Insurance Company Refuses to Cover Preemie, Leaving Parents with $200K in Medical Bills

Image Source: The Jay Family

As soon as Amy Jay and her husband Mac decided to have a second baby, they knew they’d need a little extra medical attention during the pregnancy. Amy tells Babble that she has Polycystic Ovarian Syndrome (PCOS), as well as a history of recurring miscarriages. So she needed help getting pregnant — and also staying pregnant.

Amy knew how expensive all of her fertility treatments would be, and like many of us with confusing and complicated health insurance plans, she says she took great pains to first make sure everything would be adequately covered by her insurance company.

Before long, she was pregnant — and over-the-moon with happiness. That is, until the bills started rolling in.

As one exorbitant bill after the next began to arrive in the mail, the couple quickly began to realize that their insurance plan was a bit of a dud. And worst of all, there might not be a way for them to continue using it without breaking the bank. (For example, the progesterone suppositories Amy needed to take to prevent a miscarriage were not covered at all, so she had to pay $200 out of pocket for them each month.)

It wasn’t long before Amy and her husband decided they needed a better insurance plan — and soon enough Mac, found a new job that would provide just that. So when Amy was 34 weeks pregnant, the Jay family moved from North Carolina to Alabama. Once there, Mac could start his new job and Amy, their soon-to-be baby, and their toddler daughter Zuzu could take full advantage of the new health insurance plan.

Sounds like a solid plan, right? Except that’s not exactly how it went down.

The Jays’ new insurance plan didn’t kick in until February 1, 2017 — which was cutting it close, considering the couple’s baby was due February 9. Amy wasn’t about to take any chances, and took advantage of COBRA in the meantime, which is a federal law that allows you to stay on your former employee’s health insurance for a limited time, until your new insurance kicks in.

The couple was able to do just that, staying on Mac’s former insurance plan to bridge the gap in case the baby came early. But it wasn’t cheap: Amy tells Babble that they needed to pay for this insurance themselves.

Soon came another little surprise: It turned out Little Evelyn, the Jays’ second daughter, had plans of her own — and arrived a whole four weeks early. Amy tells Babble that they knew pretty immediately that her daughter was in trouble. Evelyn’s lungs weren’t functioning correctly, and she was soon diagnosed with Respiratory Distress Syndrome. As a result, Evelyn spent the first two weeks of her life in the NICU, fighting to stay alive.

Image Source: The Jay Family

Amy says that Evelyn lacked the elasticity to function correctly. “Because of that, she got a collapsed lung just from crying,” she explains. “It was disaster after disaster for the first several days.”

Despite the terrifying emotional rollercoaster of those first few weeks, Amy says their daughter received amazing medical care, and they were relieved when they were finally able to take her home two weeks later. But just one month after that (on Amy’s birthday, to be exact), the Jays received shocking news that would change their life in a devastating way.

It came in the form of a medical bill, sent from the hospital where Evelyn was born — and it totaled a whopping $178,389.47. As the couple soon learned, their health insurance company refused to cover any of Evelyn’s medical expenses. That’s right; not a single cent.

Image Source: The Jay Family

Amy insists she checked (and double-checked) with the insurance company to make sure that she and her daughter would be adequately covered during the gap before her family’s new insurance kicked in. But as she now tells Babble, there had apparently been a miscommunication between herself and the insurance company, and her daughter was never properly added to their insurance plan. Looking back, Amy now believes her insurance supplier had been “deliberately confusing” and says that the reps she spoke to did not give her the correct information.

“No one told us, and we didn’t know until we got that bill in the mail, and it was too late to act,” Amy says. “It was deliberately confusing and no one can convince me that the entire scheme is anything but deliberately confusing.”

In the months since, Amy says she has since fought, with all her might, to get her insurance company to cover the two-week NICU stay that saved her daughter’s life. And while she’s spoken to several lawyers and other advocates, she’s consistently hit a wall. The insurance company just won’t budge; not even an inch.

For a while, Amy says her family was considering filing for bankruptcy, because they didn’t see any other way out of the debt — which totals over $200K, when you factor in the other out-of-pocket costs incurred during her pregnancy. But bankruptcy would have resulted in her husband losing his job, and the family losing most of their possessions. It would have meant starting all over with nothing, and for no other reason than some bad luck that they were unfairly dealt.

When healthcare is a commodity, a business, this is always going to happen. The American Dream is a lie if you get saddled with debt because you got sick.
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Amy is understandably broken up over all of this for her own family, but she refuses to make this ordeal just about her own family. Amy has since connected with many families, both in her community and online, who are dealing with similar situations, and has dedicated herself to making sure it doesn’t happen to more innocent families.

Amy believes this kind of thing is a systemic problem, and one that needs addressing ASAP. “When healthcare is a commodity, a business, this is always going to happen,” she tells Babble, “The American Dream is a lie if you get saddled with debt because you got sick.”

Thankfully though, there may be some hope for the Jay family, after all. When Amy’s friends learned about her situation, they set up a GoFundMe page for the family. (Amy says she didn’t even know they were doing it; but it was a pleasant and much-appreciated surprise.) So far, they have been gifted almost $20K to offset some of their medical debt.

Image Source: The Jay Family

Amy says she hopes that paying back this chunk of money right away might make it more possible for the hospital to work with them on a repayment plan that’s within their financial means. And if she can get the hospital to work with her family, Amy believes this will spare them the prospect of bankruptcy.

“We are super, super privileged and fortunate,” Amy tells Babble. “I have incredible friends who are helping me get the story out, so something can be done.”

But even so, this doesn’t quell her anger about the whole situation. Part of the reason Amy wants to get her story out there is to highlight what a glaring, catastrophic problem this is for many, many families in America.

“I’m not willing to accept it for my family, or for any family in this country,” Amy says. “This is not the last you’ll hear from me. I’m going to fight until this never happens to another family.”

If you would like to contribute a small donation, you can visit the Jay Family’s Go Fund Me page now.

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Article Posted 3 years Ago

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