Insurance, insurance, insurance

Before my husband and I decided to try for our first child, I told him I wanted to do some research. I’m a bit of a planner, and I wanted to make sure that I was doing everything necessary to ensure a happy and healthy pregnancy. I read up online quite a bit, found a copy of “What to Expect Before You’re Expecting” for a dollar at the local thrift store, and talked to some of my friends who were already moms. It was about a three-month period of focusing on being a healthier and more educated me. Some of the these things included: Abstaining from alcohol, cutting down on my caffeine, going for a physical from my primary care physician, and scheduling a check-up appointment with my OB/GYN.

I should take a moment to tell you that up until a couple of years ago I didn’t have health insurance for many, many years. This was due largely to the fact that I was a freelance artist working from contract to contract, was overall generally healthy, and felt that at the time I couldn’t afford the expense of getting an independent health plan. A couple of years ago I had the opportunity to get insurance through my job at the Foundation that I work for. Then, in the last year I had a small raise (yay for me!) but this small raise just priced me out of the affordable health care plan that I had been a part of (boo!). So, I was in search of a new plan for small groups and found an affordable one for businesses with 2-50 employees—similar to the last plan I had been on. I found both a new PCP and a new OB/GYN through my new insurance, since the plan is such small potatoes—it’s fairly limited in providing options of who I can see for care. Trust me, all of this information is important.

So—I go to meet my OB/GYN for my pre-pregnancy checkup. And I’ll admit, I’m nervous. I feel almost like it’s a blind date. I’ve seen her picture online, but other than that I really don’t know much about her. She seems nice and approachable in her picture. I decide to hope for the best. We meet and she is great, really, really great. I feel like I have lucked out. We talk about my medical history, she approves the prenatal vitamins and Omega 3’s that my friend recommended to me, and she is super attentive. I leave feeling confident and ready to make a baby.

Fast forward a few months and I am back in my Dr.’s office with my husband to confirm the joyous news of our positive pregnancy test with her. I’m about 8 weeks at this point, she talks to us a little bit, does an internal sonogram, and confirms that everything is looking great. Huzzah! We of course have to do some lab work—routine blood tests and the like—but in addition she would like for me to schedule to have an NT Scan (Nuchal Translucency Screening) done between 11 and 14 weeks. She explains that it’s a non-invasive ultrasound that will be combined with some blood-work and will test for the possibility of likelihood of Down Syndrome and some other chromosomal abnormalities. When I see the receptionist she tells me that the hospital where I’ll be delivering at is also where I’ll be getting this test done. She also tells me to be sure to schedule my appointment early, as they fill up fast.

Now, I should tell you that I’m good at following directions. I’m a Virgo. I’m precise. I like to know what’s going on and I want to feel like I’m in control. So I do just what I’m told and call early on to make my appointment. In fact, I schedule my appointment for day 1 of my 11th week. When I call to schedule the test in the Fetal Evaluation Unit of the hospital, the woman on the phone asks what insurance I have. I tell her, it’s so and so, a subsidiary of this larger insurance. She is a bit confused but ends up saying, “Don’t worry about it—we’ll figure it out when you get here.” This should have been my first red flag. But, along with being a planner and a good organizer, I’m also very trusting both in people and the universe, and I just felt like—yeah, they’ll figure it out when I get there. Ok.

The day comes, I’m 11 weeks pregnant and my husband and I arrive at the hospital. We’ve never been here before and the lobby is beautiful. Wow! Definitely not like the hospitals from the small towns where we grew up. This is a Manhattan hospital. My goodness. We go up to the appropriate floor, we are promptly 20 minutes early (as advised by the person who scheduled our appointment) and we are ready to fill out all the necessary paperwork and have the ultrasound. We sit at a desk and a woman comes over to help us, and begins to hand us forms to fill out. She asks for my insurance card—I hand it to her—and she says without skipping a beat “I need a referral from your Primary Care Physician.” Uhhhhh, what? Shouldn’t a referral from my OB/GYN be enough? My PCP doesn’t even know that I’m pregnant. The woman behind the desk insists, and also says that my OB’s office should have told me. I sigh, use my husbands cell phone and begin the process of calling my PCP’s office to fax over a referral so I can get the test. While I’m on hold with my PCP’s office, the woman comes back again, apologizes and says “We don’t take your insurance, honey.” Ok, what?!? I’m in disbelief. This can’t be right. My OB takes my insurance, this hospital that she delivers at takes my insurance—so how is it that I’m sitting at a desk in this hospital right now being told that they don’t take my insurance? The woman tries to explain to me that the Fetal Evaluation Unit is on a separate billing from Labor and Delivery, and that about two months ago they stopped taking 3 smaller insurance policies and that mine was one of them. She apologizes and says there’s nothing they can do. In fact, they even make a copy of my insurance card (blocking out my name and number) so that others in the office will know that this is one of the newly “not accepted” policies.

