So, I don't really know what to think. I called the doctor's office during my lunch break today. Called the billing department at my 1st break. Over all, not a very pleasant day.
The billing department said that the insurance has "changed their mind" (my words, not theirs) and my deductible is actually $3000 instead of the $1500 they had originally quoted to the office. So my OB estimate actually ended up going up by around $300. So that was lovely.
Then at my lunch break I called and spoke with Dr. Casal, the OB.
I asked him why I was told that there wasn't enough variance in the heart rate and then that there was too much movement. He said that the variance is to make sure that "baby is still happy" and responds to stimulus basically. The too much movement was because of all the extra fluid, the baby has more room to move so it's harder to keep track of the heart rate to be able to see if it is getting the variance/response to stimulus which is what they're looking for. So that's how there can be not enough variance and too much movement.
He again mentioned the fluid could be an indication of diabetes but my test came back good. So that wasn't the concern. He also mentioned that the extra fluid makes the uterus distend more which can cause the body to think that the pregnancy is more advanced than it actually is and increase the risk of preterm labor. He said each week that goes on that risk is lowered (duh, because each week is closer to term. But it also seems weird because I thought it was hormonal that triggered labor, not size)
He told me that everything still looks good and I'm still a candidate for the birth center. Basically the monitoring is to ensure I stay low risk so I can use the birth center.
I told him that I didn't think it was good to have all the extra tests because the insurance doesn't seem to be covering it. He says tat they have to cover it because it's medically necessary and if it isn't covering it, let them know and they'll fight the insurance company for me. However if the problem is just that I have a high deductible they can't do anything about that.
I don't know... Rob and I haven't had a chance to really talk about it because he was busy when I called him right after talking with the doctor's office.
I've had it posed to me if I will continue to allow additional testing. Honestly, while I know that technically I do "have a choice" if I want to continue to be a candidate for the birth center, I don't know that I DO have a choice. If they are presenting the extra testing as ensuring I continue to be "low risk" then if I don't consent to the testing for "proof" of being low risk, I'm afraid that I'll automatically be considered "high risk" and not be given the option. The doctor did ask me if I still wanted to use the birth center. I said that I definitely did, but I was concerned that the extra testing is going to make something out of nothing. He said he understood my concern, however, at this time, everything still looks fine and he would be the first to tell me if something changes. He also said that while in most cases extra fluid isn't a problem, it wouldn't be responsible of them to just ignore it on the off chance that there IS a problem they want to be able to catch it.
I just really don't know.
Yes, you have a choice, but you are right that the real choice is not whether to take the tests or not, but whether to use the birthing center or not. If you want to use the birthing center, then the tests are a must. If you don't want to take the tests, then the hospital delivery room will have to do.
ReplyDeleteThe doctor has found something that could be a problem at the birthing center. He has to make sure it is not a problem before he can agree to the birthing center. For him to do anything else risks a malpractice suit if something goes wrong (possibly from the insurance company who may be out more $ in that case). The insurance company could rule that the tests are a medical necessity only if you wish to use the birthing center - or not really medically necessary at all, if you were going to a hospital. The insurance company is a business and certainly can expect you to take the least expensive route.
Possibly a discussion with your insurance company might help, although even then a phone conversation is not the equivalent of a review board by the medical examiners at the insurance company.
Not sure why you chose the birthing center, but if lower cost was the reason, the balance scale may have changed. If there are other reasons, the question may be is the birthing center still desirable at what may be a higher cost.
As a point of comparison, when you were born our out of pocket expenses were right at $5,000. 28 years ago that represented a lot - several months (3, 4, ?) total household income. It took years to get it paid off working it in around regular monthly expenses. And, that was a standard hospital delivery, although you did have extra jaundice treatments. The cost was what it was and we didn't think too much about it, except to be grateful your younger siblings cost less out of pocket with different insurance coverages. On the other hand, I am pretty sure we paid way more per month with those later policies than we did when you were born.
The birth center was my choice for less medical intervention and less push to have "doctor things" happen. I had no idea what the difference in cost would be.
DeleteI guess another side to birth center vs hospital is that apparently hospitals don't require the money up front, where as the birth center expects it to be paid by 36 weeks. What happens if it isn't all paid by 36 weeks I don't really know. But we may end up finding out.