Need some serious medical/insurance help

[just cover]

My wife's brother-in-law's brother (please no jokes) has the worst decision ever to make. His wife is23 weeks pregnant with twins. She had some problems lately with spotting and in last day got some infection with a fever. Well she went into her doctor in their insurance network while there her water broke. He immediately admitted her. They are telling them if she gives birth now the babies will most likely have serious problems if they even live. If she was 24 weeks they could give her some steroid to help get the babies lungs more developed, but hey won't even try that I guess at 23 weeks. We are good friends with them and have been alot more close lately because my wife is having twins in August. It is just terrible because she says she can still feel them moving around and kicking.

HERE is the worst part yet. When she was admitted they didn't know all this would happen so as I said before they were in their insurance network in Champaign. I was told the facility was only a level 3. Over in Peoria they have a level 1 neonatal intensive care unit. They wanted to go over there immediately. THE FUKING INSURANCE SAID THEY WOULDN'T COVER THEM OVER THERE. The babies would have to have some heart problem for them to cover them at the level 1 hospital. I have no idea why that is like that. Well I think them having to terminate is pretty serious. She was also told by the level 3 that if they didn't terminate with what is happening with the fever and stuff that she might not be able to have kids.

All this just happened last night so I will probably have more info later but I just think that is about as fuked up as it gets. He has gone through every emotion. At first he was as you can imagine upset. Now he is just so mad he could kill somebody. They have a friend who knows someone at the level 1 and said since their insurance won't cover them they would be looking at least a half million. In Peoria at the level 1 they would do everything in their power to save the babies while it seems that level 3 pretty much wants them to terminate. They have been given until Monday to decide. Even if they went to the level 1, they might have the same outcome.

He has pretty much said fuk it and wants to go over there and file bankruptcy if needed. It is just so sad. His wife is just looking for any hope and even asked if they could save just one.

I don't have all the medical terminology yet but will try and explain more detalied later to anyone that can help with that end of it. Also if anyone can help with the insurance side that is appreciated also. Is there a way around them getting to the other hospital while being covered? They will know more today on what their options are medical wise.

I don't know what else I could do to help so I thought maybe somebody here might have had an experience like this.

just cover

 

[MadJack]

man, what a disturbing post. shit like this pisses me off so much i can't even describe.

i think the decision is a no-brainer, however. get the best care available and worry about who pays for it later.

good luck, man!

 

[just cover]

That is what they are probably going to do from what I heard last night. It is just a fuked situation.

thanks jack

jc

 

[buddy]

I agree with Jack.

Get the very best possible care available for the mother and the babies.

 

[letswin]

GET to the level 1, if the stupid Ins fails then file bankruptcy This si so stupid, only thing worst is if in Canda it woudl never have been cuz it takes months to get any surgeryies up there GO LEVEL one and my prayers are with them

 

[letswin]

GO right to emergancy room then they admit her uP to hosital most can get around issues of where you can/canot go if hit emergency room first

 

[SixFive]

stupid insurance company! :nono: I'm pretty sure they were told wrong and they will cover. Irregardless, that's where they need to be. 24 weeks is very iffy I'm afraid, and it's going to be a battle.

If you have any other NICU questions or questions about medical conditions the babies have, I can answer them or, I can get those answers from my close 1st cousin who works in the NICU at Kosair's in Louisville.

Hope there is a good ending to the stressful start of this post.

 

[gardenweasel]

i hope this comes out right.....

firstly,i`d go to the level 1 facility...

secondly,if the insurance company persists,i`d call the local media(hopefully you live in a liberal state) and inform them of your dilemna...

try and get in touch with a health reporter or a political reporter...

given the upcoming heated debate on national healthcare,this would be a great story for some liberal newspaper to bring to the forefront..

i`m not for universal healthcare,but,i`m just making a suggestion that might help put pressure on the family member`s insurer if push eventually comes to shove...i`d do anything i could to get out from under the inevitable big nut that your family will be burdened by...

this is a human interest story and the media loves this stuff...

it would be worth a shot.....i just hope that if the babies make it,that they`re healthy...sometimes you have to be careful what you wish for...

prayers and all the best...

 

[dawgball]

I was going to suggest going to media after babies are delivered safe from Level 1 as well.

On a side note, my step-sister and her husband were presented with the option of terminating a pregnancy at about the same time in her pregnancy. I was not present with the doctors, but it was told to me that they were basically encouraging the termination.

They decided not to terminate, thankfully.

They did have a VERY ROUGH year the first year basically living in the Ronald McDonald house next to the hospital in Louisville almost full time.

Now, three years later, Carter is in "perfect" health (as close to perfect as a 3 year old can be) with only very minor inconveniences.

 

[MadJack]

I was going to suggest going to media after babies are delivered safe from Level 1 as well.

On a side note, my step-sister and her husband were presented with the option of terminating a pregnancy at about the same time in her pregnancy. I was not present with the doctors, but it was told to me that they were basically encouraging the termination.

They decided not to terminate, thankfully.

They did have a VERY ROUGH year the first year basically living in the Ronald McDonald house next to the hospital in Louisville almost full time.

Now, three years later, Carter is in "perfect" health (as close to perfect as a 3 year old can be) with only very minor inconveniences.

identical thing happened to my niece (the twin of the niece you met) who had twins 3 years ago last december and spent at least 8 months at RM house too. the boys are healthy and strong 3 years old now.

 

[just cover]

Thanks for all the help everybody. I talked with the brother-in-law just a couple minutes ago. She has some sort of infection that is causing the early labor. They are being told by the doctos at the level 3 that they are doing the same for the mom that would be done for her at level 1. They will get test results back this afternoon as to what type of infection and results.