I hold it together really well until Chad and I get to the elevators to go back down to the lobby, and then I start to get a little upset. I’m disappointed because I was excited about seeing the baby, and I’m frustrated because I’m trying so hard to do everything right, I’m hormonal, and this feels so unfair and so out of my control. We get back down to the lobby and I call my OB’s office to let them know what happened. The receptionist basically tells me that this is ridiculous, of course they take my insurance, to sit tight and she’ll call me back soon. We sit in the beautiful lobby and wait, and wait, and wait. An hour passes, I call my OB’s office back—she tells me they still haven’t heard from billing. Chad suggests we go for a walk. “Ok” I say and he leads me about 7 blocks uptown into a baby store where we look at small cute things and I feel a little bit better. Another hour has passed, I call back again. The receptionist says she still hasn’t heard anything—best to go on with my day and she’ll be in touch with me soon so I can reschedule the appointment.

Two days later I hear back—it’s true—the fetal evaluation unit of the hospital no longer takes my insurance, even though the rest of the hospital does. This seems crazy to me, but ok, this is what is happening—I’m trying to be accepting. My OB’s office tells me that they will find a new loca
tion for me to get the test that does take my insurance. A few more days go by and I’m in my OB’s office for my 12 week appointment. She says they are still working on it, but are having difficulty finding a location—perhaps I could help. And so begins what seems like an unending maddening slew of phone calls to both my insurance company and hospitals throughout NYC trying to find a place that I can get this routine test. Because, you see – it’s not just about this test (which is optional) but the 20 week anatomy scan and any other ultrasounds I may need. My Dr. is very insistent that we need to find a place. I make phone calls, I’m put on hold, I’m transferred, I’m put on hold, I’m transferred, I’m told no. I repeat. The whole time I’m thinking “This can’t be happening. I live in New York City. How is it possible that out of all the hospitals in the city no one will take my insurance to provide me with this ultrasound.”

The clock keeps ticking and at 13 weeks I get a call from my OB’s office telling me that my Dr. is going to call me tomorrow with some news. I once again hope for the best—well aware that at this point I only have a few days left that I could still get this NT Scan test done. The next day was my birthday. Chad and I go to the Bronx Zoo and walk around and look at all the cute animals. We are about to watch the penguins get fed when my Dr. calls. She tells me that they have found a hospital that takes my insurance that will give me the test. However, there’s a catch. “Of course there is” I thought. She explains to me that only Dr.’s who deliver at this hospital can refer their patients there to get the ultrasounds, and my Dr. does not deliver at this hospital. So my options are I either pay for this test and all future ones out of pocket, or switch Dr.’s to someone that delivers at this other hospital. I thank her, get off the phone, and cry in frustration. I like my Dr., I don’t want to have to switch, this feels so unfair. I feel stuck and out of control. Chad gives me a big hug, dries my tears, and we go watch the penguin feeding because it’s the end of the day on a Friday and what else can we do in that moment.

The weekend passes, and then Monday is a holiday, which does not help the situation. Time is passing and I realize that I probably won’t get to have this test. Tuesday morning first thing I call the one midwife on my insurance plan that delivers at this other hospital. I explain my situation to the receptionist and she books an appointment for me that Thursday. I call the new hospital and I confirm that yes, if this midwife refers me I can get the ultrasounds done there, and that yes they do take my insurance. Ok, things are starting to turn around.

Thursday comes and here I am again. On another blind date, in a new office, waiting to meet the new person who will be an integral part of my life for the next few months. Chad is with me, holds my hand and is the best supportive husband ever. It’s the end of the day, I’m the last appointment, which is how they were able to squeeze me in, and I can tell immediately when the midwife enters the examination room that the receptionist didn’t share my story with her. And so, I explain the tale from beginning to end. She listens. She understands. And she then insists that I try to get that test tomorrow, no ifs, ands, or buts, and that her receptionist will make an appointment for me right now. I ask “Isn’t it too late?” She said that yes, it might be but that she wanted them to look at me anyway, because maybe it isn’t too late. I left her office feeling a bit better and glad for an appointment the next day for the ultrasound I’d been trying so desperately for.

We arrived the next day at the new hospital and as I had thought, I was too far along for the ultrasound tech to perform the proper measurement to administer the test. However, it should be noted that they did see me, they did take my insurance, and they did tell me that my baby looked happy and healthy. Which really, is all we cared about anyways.

It’s been a few weeks since this incident and I’ve grown more and more fond of my new midwife. I do believe that things happen for a reason, and that clearly I’m supposed to be where I am now, but it was a bit of a bumpy road to get to this place. It’s interesting to me that out of all the books and articles that I’ve read and the pregnancy podcasts that I’ve listened to, I really haven’t heard anyone talking about insurance issues. It was something that I really didn’t think was going to be an issue for me at all. I just felt lucky to have insurance in the first place. Ironically soon after this ultrasound visit my insurance company sent me a book and a whole folder about their wellness program and support for mothers. Somehow I wasn’t on their radar before, even when I was calling so frequently trying to get answers.

The universe guides us in mysterious ways, opening some doors, closing others, and presenting us with a path to travel on the journey. I feel like I am in good hands and that the struggle of those few weeks was meant to be. I am relieved however, that this difficult time seems to be behind us, and now we can be concentrating on other things like remembering to drink enough water, get enough sleep (or at least try), and anticipate that exciting day when I’ll get to feel our baby really kick for the first time.