Tuesday, March 6, 2012

No luck at the doctor's office

So, we finally have health insurance! The midwives encouraged me to go see a doctor right away to get some bloodwork done. I also needed to find a doctor who was willing to give me the Rhogam shot after birth. (For those who don't know, this is because I have Rh- blood and my babies will all have a good chance of being positive. The Rhogam shot keeps me from forming Rh antibodies which would attack my future children. So, kind of important!) I have to receive it within 48 hours of birth, so I wanted to find a doctor well ahead of time who would be willing to have it standing by for me at his office.

The third thing I wanted to see the doctor for is a referral for my insurance. I found out recently that my insurance may actually pay some or all of the midwives' fee! Since it's a lot of money for us, I leaped at that possibility. A call to my insurance company informed me that it will be a little difficult to get the midwives covered. I need an exemption because they are out-of-network. But, I should be able to get one! However, I can't request it myself. My primary care provider has to call the insurance company with all the midwives' information and request it for me. That sounded awfully complicated, but I carefully collected all the instructions the doctor would need and made an appointment.

Going to see the doctor on a weekday is a big deal for me. First, I had to drive John to work -- 45 minutes there, 45 minutes back. And then do that again to pick him up. That's what I have to do every time I need the car. I also decided to get a babysitter for Marko because I couldn't imagine wrangling him in a tiny consulting room while also discussing the ins and outs of my health insurance. I also had to arrive half an hour early because I'm a new patient -- so that the total time I was gone was an hour and a half, for what I thought could have been a fifteen-minute appointment.

The senior partner who was recommended to me is apparently hard to get in to see, so I was scheduled with a younger doctor, a very nice D.O. She kept me waiting for 20 minutes (sigh) but she was very friendly and actually took her time with me, so that was good. But when I told her all the things I needed, she kind of puckered her forehead. "I don't know if we can do that," she said. "We don't do backup care for homebirths."

"I don't want backup care," I said. "I just want a blood draw, a Rhogam shot, and this referral. I'm not looking for prenatal care. I'm just coming to my primary care provider for some primary-care stuff."

She looked kind of doubtful and said she would have to ask the higher-ups in the practice. She left for quite some time (leaving me a chance to read Diabetes Monthly and a horror story on the bulletin board intended to convince me to get the flu shot -- I had already finished American Baby (and planned several letters to the editor of that magazine -- it is full of misinformation) while waiting for her to come in the first time). When she came back, she was disappointed. She had hoped they could do something for me, but sadly, they could not. A blood draw and a Rhogam shot are both prenatal care. They only give prenatal care as a package deal -- all or nothing. And if I got my prenatal care with them, I would have to deliver with them or another doctor they approved. Otherwise they would be assuming liability for my homebirth and they couldn't do that.

And as for the referral -- no way. Referring me to a midwife would imply that they approved of my going to a midwife, which would imply that they were taking on responsibility, which means -- more liability.

The doctor also told me she wasn't sure I could find any doctor anywhere who would do what I wanted. I only hope she is wrong about that. She advised that if I can't find another doctor to do the Rhogam, to show up in the emergency room after the birth, and they will have to give it to me. Which I suppose is an option, though hardly my favorite.

It's annoying to be healthy as a horse and yet have this crazy medical condition that requires nothing but a simple shot -- but a shot which must be prescribed by a physician and administered by a nurse, no exceptions. And no physician wants to take on the liability of treating me for this simple condition ... because, to them, pregnancy is the disease, not Rh incompatibility. Whereas I believe that pregnancy isn't an illness and I don't need a doctor for it -- I need a doctor for the actual medical condition I do have.

The insurance part is even more annoying. The insurance company would rather pay $10,000 plus to a doctor than $3000 to a midwife. And to get them to pay a midwife, I have to get a doctor who will refer me to one -- but since there is absolutely nothing in it for the doctor, and it would be, in effect, referring me to their competition, I just don't see why a doctor would agree to that.

Really, the only answer to all of this is to change my primary care provider to someone else and do this whole runaround again. And again, if necessary. The driving, the babysitter, the hassle, the copay -- just to speak with a doctor, who might turn me down. If it were just the insurance money, I'd be tempted to give up. (Though don't get me wrong -- we could really, really use the money. Especially since this insurance is really freaking expensive and more than we can afford ... it would be nice to recoup some of the money we're paying for it.) But since it's a question of the health and safety of my future children, I have to try my best to find a doctor who I can be quite sure will care for me.

Being "alternative" in any way is rough. I've already been "let go" by one pediatrician by our unwillingness to vaccinate on schedule. Apparently the way of the medical field nowadays is just to refuse to treat you unless you do everything their way. It just isn't fair.


Sarah Faith said...

I thought midwives could do Rhogam??

Jeanette said...

I am a nurse practitioner. Here in Washington state a CNM can administer Rhogam and lay midwifes cannot. The regulations vary from state to state. I am surprised that if your midwife is unable to provide such common services to her patients that she does not have another health care provider that she partners with to refer them to. Have you tried any nurse practitioner based practices? I think you may have better luck, although I am biased :-) We are trained in a nursing model of holistic health promotion rather than the disease and intervention based medical model most doctors are trained in. I wish we lived in the same state, I would be happy to help you.

Jeanette said...

I forgot to mention in my first comment, I completely agree with you about American Baby. I don't even bother to look through it any more. I am perpetually annoyed by all the misinformation they print. Unfortunately, a lot of parents are not as well informed as you and believe anything they read in a parenting magazine. I wish they would be more responsible about verifying the accuracy of their content. Okay, stepping down from my soapbox now. Good luck in getting the blood draw and rhogam situation resolved!

Momsomniac said...

I don't know if they can assist at all, but you may want to ask these folks for a name in your area as far as getting the blood draw and shot go. They may have some info:

My friend Danielle Preston (you can find her on the web) teaches the Bradley method. I wish I'd known her before I had son 1. I probably still would have ended up in the hospital, what with my super duper advance maternal age and all ; ), but I'd have had more control.

My real name is Dianne, by the way. Though Danielle will know who I am, the folks near you will not.

Best of luck with this!

Sheila said...

My midwives are certified professional midwives. Since they're not nurses, they can't prescribe Rhogam. They do know some CNM's who would be able to give it to me ... an hour away. I'm hoping for something a little simpler, considering I would have to drive all the way out there the day after giving birth!

Jeanette, there are definitely a lot of great midwives in Washington! My mom's were fabulous. The laws are pretty good there, I think.

The particular issue I had with this American Baby was their article on when to give up various habits like bottles and binkies. For giving up nursing, it said, "Anytime after six months. The AAP recommends exclusive breastfeeding up to six months, but after that, it's your call." Not mentioning that the AAP recommends six more months of nursing along with complementary solid foods. It was next-door neighbor to an outright lie to cite the AAP like that, implying that the AAP recommends weaning at six months, which it doesn't.

I might try them, Momsomniac. I also have a recommendation for an osteopath I may go see. Those are handy -- they ARE real doctors, and so can prescribe things and so on, but they tend to be more naturally minded ... or so I hear. At any rate my friend's osteopath is supposed to be very good.

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