Lily was born at 5:05 a.m. on Monday, August 10, 2009 at Mercy Gilbert Medical Center in Gilbert, Arizona. She weighed in at eight pounds one ounce and was 20.25 inches in length. From the very first time I saw Lily I was captivated by the light in her eyes. She is truly the light of my life and my husband’s.
My pregnancy with Lily had for the most part been quite uneventful… which in my opinion is the way-to-go. It wasn’t until I was 34 weeks pregnant and began experiencing pre-term labor that things got interesting. A trip to OB Triage, multiple shots and a prescription for medicines to stop uterine contractions along with prescribed bed rest were able to keep my labor at bay and give Lily the additional time she needed in the womb. When I began experiencing regular and painful contractions three weeks later (still pre-term) I found myself back at OB Triage.
When Lily eventually did arrive she was at an estimated 39 weeks gestation. I was admitted to the hospital on a Sunday evening and was already dilated to six centimeters. After receiving an epidural (one of the best decisions I’ve ever made) I progressed to ten centimeters and at my nurse and doctor’s direction began to push. After pushing for approximately one hour my doctor told me that she was concerned because Lily was starting to have non-reassuring heart tones. The doctor could feel the top of Lily’s head, but she wasn’t perking up. My doctor became concerned that Lily’s head was not going to fit through the birth canal and that even if she was able to deliver Lily’s head there was a possibility that Lily’s shoulders could get caught resulting in a “bum” arm. My doctor recommended that we proceed with a cesarean section because she felt it was medically necessary to ensure Lily’s safety. My husband and I agreed. When Lily was born she was in excellent health and scored a nine on both of her APGAR tests. She was born with a rather severe “cone head” as you can see in her early pictures. Luckily, I am happy to report that her head is continuing to transform into a normal shape.
Lily is a happy, healthy baby and I am blessed to be her mother. Everyone tells you how wonderful it is to hold your baby in your arms, but until you actually do, I don’t think you can really understand what an incredible miracle it is. When I think of what could have happened to Lily had I gone against my doctor’s recommendation and attempted to deliver vaginally, my heart sinks. The “what if” list is almost unimaginable. What if Lily’s head had become trapped in the birth canal and her oxygen had been cut off? What if she had suffered brain damage? What if she had been born with a dislocated or torn shoulder? What if she had ingested meconium? What if… What if… What if…?
Luckily those “what ifs” didn’t happen. I followed my doctor’s expert medical advice and did what any mother would do, I protected my child from possible harm. I had never intended to have a cesarean section. In fact, I really never considered it a possibility. I only skimmed over the “c-section” sections of the more than five pregnancy/labor/delivery books I read while pregnant with Lily. I even remember asking my doctor in the delivery room, “is this medically necessary? My insurance company will only cover a c-section if it is medically necessary.” My doctor’s response was “yes!” Little did I know, my doctor’s definition of “medical necessity” would differ from BCBSAZ’s.
The new “what if” I find myself asking is “what if I didn’t have to spend the first five months of Lily’s life appealing Blue Cross Blue Shield of Arizona?”
Within one month of Lily’s birth I received a notice from Blue Cross Blue Shield stating that the claims resulting from my cesarean section were being denied because maternity was not a benefit of my policy. At first I was confused, then I was shocked, then I thought there must be some misunderstanding. Only later did I realize that due to a change in the BCBSAZ definition of “complication of pregnancy”, fetal distress was no longer considered a complication of pregnancy. As a result of the change, my cesarean section was not considered medically necessary by BCBSAZ and the claims associated with the cesarean section would not be covered. It was then that I began down the long road of appealing the BCBSAZ decision.
In the months since Lily was born she has passed countless developmental milestones. She smiles, laughs, rolls over from her front to her back and her back to her front. She is reaching for toys, holding items in her hands and even likes to try to hold her own bottle. We regularly participate in a mother/child exercise group and enjoy reading books before bed time. Just before Christmas Lily started eating rice cereal and just recently has added bananas to her menu. My husband continues to work as a professional mobile DJ and go to school full-time at Arizona State University as an education major. I have been working full-time from home since Lily was just four weeks old. In addition to my own freelance business, I have spent more than 100 hours on the appeals related to Lily’s birth. I consider myself lucky to be able to spend as much time with Lily as I do… but the truth is, I should be able to spend more. I should be able to spend evenings and weekends with my husband and daughter and not with my computer writing letters and appealing claim denials. This experience has left a bitter taste in my mouth for insurance companies and the frustration I feel is at an all time high. My hope is that by sharing my story with as many people as possible I might actually be able to make a difference. I might actually be able to call attention to a real problem in our health care system… health insurance.
As for Lily… she is doing great and enjoying life to the fullest.