Insurance Nightmare

Okay - I'm a drama queen. It's really not that bad. Here's the deal - my company offers a 100% employer paid "short term disability" policy that provides 8-12 weeks of 100% paid coverage per year (on a rolling basis). Maternity is covered under this policy, with eight weeks guaranteed AFTER THE BIRTH of a child. The other four weeks are available to be used before or after the birth (or not at all) depending on my health. Makes sense, right?

The catch is that the only thing that eliminates the waiting period is the birth of a child. Bailey, of course, has not been born yet. I am eligible for the additional four weeks...after an 8 work-day waiting period. For me, that is through the end of this week (three days last week, then five this week).

A second benefit offered by my company is what is called "family care leave". This is different because it's not covered by insurance - it's a benefit that the firm offers (and pays for). This provides two additional weeks of paid leave in order to care for a child. It does not have to be taken in connection with a maternity leave, but it can be.

So, the original plan was for me to take my eight weeks after Bailey was born that is provided by short-term disability. Then, I would tack on the additional 2 weeks of family care leave. After that, I was going to tack on the 2 weeks of paid time off that I had been able to accrue - hence...a full 12 weeks of 100% paid maternity coverage.

Well, because of this waiting period, I am having to use my PTO time to cover the gap between when the additional four weeks of short term disability kicks in. Of course, Bailey could be born at anytime, which would null and void this whole problem - except that I still would have to use my PTO time to cover this time.

Here's the bitch, though - I may not be eligible for the additional four weeks of coverage. After going around and around with the insurance company, I wasn't able to get any kind of answer about what would disqualify me. Sure, I've been taken out of work by my doctor, but that may not be enough of a reason. Seriously. So, I have had the paperwork filled out and it's on it's way to the insurance company. They will analyze and evaluate it and make their decision. If they decide to reject my claim, we are up shit creek until Bailey is born. They can't deny the need once a child is born - they can't say that I don't have a true medical condition. If they do deny the claim, and Bailey is born BEFORE next Tuesday (the 24th), I have the PTO time to cover my absence from work and then the disability kicks in. If they deny me, but she isn't born before then, a period of no pay begins.

Which, we can't handle. Well, let me rephrase that - we can handle it financially, just not easily. Our life needs both salaries, which is why it is so wonderful that my company offers these benefits. I mean, I get 10 weeks off work, without ever seeing a loss in my paycheck after she is born. That's unreal. I'd get more if I had more PTO time. I'm not complaining about my benefits...just about the insurance company.

Of course, if they approve the claim, it will be retroactive and will cover anytime after the 8 day waiting period, before the birth of Bailey. That would be ideal. We'll hopefully know in the next 10 days how that will play out.

If they do end up denying us, we are going to push hard for an induction next week. I know that is contrary to everything that I've said since this pregnancy started, but reality kicks in at some point. We can't go a long time without a paycheck from me, and I can't go back to work. The only way to force the hand of the insurance company is to give birth. Next week, we will be fully 39 weeks pregnant. I'm hoping that, if she doesn't come on her own before then, we can convince them to induce me at that time. Maybe we can't. And if we can't, I will have to go back to work.

So...here's hoping she's either ready to come, the insurance company approves our claim, or the doctors will help us out...