This entry is the first in a series of insurance horror stories, stories which -- although they have been massaged a bit to protect the innocent (and fend off insurance companies' attorneys) -- are still too true for comfort.
Consider yourself warned, these stories are not for the faint of heart.
It sure hadn't been easy. While Judith had children from her prior marriage, Ira had none. It meant a lot to him that he'd be a father soon, and as much to her that she could finally give him what he'd sought after.
He eased back in his seat. The faux wood chair in which he sat did little in terms of comfort or looks for the doctor's office. His tailbone hurt from sitting. They'd been fifteen minutes early to their appointment. A glance at Ira's watch revealed that the doctor was already twenty minutes late.
As if summoned by Ira's thoughts, Dr. Mossberg bustled in through the door of his practice, the slat blinds in the door slapping against the glass as he stepped in. The doctor hadn't time for so much as a hello as he left the reception area for the office in back. The reception window slid open a minute later, revealing the face of the all-too-bored-with-her-job teenage girl who staffed the desk.
"Burnside?" she said.
Ira nearly sprang out of his chair. "Yes, that's us."
Ira held open the door for Judith as the receptionist buzzed them in. They rounded the corner and met Dr. Mossberg at his desk. "Come, sit," said the doctor, holding out his arms to indicate the two chairs across from him.
"I understand you're coming to me because your wife is having a baby," the doctor went on.
"Yes," said Ira. "My first."
Dr. Mossberg's eyes flitted over to Judith. An uncomfortable silence set in.
"My third," Judith volunteered.
Mossberg nodded, and it was an exaggerated gesture, as though he knew something they didn't and was on the verge of telling them. "I thought as much," he said, snapping shut the folder on his desk. "I just got off the phone with your insurance company. They're declining coverage."
"What!" Ira leapt out of his chair. "That's not possible. My company's health plan covers my wife and I for all maternity expenses."
"Well, yes and no," Mossberg was hesitant to say. "You," he said, looking at Ira,"are covered for all maternity expenses." He shifted over to Judith. "You are not."
Ira was flabbergasted. "That's ridiculous. I'm not the one carrying this child, she is!"
"I'm sorry," Mossberg cut in.
"No! That's inexcusable! What am I paying their premiums for, if not this?"
"Insurance is about risk, Mister Burnside. You pay them to take a gamble on you not getting sick, or in your case..." He trailed off, jabbed his pen in Judith's direction. "Much like you took a risk that your wife wouldn't be covered under your insurance policy when you married her. I'm sorry, but like any game, there are winners and losers."
Ira brought a cold look to bear on Dr. Mossberg.
"Don't be angry with me," said the doctor. "I don't write insurance policies, but they are how I get paid. Unless you want to go out of pocket."
Judith was on the verge of tears. "We... we can't afford that."
Mossberg gave such a thoughtful nod that it couldn't have been more insincere.
"On what grounds is our coverage denied?" Ira asked.
Mossberg paused. "Pre-existing condition."
Ira stared at Judith. She looked back at him with panicked eyes.
"What condition, doctor?" Ira asked.
Mossberg shrugged with his palms up. "Well, she did say she'd been pregnant before, and that settles it in their book. Your health plan explicitly excludes pre-existing conditions from coverage."
Ira was beside himself. "So you're saying working people like us can't have more than two children?"
"Well, no," Mossberg stammered. "No one's preventing you from having a big family." He paused and his tone darkened. "As long as you don't mind paying for them yourself." Mossberg rocked back in his chair, knit his fingers at his chest. "So, what to do, folks?"