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Entry 4

Posted Thursday, Oct. 31, 2002, at 1:09 PM ET

Zac Unger is a firefighter in Oakland, Calif. His daughter was born three months premature and is in the neonatal ICU.

More photos from Zac Unger.

I spent most of the day yesterday on the phone with insurance companies. Every single thing about Percy is small, except for her medical bills, which are enormous. We've had trouble with our insurance ever since we started having miscarriages, and it's been getting worse. The fact that Percy was born via surrogacy only added to the confusion. Originally our insurer refused to pay for any of Percy's care; they claimed that our surrogate's coverage should be charged instead. Since Percy is 100 percent ours genetically, Jessaca's insurance company was understandably reluctant to assume the cost of her care.

After much prodding, my insurer agreed to pay for Percy's bills, but only after the first 30 days of her life. It would take me 10 years at my current job to pay for the cost of one month of hospitalization in the NICU. With the help of a very understanding cashier here at the hospital, I think we've finally gotten our point across and extracted from the insurance company an agreement to do what they're supposed to. Until I see all the paperwork (or until the bills come rolling directly to me) I have this unsettling feeling that our financial fate is dependent on the good graces of the insurance industry.

After the first 10 days of hospitalization, Percy had rung up charges of $380,000. And that doesn't include the cost for the doctors, who bill separately. On her first day Percy got three doses of artificial surfactant, the viscous goo that keeps the air sacs in our lungs inflated. It's a miracle drug, and Percy wouldn't be doing nearly so well if she hadn't gotten it, but each dose costs $3,500. When nobody you love is sick it's easy to be dispassionate about the outlandish price of medical care and to debate the costs and benefits to society of fighting to save difficult patients. But when it's your own daughter, you want all the big money spent. Similarly, yesterday I asked the doctor why, if most preemies get infections, shouldn't they all be given antibiotics prohphylactically? He gave me a perfectly reasonable answer about the risks of creating drug-resistant superbugs. I'd like to be concerned about hypothetical future babies, but all I really care about is the immediate health of my own sick girl.

Our current insurance crisis involves the fact that my plan has a lifetime per-person maximum of $2 million, and I think we're going to blow right past that over her projected three-month stay. I'd hate to make it through this ordeal only to leave Percy uninsured when she gets chickenpox in 10 years. I thought we could just switch Percy to an HMO with no maximum that my wife's employer offers. But the insurance industry has a rule that children of two-plan parents must be covered by the parent whose birthday falls earliest in the year. Unfortunately that's me. We considered ways for Percy to lose my coverage and get switched to Shona's, but all of them—quitting my job, getting a divorce, faking my death—seemed unworkable. The other option is to switch to a no-maximum plan at my job, but it carries a $600 per month co-pay. They say that when Percy's not in crisis anymore, when she's just a feeder and a grower, that her bills will come down dramatically, and we may not ever reach the 2 million mark. But I'm left trying to weigh my current budget against future costs that are both entirely unpredictable and utterly critical.

In our thoughts about switching carriers, Shona and I have offered up so many odd variations that we've thoroughly confused the benefits people at our jobs. It's also nearly impossible to get definitive answers out of the insurers themselves about what the various coverages will actually cover. Whichever course we choose will be essentially a guess, and we won't know how deeply we've miscalculated until we reach our next unforeseen medical crisis in the years to come.

The good news amid all the hassle is that Percy's feeling better. The Ceftazidime and Vancomycin have worked their (expensive) magic, and her infection levels are dropping. She's up to 144 cc's of milk a day, and when the nurses evacuate her stomach before every feeding, there's nothing in there, a good sign that she's learning to digest well. The nurse puts her in a little shirt for the first time, and it's so big it looks like a wizard's cape. She opens her eyes more and more, and she's got this incredible little toothless smile that she puts on after she stretches and rubs her eyes. She's seeming more and more like a real baby, and I can even start to imagine that one day she'll be able to come home with us like a normal kid.

We'll get this insurance stuff worked out somehow. I'm confident of that, though I'm not sure why. I just hate the fact that I have to spend a single ounce of my emotional energy worrying about this crap when I should be focusing exclusively on Percy. My lowest moments aren't when we're facing a new medical crisis, but when I'm on the phone with an idiot, or even with a well-intentioned lackey working under a bureaucratic mandate to value money over my daughter's life. In the end I take a fair amount of glee in the fact that no matter how many years' worth of premiums I pay, my family will always be a gigantic net loss for the insurance industry.

