The $30,000 babyPosted: Updated:
PHOENIX -- A Valley couple say they're fighting a losing battle with their health insurance company so they contacted 3 On Your Side for help.
Thirty thousand dollars is on the line here. An East Valley couple say Blue Cross Blue Shield should pick up that cost, but the insurance giant has a different point of view.
Robert Cobo and Elizabeth Langford say they are overjoyed with their 5-month-old baby girl, Lily.
"We are so glad she's here, we are so blessed that she is healthy, she's happy, but we just never anticipated that this would come along with a baby," Langford said.
Langford is talking about the price tag for delivering Lily.
Langford and her husband had health insurance through Blue Cross Blue Shield and they were expecting some out-of-pocket expenses. In fact, they say, they thought most of that expense was upfront.
"Our insurance doesn't include maternity coverage so we paid about $10,000 out of pocket already for all of our prenatal maternity care and we prepaid to the hospital and anesthesiologist," she said.
Now, Langford says she wasn't planning on having a Caesarean section, so she didn't purchase that part of the policy. Besides, she says even if a C-section was done due to a last-minute medical necessity, she says her Blue Cross Blue Shield insurance policy would cover it anyway.
In fact, in the policy it says "that complications of pregnancy resulting in a C-section for medically necessary reasons would be covered."
Unfortunately, after two hours of pushing during labor, Langford says getting Lily out actually did become a medical necessity.
"She was having some non-reassuring fetal heart tones, little bit of fetal distress and our doctor suggested the best thing to do was to go ahead and do a C-section," she said.
But after Lily was born healthy, Langford and her husband got all kinds of hospital bills for thousands of dollars, bills that Blue Cross Blue Shield apparently was not going to cover.
"About a month and a half after Lily was born we got our first bill and it was for about $17,000 for the Caesarean section," Langford said.
When the bills finally stopped rolling in, they amounted to around $30,000, but what about that clause that says Blue Cross Blue Shield would pay for the C-section if delivering Lily became a medical necessity?
"Blue Cross Blue Shield is no longer saying that fetal distress is a reason for a C-section," Langford said. "It's no longer medically necessary."
The doctor who delivered Langford's baby even wrote a letter saying her Caesarean section was medically necessary, but Langord says it didn't matter because Blue Cross Blue Shield has a very short list of items that are considered "medically necessary." If Lily happened to have not survived labor, well, Blue Cross Blue Shield would have covered the C-section then.
"Although fetal death is listed second on listed items they do cover, we feel our doctor pre-empted that by doing the C-section," Langford said.
3 On Your Side contacted Blue Cross Blue Shield which maintains that their decision to deny coverage for Langford's C-section was appropriate. Still, for Langord and her family they say it's rather interesting for an insurance company to make such decisions when that decision is the one that can save Blue Cross Blue Shield around $30,000.
"For them to be able to make their own guidelines as to what a complication of pregnancy is and what medically necessary is, is a little scary," Langford said. "Our little bundle of joy came with an additional $30,000 price tag."
Langford and her husband are appealing the denial and are currently in their third appeal phase.