Two Families. Two pregnancies. Two similar delivery stories. Two different outcomes. The Carilli Family and their daughter Ella and The Cobo Family and their daughter Lily.
Ella (top) Lily (bottom)
One doctor who should have recognized the warning signs that Ella was in distress and didn't. One doctor who did recognize the warning signs that Lily was in distress.
One doctor who never told us the risks of proceeding with a regular birth as opposed to delivering by C-Section. One doctor who clearly explained the risks of proceeding.
One doctor who did not recommend a C-Section. One doctor who did.
One baby born in critical condition, due to meconium aspiration (the filling of the lungs of a tarry poop like substance usually caused be a traumatic and difficult birth). One baby born perfectly healthy.
One baby ripped from her parents arms and taken by helicopter to a level 3 neonatal intensive care center where she would stay for 11 days and rack up over $30,000 in medical bills. One baby gets to go home with her loving parents who are unaware that their world is about to be turned upside down.
One family was told the State would pay for any amount our insurance company might refuse to pay with the exception of $500. One family was told their insurance company had changed their policies AFTER the Family purchased their care plan and hence they are refusing to pay for their emergency C-Section. That family received a $17,000+ bill.
In spite of their doctor stating repeatedly in writing that she believes the C-Section was necessary because their baby was in distress, the insurance company still refuses to pay. They have actually issued a statement that "fetal distress" is not an approved reason to have a C-Section. Really????????? I can't think of two better reasons for having an emergency C-Section then either mother's in distress or baby is in distress. Apparently they disagree. Or rather, they just worry more about the bottom line and their profits.
This is one example of thousands one can find with a simple google search as to why our Healthcare system in this Country is royally messed up. We have never had a problem with our Insurance company and we are fortunate to have insurance subsidized through my husband's employer. This family has two self employed parents who are on their own when it comes to buying health insurance for their family. They are contributing members of society, hard workers, don't use State assistance for anything and thought they were doing the right thing by waiting till they were financially ready to have a baby and until they could afford to buy medical insurance for their family. And now instead of enjoying the first year of Lily's life her mom has spent hundreds of hours talking to anyone who will listen who might be able to help her family fight the insurance company and get her bill paid. The big kicker, although the bill sent to this family was over $17k due to negotiated discounted contract rates between medical providers and insurance companies Blue Cross Blue Shield of Arizona would only have to pay the hospital about $6,500 for this C-Section. And yet they would rather this hardworking family scrounge to come up with this money to pay for something that was clearly medically necessary to save their baby's life and livelihood.
Insurance companies do not belong in our hospital rooms or in our doctors offices when we are deciding on care or treatments for the sick or the dying. Insurance companies and hospitals should not be industries that are for profit. This is how our healthcare system has gotten so out of control and why so many people cant get the care or medicine they need. If they were illegal immigrants or on welfare/state health their C-Section would probably be paid for. But they are hardworking middle class family instead facing over $30,000 in bills. I am so grateful that I didn't bring Ella home from the hospital with a stack of $30K in medical bills to go with her. Because we probably wouldn't have had another baby as a result. And it makes me so sad to know that my second baby Ryen was born by an elective C-Section. I didn't even NEED to have it. My doctor did it to give us peace of mind because of what we went through with Ella. And my insurance company didn't blink at paying it. Doesn't seem right that a family that actually needed this procedure cant get the same from their insurance company.
I am disgusted with Blue Cross/Blue Shield. A company I always respected in the past. If they are EVER a choice for us going forward (even if they are the cheapest) I will NEVER choose them as a result of this family and their struggle. If you have them and you can switch I urge you to. In the meantime please show your support for this family. Their story will be airing on Chandler 3 on your side on Monday February 1st, between 5:30-6pm and again at 9pm. They also have a facebook group page you can join by clicking here
http://www.facebook.com/iamlilysmom?ref=ts you can also follow the progress of her case on her blog
http://lilysmom.com/.
If you or anyone you know is an attorney licensed to practice in the state of AZ please consider taking on her case pro-bono. If she had the money to hire an attorney she would have the money to pay this bill. Litigation or at least the threat of it, is probably the only thing that is going to get this Company to do the right thing. It will cost them way more than $6500 to fight her in court then pay for the damn C-Section. They are obviously hoping the more they deny her the more she will lose hope and give up. They obviously messed with the wrong woman!
I had the pleasure of speaking with Elizabeth Cobo (Lily's Mom) this morning for awhile. And she said something I think is AMAZING. Even if the Insurance Company agreed to pay for her C-Section as long as she agreed to go away quietly, take down her website and no longer talk about her case, she is not sure she could bring herself to say yes. Even though her ultimate goal of getting her bill paid would happen she doesn't want them to buy her silence, because she doesn't want ANY other Woman, Mother, or Family out there to ever get blind-sided by something like this. If she can prevent one family from going through this, then maybe it was all worth it. Obviously her and her husband feel very blessed Lily is happy and healthy and GORGEOUS, but they really believe that maybe this is happening to them for a reason. So that they can be an inspiration to others to fight back against insurance companies, and to speak up against injustices to others, and to educate people on the notion that just cause your Doctor who is a medical professional believes a procedure is necessary to save a life, doesn't mean an insurance company will agree. And right now, they have all the power.
What are you willing to do about it? Will you get involved or keep saying, well it is not me so I don't care? What if it is you one day? What if it is a cancer treatment or a life saving transplant and your insurance company decides they care more about their bottom line then saving your life? This is a time in our nation when healthcare reform is in the spotlight and every American has a chance to have your voice heard. Get involved. Get out and vote. Write letters to your representatives. Write angry letters to Blue Cross Blue shield about this case if you want to. Or you can just keep praying it doesn't touch you or yours.
Good Luck to the Cobo Family. Fight the good fight and don't lose faith. Hopefully help will come from somewhere soon.
