Ins. Co want money paid back!!!!

[Stacey N]

I am so upset right now!
I just got a letter from my insurance company and they are now saying that they have a surrogacy exclusion. I know I checked before we started our first cycle back in 2005. Thus far they have paid EVERYTHING but my out of pocket deductable for 2 pregnancies and NOW they want it all back!!!!
We are talking about $15-20,000 dollars.

Has this ever happened to anyone here?
Can they really do this? After this long?

We never kept the surrogacy a secret in any of my medical records for either pregnancy?

Any help/advise would be so helpful.
TIA!!

[riverwalk]

I wouldnt bother with it much. Give it to your lawyer and let them handle it.

andi

[angelinwaiting]

Originally Posted by Stacey N

I am so upset right now!
I just got a letter from my insurance company and they are now saying that they have a surrogacy exclusion. I know I checked before we started our first cycle back in 2005. Thus far they have paid EVERYTHING but my out of pocket deductable for 2 pregnancies and NOW they want it all back!!!!
We are talking about $15-20,000 dollars.

Has this ever happened to anyone here?
Can they really do this? After this long?

We never kept the surrogacy a secret in any of my medical records for either pregnancy?

Any help/advise would be so helpful.
TIA!!

Yes I have had this happen and I am STILL fighting it (this was back from my 2005 Birth of my surro daughter).

For the bad news: Yes they can do this. They have so long to turn around and reguest everything back. You will have to look in your book EVERY year to make sure it does not have a exclusion. They can change this at any time and without your knowledge of so. IF you went onto a surrogacy with no surrogacy exclusion you are covered. If they changed the policy during the pregnancy you are then covered by a pre-existing thing. Meaning you were already pregnant and they cant change the rules so to speak during that pregnancy.

You can appeal it like I have done but it will take a long time to fight. I have my court date in July for this and it has been 3 years. We are fighting for discrimnation and so far, they have found probable cause and they are now accepting this in court. You will have to fight tooth and nail. You will have to have the policy in hand from that year to show that it didnt have an exclusion. You will have to prove what their wording meant (if it states surrogate parenting then what that meaning truely is). Before you go further with ANY legal advice or sueing you first have to go through the steps of appeal first. You have 3 appeals and after all 3 are denied, lawyer up and proceed with what they feel is best.

Good Luck with everything and hang in there. This is will NOT be an easy road ahead for you and wish you all the best. If you ever need someone to talk to you are more then welcome to PM me at any time.

[mommajones]

my lawyer just explained this to me as well. I am fighting to get my job back as I was fired because of my surrogacy. She warned me that if we sue them, they could possibly sue me back for the insurance AND short term disablity that was paid out to me.

THIS FREAKING SUCKS!! Im sorry that its happening. There has to be a change in the legal department and justice department to get this crap stopped.

[Emidan]

Email Carrie [crambo] about this.
We put together a snazzy letter and after she sent that to the insurance company, thing took a turn for the better.

Needless to say, when this happened to a friend of ours (on the same insurance, just a different plan, here in the same state), we changed the info to accomadate her and she sent it in, and that took care of that!

If there is not a surrogacy exclusion, they can't deny the benefits. they also cannot put a lein on your compensation, as they don't have an exclusion stipulating that...

Good luck!

[blessedinpa]

In my opinion....if you do get stuck paying this money back.....pay them $5/month! If you are making an honest attempt to pay it back (regardless of the amount)....I don't think they can do anything to you!!

[LIS's mom]

It happened to us. Our SM swore that her ins. co. would cover the pg (TS) and when she was 4 mos. she was sent a letter demanding repayment for every dollar they'd paid. It never occurred to me to fight it and our surrogate wasn't interested in helping us (at the very least explaining that the pg. was TS). I also never occurred to us to leave our SM with any unpaid medical bills.

There were some panicky weeks while we worked to find her new ins.-which we did. It took months, after dd's birth, to settle with and pay back all of the drs., labs, hospitals, radiology offices while our SM threatened us with legal action. It was NEVER our intention to defraud anyone; however, we felt mislead by her and there was great anger by the time she had her lawyer threaten us. We worked very hard to contact everyone who billed her (AND we'd asked for the bills when she was 5 mos. pg but didn't receive them till after dd was born) and make arrangements to make cash payments.


