Synagis Round 3 + more insurance woes

It was another trek to the Pediatrician's office today for more shots! Although we hate to see the babies in pain, the good thing about these appointments is that they get weighed each time.

Krista is our heaviest at 16 lbs. 5 oz.!

Jamison is next weighing in at 16 lbs. 3 oz.!

Last but not least, Kiera is holding her own at 13 lbs. 4.5 oz.!

Unfortunately, it seems like we can't go to the doctor without there being some kind of drama! When we got to the front desk, I was greeted with "Your insurance has taken back all of your payments since October because you have a different insurance as your primary." This is so frustrating because we have been having insurance issues since the babies were born. We'd been using the insurance from my teaching job for years and then we added Eric's insurance as a secondary back in October 2007. This worked out well for us so that all of our expenses with the pregnancy, delivery and hospital stays for both the babies and myself were fully covered. Once we got the babies home from the NICU, this is where our problems began.

Here's in a nutshell what we've been dealing with. DISCLAIMER: This explanation is a bit long and painful but if you don't mind humoring me while I vent, please read on!

• July - I attempted numerous times to add the three kiddos to my insurance policy but kept getting the run around from HR at the Board of Education. After numerous phone calls, emails and headaches over a two week period of time, I finally was told that the babies were added just in time for the 30 day past birth deadline.
  

• August - I start getting phone calls from all of our medical providers (Pediatrician, apnea monitor rental company, home health care office) telling me that they tried to process claims and they were told the babies weren't on the policy. WHAT?! After doing several hours of investigating on my end, I find out that according to the insurance company, there were some babies on the policy: BABY BOY and BABY GIRL but no specifics and BABY GIRL #2 MIA! Apparently, the fact that I submitted a "change of lifestyle" form 6 times to HR (via USPS, email, fax, and in-hand by my aunt who works at the Board of Ed) wasn't enough to get the proper information on file. So again, after countless hours on the phone (in my free time, of course), we got the babies added, even though my policy would be terminated on the 31st of the month, since I was taking a leave of absence.
  

• September - Eric's insurance now becomes our Primary insurance since mine was supposed to end (or so we thought!) We start getting bills from some mysterious doctor in North Carolina wanting $375 per baby! Back to the phone for me for many more hours to discover that this NC doctor is the one who is reading the downloaded data from the apnea monitors but my insurance was trying to process the downloads from July/August as an out-of-network claim and therefore, expected me to pay for this service. The thing is, we knew nothing about this. Obviously, we did not drive preemie newborns 6 hours away to NC to see some doctor so I had to explain this to my insurance company. They told me they would look into it.
  

• October - We start receiving "explanation of benefits" in the mail stating how claims were processed successfully for services rendered after Sept. 1 from my insurance when it should have been covered by Eric's insurance. More phone calls, more headaches. Still no word on the out-of-network NC doctor issue and another bill comes from them from the next set of data downloads from the monitors, now totaling together over $2200! Thankfully, at the end of the month, we finally get my insurance to fix the NC boo boo so we think that is the end of it. Not so! We start getting mailers from Eric's insurance stating that they ARE NOT our Primary insurance. WHAT THE HECK?! I had to call them and fill them in that sorry to disappoint them but they ARE the Primary insurance.

• November/December - Things started out quiet so we figured this was finally behind us until we get more "explanation of benefits" from my insurance saying that they were again paying for services rendered after my policy's termination date. I called and emailed HR again to confirm that I no longer had benefits through them. After all of this, Eric's company was bought out by another company several years ago and the benefits were finally switching over for 2009 so we had to choose a different health insurance company altogether! We researched each of the seven choices but all were at least triple what we were paying for the current policy and with higher co-pays: RIDICULOUS!!! We chose the lesser of the evils, selected our PCPs and waited for insurance cards to arrive. During this time as well, we're trying to make sure that all of the trio's care is covered like their monitors, Synagis shots for RSV and immunizations. We had to work quickly to make sure everything was in place and ready to go for all of the doctor's appointments forthcoming in early January.

• January - We get the NEW insurance cards in the mail, quicker than we expected, YAY! However, we look at the cards and notice: "No Primary Care Physician Selected." Come on now! I had to make a phone call to get that fixed and we are still awaiting the new cards.

• Today - So in addition to being told that Eric's insurance wasn't our primary insurance, I hand over the NEW insurance cards to be told that we might not be able to have our appointment with the PCP's name missing. I told them that they needed to call to verify that we had, indeed, notified the insurance company of our selection and that this shouldn't be a problem. While they were making the phone call, I left Eric with the babies so I could go out into the hallway to call my former employer to tell them the news that I still had their insurance! The lady I spoke to was very nice, unlike the lady who greeted me so cordially at the pediatrician's front desk, and she looked me up in the system. Low and behold, for some unknown reason, it was showing that my insurance terminated on DECEMBER 31st! This, of course, was a mistake because it was supposed to end on AUGUST 31st! The HR lady was as confused about this as I was and said that if I wasn't paying COBRA (which we were not - $1700/mo. for family coverage is INSANE and we already had alternate coverage) then it should have terminated. YA THINK? She said that she would do her best to get this handled but that she was very busy with other insurance issues with new 2009 policies and said to call back in a few days. What a mess! Hopefully, this will all get straightened out eventually but not without more headaches and drama. To play Pollyanna's "Glad Game" where you need to find the bright side of every situation, even through all of these woes, I'm very glad we have insurance in the first place and I'm glad that I did manage to get some free formula samples for all our troubles!