again, until he would sustain sat’s in the 80’s for at least 5 minutes. I think the automatic stop point was 70%. Yeah–disgusting. The nurse shut him off, he dropped to 85% in about 3 minutes and said–yup, looks like he failed, we are NOT making him stay low for 5 minutes. Sick, sick sick. Like it is every parents dream to bring their baby home tethered to a 20 foot cord all day and night.
He also has a life threatening metabolic condition and has to have medication twice a day. Took me 4 months to get them to cover it for him.
Hang in there!!
Lisa says:
Heather, I’m so sorry you’re having to deal with this. I thought it was bad when I found out my surgeons would not accept any insurance late last year. Thank goodness they are kind and didn’t charge me the full amounts they could have. Although, when I look at the breakdowns from all of my office visits over the past year+, it amazes me as well how much simple things, like walking into the office, can cost! Our primary physician will run numerous unneccessary tests during our yearly checkups unless we tell them not to. It’s incredible to me how quick some doctors are to run tests when they’re not needed, how much everything costs to insurance companies, and how often insurance companies won’t cover things that are actually important to the health and safety of citizens.
Someone may have mentioned this already, but I’ve heard that it’s a good idea to send any written communication to your insurance provider by certified mail that requires a signature so you have proof that it was received.
Good luck. We think about you all the time.
mysterious malady says:
I’ve been reading your blog for a while and sadly enough it was Maddie’s passing that brought me here.
I’m from India and while certain things are expensive, health care is one thing that is more accessible than others. Ultrasounds here cost the equivalent of 10 US $ and I am not talking about some shady clinic. A good hospital. I wish health care was not so messed up here in the US. This provides no respite from the nonsense that you are being put through, but I really wanted to say is: I am willing (I’d say praying if I believed in god) the universe to let this go well for you and a happy life for your family.
MM.
.-= mysterious malady´s last blog ..… =-.
Amy Kate says:
Heather, that just sucks. And, I gotta tell you, for a “bad business decision” like you, there have to be at least a couple “good business decisions” like me who go for their annual pap and don’t see a doctor again for a year, and so one would like to think it balances out somehow, like insurance karma. Or I’d like to think that, anyway.
.-= Amy Kate´s last blog ..Buttons and zippers?! =-.
sabrina in Philly says:
I was going to try and read through the comments before I asked this. Just in case it was already asked? But I didnt have the time :^)
Sorry if someone already asked you this question??
Did you try and apply with your state? Usually pregnant women receive free health care through their state? I thought this was a nation wide thing. It does depend on you income?
Im sure you knew this already, but just in case
Hopefully this health care issues with our country will change! I am so sorry that you have to deal with this on top of everything else
xoxoxo
.-= sabrina in Philly´s last blog ..A Few Changes! =-.
Al_Pal says:
Oh geez. Best wishes with getting the ultrasound worked out.
♥
anne says:
if i remember correctly, ultrasounds out of pocket with no insurance were around $300 when i was pregnant (that was in Los Angeles, 1 year ago) I would hope they could give you a special rate. Also, we went to a place in Glendale that does 4D ultrasounds (for pleasure) I would highly recommend them, we went often, as I needed the peace of mind seeing my little baby moving around in there.
Their site is http://www.sono4d.com
ultrasounds packages there start at $83.00 (but again they are not medical, just for “pleasure”) It is amazing to see the features of your unborn baby in 4D!
Summer says:
Heather- I’m so sorry that you have to go through this. I agree with the PP, maybe you can negotiate a special rate with your doctor. Also, maybe the doctor will be willing to sneak you a freebie here and there.
As for the “pleasure” ultra sounds, we had one with our son and the company sent the results to our doctor for review. It was less than $100 plus included a discount on future visits. Just an idea. Best wishes!
.-= Summer´s last blog ..Something in the Air =-.
Jenn says:
I had an ultrasound on my leg a couple months ago to make sure there wasn’t a blood clot and I got a bill from the hospital (which was ultimately covered by insurance) for almost $1400. For something that took 15 mins. I was very upset that it would cost so much for something so simple.
Candi says:
I hate COBRA. It is a joke. Like you, I think it is great to have the option, but the price is ridiculous!
I used COBRA for a short while with my first pregnancy and for just me it was over $500. Then last Oct. my husband lost his job. His company paid for 1 month of COBRA as part of his severance package. After that, it would have cost us $1300 a month. I am diabetic and need ins., but there was no way we could afford it. We live in VA and they don’t offer any type of medical assistance to people like me (I know CA had medi-cal). I was either too young or too old….I was able to get state coverage for my kids. Since I knew I was about to be without ins., I stock piled my medication and supplies as best as I could.
I looked into insuring myself, but like you, ran into issues with my pre-existing condition. A lot of them said they would accept me, but when I read the fine print, they wouldn’t cover anything that had to do with my pre-existing condition. Gee….that really helps me out!
Thankfully, my husband got a new job with benefits before my 62 day gap in coverage passed. I did get the notice that we qualified for the reduced rate for COBRA, but that was already after we had ins.
.-= Candi´s last blog ..Picky? =-.