I always blamed myself for not demanding the booklet--yes, I requested it several times but SM said it was too big to copy and honestly, my biggest fault was that I was too anxious to get started. Even though all our bills were paid in full and we had ins. in place before dd's birth, I hope that you can resolve this in a much nicer manner than our situation. The fact that you're even trying to help your IPs speaks volumes. After having lived though a similar situation, I don't understand why you're assuming that any of the expense is yours. Our SM's atty had no problem calling and writing us threatening letters. It hardly left us with good feelings toward our surro but it's an indication that she had NO intention of taking any financial responsibility for the surrogacy (and rightfully so--it was just the method that was objectionable).

[MomofTwo]

Im confused why a surrogate would be responsible at any point to pay back the money if this was to happen and you lost the appeals then arent you covered leagally. There is no way I would be the one to pay back anything surrogacy related if this were to happen. I thought this is why we have a contract to cover us no matter what. Im just trying to understand how this could happen to someone....I dont have an exclusion and Im gonna print out my policy and keep it close so if they change something but my IP's would be the ones to pay it back.

[tiggermom]

If the condition of your contract was that your health insurance would cover the pregnancy and your atty verified this, then I would say when push came to shove you would be accountable. You and/or your atty were responsible for verifying the information and if there was a doubt then an insurance policy would have been put into place. (This of course is all just being the devils advocate as I have no idea how anyone's insurance came into play in any of these situations).

I'm not sure how contracts are worded for each person, but this is a perfect example of taking your time and making sure all the t's are crossed and i's dotted.

Insurance companies have the right to take money back they feel wasn't supposed to be paid out, especially when compensation was involved.

[9monthnanny]

Oh how upsetting! I am sorry they are doing this. How can they if there wasn't an exclusion and they covered everything? I would get an atty involved asap.

[Meadow]

Originally Posted by blessedinpa

In my opinion....if you do get stuck paying this money back.....pay them $5/month! If you are making an honest attempt to pay it back (regardless of the amount)....I don't think they can do anything to you!!

They can still turn you over to collection agency if they dont believe you are paying enough a month. I use to do medical billing for a local hospital and headed up the collections department. I thought the same thing you did until I worked there. I would call the patient first and let them know then send them a letter. I would also offer them a chance to file for uncompensated care (charity) but i doubt a insurance company will do that.

[Jen.CT.surro]

This is why when I get my contract I want to be sure it is worded such that IP's will pay for any expenses uncovered, denied, or recouped from my insurance and that they will be responsible to pay for legal action against the insurance company if needed.

I don't have an exclusion, but the policy is self funded and written by my employer and I have a feeling they will try to squeak one in and make it retro active or something!!

I HATE INSURANCE COMPANIES... they are a bunch of jerks!

[MaryannsMiracle]

That is terrible. I am sorry this is happening to you. Insurace companies DO have the power to do this. This is one of thereasons I am VERY cautious of using MA Health or state assited insurance or any insurance for that matter in a surrogacy. They will make you pay back every last penny. It happened in my family althought not a surrogacy. It was with Blue Cross Blue Sheild and we had to pay for everything down to prescription they has paid for.

My Mom was hit by a car as a pedestrian in 1998 and sustained injuries. The driver ran a red light, admitted he was in the wrong and encouraged her to bill his insurance. Because her doctor refused to bill the mans insurance and billed BC/BS instead, a lein was put on my mom's case. Of course is was to late to bill the man's insurace by the time we found out and BC/BS had paid all the bills. It ended up costing my mom an additional $3000 pluse her entire settlement which was quite a large amount of money. The laywer really tried but the insurance company wasn't having it. They ended up winning and got their money.
All that said, insurance companies are pretty slick and it is extremely important to document, date an save everything in writting. I won't ever trust what someone tells me over the phone. I have had people tell me "it shouldn't be a problem" or "she is definately covered", only to find out it was a problem and she wasn't covered.

My guess is as surrogacy is becoming more popular, insurance companies are going to start tightening the reigns and making laws to exclude surrogacy.

Whenever compensation of any kind is involved with insurace coverage, insurance companies are right on top of it..
I hope you are able to get this straightened out.

