R
rfred
Guest
This is a Virginia individual health plan with a maternity rider. The rider has a $2500 deductible. I was told that this deductible covered the entire pregnancy from conception through delivery, including any complications. The plan is now saying that "Gestational Diabetes" is not a complication of pregnancy and therefore the costs associated with this will go towards my regular deductible. The rider itself is short, and ambiguous. I have faxed (The only means of communication for medical review.) a letter to them in hopes of contesting this decision. Are there any precedents for this sort of thing? How could anyone reasonably expect that this condition would not be covered under the maternity part of a plan?
Any help on how to argue this would be most helpful. I feel as though I was decieved, and now that I am 9 months pregnant I have no way to predict what my actual costs will be because this decision on their part calls into question everything else that they told me. I am now faced with the possibility that they will try to use up a 1999 deductible of $2500, a 2000 deductible of $2500, as well as the maternity deductible of $2500. Their E.O.B. forms do not give me enough information to determine which charges go to which deductible, making it nearly impossible for me to contest anything.
Please any help would be very much appreciated.
Any help on how to argue this would be most helpful. I feel as though I was decieved, and now that I am 9 months pregnant I have no way to predict what my actual costs will be because this decision on their part calls into question everything else that they told me. I am now faced with the possibility that they will try to use up a 1999 deductible of $2500, a 2000 deductible of $2500, as well as the maternity deductible of $2500. Their E.O.B. forms do not give me enough information to determine which charges go to which deductible, making it nearly impossible for me to contest anything.
Please any help would be very much appreciated.