despite being members for five years, chm refused to pay for our maternity need. the thing was like that.
we’ve had most family members on the lowest silver level because it’s the best fit for our family; higher personal liability, meaning a higher deductible in exchange for a lower monthly fee. however my wife had always been gold level and we used chm for two births and a broken arm. it worked, albeit slowly. the time from submission to payment was often 3-4 months and the method of clearing or dealing with additional documents was clumsy but overall ok. so here we were with baby #5. A few weeks after applying, and assuming we were done having babies for now (perhaps forever? 😀), I was on our chm member portal and saw how much we could save by switching to silver, so I did. obviously no maternity cover, but I was willing to take a chance. there were no popups or warnings of any kind that if you do this you will cancel or lose the ongoing need. I had forgotten about that. the need progressed slower than normal. (I had presented it in August). they asked for clarification of the doula line in the midwife bill. we provide it. in December I called to see why the need had not been paid. there was no mention of switching to silver. the lady on the phone worked with me to make sure everything was in order and payment would go out promptly. only she didn’t. Instead of a check in the mail, we received a denial letter because my wife was silver. I called and appealed. I spoke with an Anthony, I explained everything to him, I proposed to him to pay the difference between bronze and gold for the months we had lost. What if it had been a great need? What if someone accidentally switched to a lower tier and put tens of thousands of dollars at risk? I was appalled by the lack of empathy and the “it’s our policy and it’s clearly spelled out in the member handbook” attitude. I read the member handbook when we signed up several years ago, but haven’t reviewed it thoroughly since then and struggled to find it in their policies after this happened. In effect, Anthony said that his hands were tied and that he could appeal to the “eligibility review board.” so I immediately sent the following letter:
Reading: Christian plans health care reviews
to the eligibility review board,
first let me express what a blessing chm has been to our family. we have been so blessed to be able to participate in sharing with other believers. In the years since we became members, we have had several babies and a broken arm and have been blessed by the gifts of others, as well as have been privileged to share the needs of others on a monthly basis.
As far as our current maternity needs are concerned, our little son was born on August 3rd. I completed the paperwork and uploaded it through the portal on August 4th. I think it was around the 15th when I was on the member portal going through everything. my wife was at the gold level, myself and our children at the silver level. I thought something like “well, this was baby #5. I think either (a) we’re done or (b) baby # is a few years away. #6″, so (because diapers are expensive!) I changed it to silver.
See also: More than Skin Deep? A Thrive Skin Review – Mom Does Reviews
It never crossed my mind that doing so would cause a cancellation of the current maternity need that I had just previously filed.
over the course of the next two months (I think it was mostly December), chm requested clarification on the details of the documents or requested additional items such as: – a message on the portal stating that the midwife needed to itemize the invoice , the part of the doulah birth attendant was not covered, etc. – a signed new comprehension checklist request – a signed updated hipaa
The last two requests were made just before Christmas. so in the end, i spent some time on the phone with chm, just to make sure you had everything you needed, including uploading and emailing both ways, so you had what you needed quickly.
fast-forwarding to this month, I received a denial letter that the need was disqualified due to my change in my wife’s membership.
Now I understand where you’re coming from and your position makes a lot of sense. but please also consider it from my perspective: I keep thinking, what if this had been a real hardship for our family or another member, to the extent of many thousands of dollars? I guess I’m appalled at how easy it was for me to make the change, and without any “are you sure you want to make this change” popup or warning message? and referring to their guidelines and what is at stake if you do. I would beg you to implement some sort of popup or warning message.
See also: Pros & Cons: Club Car Golf Carts vs. EZGO Golf Carts – WHEELZ Custom Carts
In light of the above, I ask that you consider restoring our need for motherhood to an active state. As a good faith gesture on my part, I would like to upgrade my wife back to gold and donate the difference between silver and gold for months after the upgrade.
thank you for your attention to this matter and your service to the body of christ.
sincerely…
I have attached our family photo and birth announcement.
——-
after several more weeks of waiting, chm reissued a final decision and rejection letter. They didn’t believe our explanation of not knowing the policy was enough and couldn’t set a precedent.
See also: The 11 Best Jogging Strollers of 2023 | Tested by Verywell Family
