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In April 2011, I welcomed a baby into my arms, at home, with the help of a Certified Professional Midwife (well, to be precise, there were two CPMs plus my friend/photographer, aunt, cousin and a mixture of other children).  I had insurance at the time, which I was told would cover midwife services.  Since she is a legal provider, it seemed like a fun idea to try to get her fees reimbursed.  Yeah, I was totally naive and thought it would be simple.

We began with her attempting to bill them.  I’m not going to detail her efforts, as they are hers and not mine.  I do know that after months of back-and-forth with Cigna, we were both incredibly frustrated.  It seemed like the best course of action was to pursue a different avenue….she would give me the invoice for her entire fee and I would attempt to get reimbursed (I paid her fees up front).

I’ve lost the original paperwork, but I know that we switched to me trying to get reimbursement in September-ish.  Her efforts had all been denied, for various reasons.  Here is the breakdown of how it’s played out so far:

10/22/11 ~ Spoke with Arianna

*Maternity Care Global Bill was denied because of missing procedure codes, each visit needed a procedure code.  This resulted in an interesting conversation about codes, who has access to them and so on.  When I prodded about what type of code was needed, she assured me that all providers know what codes to use.  When I prodded about how they knew that, she informed me that every provider is given a book with codes when they get a license.  When I asked about providers who don’t get licenses, she balked and said there really was no reason for me to be concerned with codes, to know where they come from or to have anything to do with them.

*Initial visit on 9/22/10 not covered due to non-coverage at the time.  I let her know I’ll check the validity of that and call back.  Turned out that my enrollment, which we were told by both employer and insurance company would start from the day of marriage, did not start until 9/28/10.

10/28/11 ~ Spoke with Erica

*Suggests that because of coverage date issue I resubmit the claim with the 9/22 visit removed.  New bill has starting date of 11/3/10, put a procedure code next to each visit

*Submit claim with “Corrected Claim” written across the top, keep proof of original submission date

11/2/11 ~ Corrected Claim Form faxed into Cigna

11/19/11 ~ Spoke with Carol

*Claim has been denied.

*Discover $200 bill, denied on several occasions and filed by midwife originally, is still floating around.  Ask for that to be ignored, denied again or whatever.

*She sends back claim, with a confirmation #6463

(Here’s where it gets tricky for a few weeks.  When filing for reimbursement, always, ALWAYS verify which claim you are speaking about.  If you get a confirmation number, as I did, use that number to track where your claim is.  This is like an ID tag for your claim.)

12/2/11 ~ Spoke with Ryan

*Claim denied because of timely filing.  I informed him that I was calling in reference to the corrected claim, which had a proper date on it and could not have been denied on that basis.  He said they were going off the original claim (with the wrong date).

*Corrected claim resubmitted, confirmation #6924

(Again, see where my mistake is?  I didn’t check to make sure we were discussing the correct claim.  I thought it was enough to say the amount of the bill, the date, etc., but it was NOT enough.)

12/7/11 ~ Spoke with Jackelyn

*My midwife received a notice about her (we thought) denied $200 bill.  This was the bill that I had asked to be taken out of circulation (even though it shouldn’t have been anyway, since it had been denied several times) twice now!  In addition, the implication of the notice she received was that if she were to sign it and “accept” a reduced rate of $130, that would be all the payment made for the pregnancy!  She informs me that somehow this bill was opened back up in November, something that NO ONE ELSE has mentioned.  I ask her to close that out, again.

*She tells me that the corrected claim will be denied because it wasn’t filed in time.  I try to explain the dating issues, but I get exasperated and finally just say “thanks” before hanging up.

12/17/11 ~ Spoke with Joyce

*Corrected claim was closed at my request.  WHAT?!?!?!

*Turns out the confirmation #6463 was for the $200 bill being sent back (on 11/19/11), instead of the $2500 corrected claim being sent back.  This entire time I have been running around in a circle over a bill I thought was gone!

*My midwife also received another request, this time for her SSN, which is on the corrected claim.  Joyce tells me to ignore this, it is from the $200 bill that was supposed to be closed.

*Corrected Claim for $2500 with initial visit date of 11/3/10 sent back AGAIN.  I verify that all the information is correct, that she is indeed sending the corrected claim for $2500 and NOT the bill for $200.  I ask her to read to me exactly what she sees on her screen.  It seems right, I am given a confirmation #4737

1/6/12 ~ Spoke with James

*He informs me of all the mistakes, he will make sure everything is correct, he will call me if there are any problems.  I politely tell him all the other people have said that, too and they were all liars.  He gives me “his guarantee”.  I get a confirmation #187

1/15/12 ~ Spoke with Jessica

*She verifies that “they” (the jerks who are doing everything to keep me from my money) are working on the corrected claim.

1/17/12 ~ Spoke with Pat

*She tells me that the corrected claim has been sent to James for follow-up information on 1/11/12.  She asks if he’s called me yet and I say no, but I just called two days ago and no one informed me of that status.  She says he’ll call me and I ask when, to which she replies “today”.  ARGH!

*James calls and says he got the message that I had some follow-up information for him.  WTF?  I tell him that Pat told me my corrected claim had been sent to him to call me for that very reason.  He laughs and says that she misread the notes, my corrected claim is still in processing.  He reminds me that he said he would call if he needed something and I chuckle while letting him know that my new tactic is to call every other day to check.  He laughs and says that sounds like a good idea.

Stay tuned for the (hopefully) happy ending of this drama….

Part II