Entry 4

Posted Thursday, Oct. 31, 2002, at 1:09 PM ET
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Zac Unger is a firefighter in Oakland, Calif. His daughter was born three months premature and is in the neonatal ICU.
COMMENTS

Remark From The Fray (Day 4):

Zac, you need insurance counseling. Your post contains some misinformation that could be costing you a bundle of money. The most glaring is that the insurance company has a rule on whose insurance company has to cover a baby when each parent has different insurance. There is no such rule. Your wife should have been able to pick up coverage of your infant from day one (this is a little complicated, since it depends on a couple of additional facts, but most of the time you can add a dependent upon the birth of one). The so-called birthday rule has to do with the coordination of benefits when someone is covered by more than one insurer, not on whether the insurer owes you coverage to begin with.
Under federal law you have the right to add a new dependent so long as you act within 30 days to add her -- the surrogate thing is a little odd -- but the right applies to adoptive children, so whichever way, if you are the legal guardian of a new dependent there should be no issue with coverage if you act promptly. Finally, ignore those hospital charges. Your insurer, and certainly your wife's HMO should be able to negotiate serious discounts, and I mean in the 30-50% range. Moreover, and here's where you need to keep on top of things: Your maximum -- as well as your copayments and co-insurance -- should be calculated in line with what your insurer is PAYING and not what your hospital is CHARGING. Charges are a hospital's wish list. No one really pays full charges. Unless your insurer is seriously out of step with the California norm. You don't want your $2million maximum being determined by an amount that is being charged if your insurer has only paid half that much. Good luck.

-- Barbara

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here.)


Remark From The Fray (Day 3):

Try Hazel's -- very good, will be a nice break for you from the bad strip mall food. Also, take a drive out into the country side sometime. Very pretty and may get your mind off the vagabond. The central valley does have its virtues, and I hope it helps your baby girl to grow strong so you can take her home.

-- Emily de Ayora

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here.)


Remarks From The Fray (Day 2)

Am I alone in my confusion? I don't understand why a person would pour thousands of dollars and gallons of tears into the effort of bearing their own child when there are so many children already out there who need a good home and loving parents.

I feel for the author. My prayers are with him, his wife, and their tiny, fragile daughter. But in the back of my mind, I wonder why these people were so desperate to have "their own" child that they endured six miscarriages, paid for in vitro fertilization and a surrogate mother when they could more easily have saved a child from our overcrowded foster care system, or from starvation and poverty in a 3rd world country.

What motivates this difficult, and, to my mind, somewhat selfish choice? Even though I am not a parent myself, I do understand that there are no easy answers, no simple solutions.

-- Miss mae

(To reply, click
here.)


You try because it would be YOUR flesh and blood. Surrogate or not, Percy will be their flesh and blood. My wife and I had a difficult time having a successful conception. And while the thought of adopting, possibly from the 3rd world, was discussed at various times, until someone comes out and says "You can't have your own...period", you keep trying. And for better of worse, medical science has given people a lot of things to try.

-- Scott

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here.)


I guess some people have a special need to pass on their genetic material, but I can't imagine loving our daughter any more if we had gone through the pregnancy ourselves.

However, I hesitate to suggest adoption too strongly. After all, if someone can't view an adopted child as "their own" or somehow inferior to a birth child, then they really shouldn't adopt.

-- Ferante

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here.)


Everyone knows that there are risks involved in the costly process of assisted pregnancies, but there are just as many in the difficult and sometimes process of adoption. People sometimes wait years for a child, or are deemed, for one reason or another, unsuitable to adopt. People who have done all the paperwork to adopt children in foreign countries have suddenly been told that they can not bring their children home due to kinks in the red tape. Young mothers who give up their children for adoption have come back later and taken the child back. Foster care can be equally heart-breaking. Families take in a child and become attached to that child, only to have the child removed at a later date. Surrogacy is a choice. It is one that medicine has made available to us, and no one should be criticized for the decision to take advantage of that advance.

-- Christe

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here.)


Remarks From The Fray (Day 1)

This one brought back a lot of memories. As another "graduate of NICU" and as an alumnus of the Life on a Lillypad club (what our mothers-on-bedrest group was called), I watched others go through this and thought "but for the grace of God there go I".

I was pregnant with the twins, and started spotting in class (I was in college at the time). I went to the doctor, and he sent me directly to the hospital where I spent four months on drugs (magnesium sulfate and tributiline) to stop premature labor. Luckily for me, it worked, and instead of being born at 24 weeks and at just over a pound a piece, my daughters were born at 35 1/2 weeks, at over 5 pounds a piece. We spent 16 days in NICU due to hardcore jaundice and a suspected heart murmur in one of them.

I was incredibly lucky, in many respects. My daughters were over seven pounds before they came home - they made up for lost time in a big way. The heart murmur never materialized into anything real and a few days under the lights dealt with the jaundice. The only side effect we had was spending six months on caffeine and periodic monitoring to prevent and monitor sleep apnea (worked - mostly because they didn't sleep!). We took them off it in due time, it took three days for their systems to get to normal, and they have never looked back. That was almost 12 years ago.

I can remember the fear of looking at your child in incubator, afraid every second of loosing her, starting at every beep and red light on the countless machines hanging off her. I only had to do it for a couple of weeks - they have months of this heartbreak in store even if all goes well. I watched other parents looking through the glass at extremely tiny ones, with hope and terror and anguish warring for space on their faces. I can empathise about the pain of not being able to hold the child - that was the hardest part for many of the mothers. I can assure you that the only thing you can do at this point is talk about the baby and pray, and wash your hands all the time (I would swear I still have Betadine stains under my nails).

He has a tough row to hoe, both as a father and as a husband. You are so helpless. If he finds any sort of help and comfort from writing this stuff down, then let him. I'll read, and commiserate.

-- MsZilla

(To reply, click
here.)

(11/1)

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