Now there is a question of how far along she is. Her doctor is saying she is 24 weeks, but the hospital specialist is saying only 23 weeks 3 days. From what the law says this is a big deal. The 24 weeks is a law that they have to do everything in their power to treat.

They have talked with insurance again and his coverage won't cover the babies at the level 1 if they go early unless there is some major heart defect - why I have no idea. The insurance is saying they can do the same thing for the premies at the level 3 as they would at the level 1 unless there was something wrong with their heart. That just blows me away. the doctors at the level 3 are telling them they have maybe a 2-4% chance of the babies coming out so called normal. They have pretty much been telling they could be in a wheel chair for life, massive lung problems, spinal bifoda, their eyes won't be fully formed where they might be blind or need tons of surgery. The brother-in-law thinks the reason there is such a big fight over the age of the babies is they can terminate before 24 weeks. After 24 weeks they can't and have to do everything to save them. He said it seems they are pushing for termination.

I would think the insurance would get her over to Peoria at the level 1 to try and stop the early contractions and get rid of the infection. They would be saving more money by her having the babies later when they are more formed then not getting proper or better care now and dealing with twins with serious health problems later.

I guess they will have to make a decision after the tests come back this afternoon. My advice was the same as you guys- get the best possible care and let them figure out who will pay what later. I am sure a call to the media would help sway some opinions who will pay what.

Thanks again everybody

jc

 

[escarzamd]

As far as the medical treatment, its probably true that a maternal-fetal med specialist in Champaign could manage her, treat whatever is causing fever and suppress labor.......the steroid question falls under what's causing her fever in the first place? They're probably a little scared of making mom worse with the doses given to speed up fetal lung maturity, but if she's healthy, I would think she could handle it. Its just such a touchy time in the pregnancy and twins makes it doubly so..........personally I sweat like a sumbitch with these patients in front of me.......


Getting around insurance b.s. is a little more difficult but one thing I know for sure is they (ins.) would have much less room to outflank them if they were actually in Peoria when a problem arose. Tougher case to make since she is in crisis and already in hospital in Champaign, but with hope, she can get through current situation.......then next time scoot straight to Peoria with any problems and feed 'em a line about "just visiting" or some other such plausible reason to be out-of-town. They have to take the patient in front of them as far as the care. I would hope his ins. wouldn't freeze 'em out at that point, but who the fvck knows these days?

Scary stuff.......not much help from me, I know. BOL.........I'll answer any other ????s you have, and if I don't know the answer, I'll look it up.

 

[DOGS THAT BARK]

From insurance standpoint can't help you much as apparantly you must be dealing with HMO--would be curious which one. In 24 years in business I have refused to have any part of true HMO's because of their unpredictabilty.
Can't relate to your level 1/level 3 hospitals????

 

[escarzamd]

Level I and Level III is just a way of describing capability.........P-town level I b/c they have a NICU and maybe some neonatal surg capability (doubt that)....

 

[DOGS THAT BARK]

Thanks Doc--
I do leg work and file appeals on lots of out-of-network situations. Many times the ins co and Dr get together when situation warrants and Ins Co will approve as in-net-work and Dr/facilties will except their prevailing rate in return.
The Henry-Joyce Cancer Clinic &Clinical Reasearch Center @ Vandy have went the extra mile on numerous occasions.

 

[just cover]

Well things have looked better since yesterday. Her bloodwork came back with no sign of infection and contractions have pretty much stopped. They are being told today is key if she can keep from early labor. They have given her the steroids.

Now another weird part. Since they are saying she is less than 24 weeks, the hospital will not do any extrordinary measures if the babies have no brain function, or severe problems if she has early labor. This place to me anyway just seems hell bent on terminating or not even trying to help them.

On Friday they were so depressed along with nothing but terminate, terminate, terminate from the hospital they were ready to terminate. Now they have pretty much changes their minds and are fighting against the hospital and wanting to do everything they can to not. If they make it through the next couple of days they might just come out to be alright. Right now the babies are fine except for the lack of development. It has something to do with her and her body going into early labor. I just think the hospital and insurance company were only giving them one choice and that was terminate. What is going to happen if they end holding off labor for a few weeks or month and they come out healthy or close to it. These fuks wanted them to terminate on Friday.

Also if they do ok and get stabalized they are going to Peoria so they are closer. It is the best in the state for neonatal intensive care from what I hear. Also will try and find who he is dealing with insurance wise.

Thanks guys

jc

 

[vinnie]

I don't want to get started will the insurance co. all I can offer is my prayers. GOD BLESS THEM !

 

[ripken8]

my prayers are with them. good luck...

 

[BobbyBlueChip]

Is the hospital a Christian hospital? The only reason I ask is they have some moral dillemas with babies before 24 weeks and I wouldn't trust a thing that they're saying if it is.

There's also plenty that the Level I can do that the Level III can't as far as the first half hour after birth which will be critical. The problem is I don't know if the conditions that the mother has would preclude her from moving hospitals.

Every day that the twins are inside helps exponentially and if she can get to 24 weeks, then it's over 50%. Your friends are in a horrible decision and with the drugs that they've probably given the mom and the lack of sleep with both mom and dad, they've got some pretty heavy decisions to make. The best thing that you can do for both of them is get them as much information that they need to make an informed decision.

Best of luck to them and my prayers are with them.

 

[Morris]

I can't offer any insurance advise only prayers and good luck.

We have twins and so does my daughter. I know that every week that she keeps them is better. I know my wife started contractions early so she was confined to bed for 2 months. GL