My daughter Emily texted me from school one day and said her throat hurt. Strep had been going around, so I made an appointment at her pediatrician for the same day. Still, I knew she had been showing symptoms (frequent urination, weight loss, constant hunger) in recent weeks that might point to Type 1 diabetes; my brothers had had Type 1. Her strep test came back positive, and I mentioned the other symptoms to the doctor. They ran a urinalysis and then came back for a finger poke. Afterwards, the doctor came back in and told me they suspected diabetes and that we needed to go to the ER.
We stayed in the hospital for two nights while my 12-year-old daughter, my husband, and I learned Diabetes 101. Emily was emotionally and physically exhausted, but feeling better with her blood sugar coming down. We went home and tried to adapt to the new normal of blood sugar management.
A few weeks later, I got a statement from my insurance company saying I would have to pay the hospital over $15,000. They stated that Emily’s hospital stay was “not medically necessary”. This was signed off by a doctor at the insurance company who had never seen Emily in person. Based on all the data from the hospital, he stated that she should have been sent home after her first shot of insulin since it had brought down her blood sugar.
Reading this, I began to cry. I had been holding it together, but this bill just left me shattered. Did this insurance company have any idea what we were going through? I was living in constant fear of losing my daughter overnight, and now I owed over $15,000 for a two-night stay in a hospital room. After the initial shock wore off, I got very angry. I was a stay-at-home Mom at the time, and I had the time and the drive to fight this.
My strategy was to try multiple avenues to get the bill resolved. I started by contacting the hospital social worker assigned to Emily. She pointed me in a couple different directions. I then contacted the insurance company directly and spoke to some very unknowledgable people who really couldn’t tell me much; they at least started an appeal for me. I also contacted the Connecticut Office of the Healthcare Advocate; a week late, I was contacted by a state nurse that was assigned to my case. She started another appeal with the insurance company through her contacts. I also posted my story on the insurance company’s Facebook page. Almost immediately, someone contacted me with a name and number of someone I should call about the rejection. I also emailed the president of the insurance company.
Having tried everything, I then just had to wait. It was agonizing.
After a few more weeks, the decision came back from my insurance company that the claim was still being rejected and that I would have to pay for her hospital stay. I informed the hospital social worker of the decision and she put the hospital’s insurance workers on the case. A few weeks later, the hospital and the insurance company came to an agreement that I had to pay just 1 percent of the bill.
I was relieved, but still so so very angry. The best place for her at the time of her diagnosis was the hospital, and if we had waited any longer to take her, we may have lost her. Would someone wait until it was too late to take their child because of such insurance horror stories? That’s why I believe it’s vital that patient advocates push back against such heartless decision to make healthcare more accessible for us all.
Christine’s story has sparked a lot of discussion on insurance policy and Type 1 diabetes here at Insulin Nation. Look for future articles on this theme in the coming months as we do some digging. In the meantime, do you have an insurance horror story to share? Send them to our editor at email@example.com.