control

what i had control of, the decisions i could make, were these:  who my obstetrician was, and what hospital i delivered at.

what i didn't have control of... now there's a longer list.  my company chose the insurance company.  the insurance company chose their "reasonable and customary" fee schedule.  fate decided on a c-section.  reality insists that c-sections require anesthesia.  the anesthesiologist chose what medicines he uses, and he chose what he charges for whatever he gave me.  i cannot for the life of me figure out who chose the anesthesiologist - he was just the one on duty, he was the one available to someone who had chosen a hospital and an obstetrician who were in-network providers.  and yet somehow, despite having made every choice i could (a total of two choices) to ensure that all of my providers were in-network, having felt completely reassured that the delivery would be completely covered by my insurance, it turns out that the anesthesiologist - the guy i was so happy to see when i needed him - he is NOT in my network.

my generous insurance company, those good samaritans... they cover 100% of out-of-network providers during childbirth. wonderful!  except that there's a huuuuuuge disconnect between what the insurance company thinks he should charge, and what he actually chose to charge.  and they sure don't cover 100% of that.

so because two entities i did not have any control over choosing - my insurance company and my anesthesiologist - cannot agree on what is reasonable and customary to charge a woman who requires numbing before she is sliced open, i have to pay the difference.

for the curious, this is what an anesthesiologist thinks is reasonable and customary: $3000.

this is what an insurance company thinks is reasonable and customary: $901.

this is what i, who had no voice in any of these decisions, have to pay: the difference.

this is shit.  this is a broken system.  i did everything right, i did everything i could, to have a 100% covered birth.  i even tried as hard as i could to not require anesthesia at all - something a lot of women don't bother doing, which is their choice, but not the one i made.  what a slap in the face, after my body failed to do what i asked of it - deliver naturally - to now owe $2099 for the privilege of being numbed before surgery.

Comments

[sara]

Appeal.

Contact the anesthesiologist and ask him for the reasons why his rate is so much higher. Drugs used, reason for the drugs used, length of requiring the anesthesia. Then contact area hospitals and ask what it costs. If NO ONE charges what your insurance co. feels "customary", they have to pay.

Chances are very good that someone somewhere fucked up and you don't have to pay. Maybe they marked it down as standard epidural when it was really a spinal block? Maybe they say that the normal c-section takes 5 minutes, but yours was more complicated because your daughter was stuck.

[hat]

first, let me say that that sucks.

secondly, all the more to hold above your child's head in the future.

child guilt-trip: priceless.

[Amanda]

dude that seriously sucks. i guess i should stop complaining about the $460 dollars that the hospital keeps telling me i still owe them from my fully covered birth-of-baby experience...