God Bless,

Maryann

[LisaBep]

In Florida there are actually state statutes that clearly spell out when, time frame criteria, and under what conditions, a health insurance company can demand reimbursement of a paid claim.

I don't have time to look at the exact statute and it wouldn't help you anyway since you are in a different state, but it would behoove you to look up your own state's statutes and investigate the legality of what your insurance company is trying to do.

I HATE our country's health insurance system! We need universal coverage!

...............sorry..........getting off my soap box now........

I sincerely hope you are able to get this straightened out in your favor!

[flame_chick]

who is the insurance company telling you this?

[blessedinpa]

Originally Posted by Meadow

They can still turn you over to collection agency if they dont believe you are paying enough a month. I use to do medical billing for a local hospital and headed up the collections department. I thought the same thing you did until I worked there. I would call the patient first and let them know then send them a letter. I would also offer them a chance to file for uncompensated care (charity) but i doubt a insurance company will do that.

Really? I always thought that you get turned into a collection agency for NOT paying, especially letting months go by without a payment... This is something I didn't know they can do is turn you in to a collection agency for making an honest attempt (not being sarcastic just didn't know they could do that)

[Eekinator]

Originally Posted by tiggermom

If the condition of your contract was that your health insurance would cover the pregnancy and your atty verified this, then I would say when push came to shove you would be accountable. You and/or your atty were responsible for verifying the information and if there was a doubt then an insurance policy would have been put into place.

Are you serious? You would perfectly ok with leaving an SM with bills she wouldn't have otherwise accumulated if it hadn't been for YOUR baby? Regardless of what the contract says, that's messed up.

I got left with the $1500 deductible from my first journey. It was even in my contract. But it would cost me more to hire an attorney to get my FIPs to pay it. It's been 5 years and it's still not paid. I'm pretty sure it'll fall off my credit at the 7 year mark. I'm just hoping I don't get sued for a judgement for it before then!

Stacey, I would fight the insurance company. But you should also give your FIPs a heads up so they can prepare financially. At the very least, morally, they should buck up. I hope for everyone's sake it doesn't become a legal issue.

[Meadow]

Originally Posted by blessedinpa

Really? I always thought that you get turned into a collection agency for NOT paying, especially letting months go by without a payment... This is something I didn't know they can do is turn you in to a collection agency for making an honest attempt (not being sarcastic just didn't know they could do that)

Yep unfortunately its true. We had guidelines we had to go by.for such and such amount to such and such amount i could ony accept such and such payment. If the patient said i can only afford something less i would go to a boss and ask special permission for lower payments. Once in a while they would be accepted, if they were somewhat close to our orginaly payment plan. Most of the time they were denied or i would have to counter offer with something the boss came up with. If they said they still couldnt pay i would explain how to get their bills either highly discounted (putting them in a lower payment bracket) or totally written off all together. Only it was alot of work on the patients end of things. They had to go to DHS and prove they didnt qualify for Medicaid. Then fill out a packet with their monthly expenses, what kind of car they owned and the blue book value on it, and a copy of last year taxes. Alot of people would never turn them in. I always told them it was worth trying. Esp if it kept them out of bad debt. Our hospital would not allow any patient with bad debt to be seen at any doctor office associated with us unless they paid their bad debts in full. They could only be seen at the ER. This lead to alot of long painful phonecalls for me trying to explain to patients why they couldnt get a surgery they needed, or see a OB they needed or take their child to a ped at our hospital. I hated that part of the job. There are lots of other doctors in town they could go to but they would fight to go to ours (if they called me that is im sure alot of people just said fine and went to other doctors). There was nothing i was allowed to do. I could put them in touch with our collection agency and that was that. I always did my best to make sure everyone on my collection list understood what they could do to help themselves before i turned them over.

[karen45]

This is why I am glad to live in Canada and have universal health care.... PLus, if you worked over 600 hours over the last 52 weeks you are entittled to 55% of your wages for 15 weeks beginning at 32 weeks. Longer and earlier is your docotr takes you off work. All pay from the government.

[SherryT]

Stacey,

This is a nightmare! I hope you can work things out with the insurance company.

Some comments made on this thread are a good reminder to all to explicitly states whom is responsible for unpaid bills. My contract states that, to the best of my knowledge, my insurance will pay. In the event that there are any unpaid medical bills, my IP's are responsible.