Due Date, Schmoo Date and Unethical Hospital Billing Shakedowns

Today was the cublette's due date. Tomorrow I begin Week 41. My OB/Gyn is Dr. Margaret Thompson, and I have utmost faith in her judgment to help me have a successful VBAC if there's any way at all for that to happen. I'll be delivering at North Austin Medical Center, which has a c-section rate of 30% - just a touch over the national average. Dr. Thompson's c-section rate is only 18%, god love her. At today's appointment we discussed my options and what our go-forward plan is. Basically, we treat this week like any other. We wait to see if anything changes. The cublette may have moved down a bit, but today there were no new developments. My cervix remains uneffaced, undilated, and way, way, way to the back of my body. Now, this doesn't mean that I couldn't go into labor at any moment and everything suddenly click into place. But it does mean that there aren't many things the doctor can do to help me get the ball rolling while my cervix remains so "unfavorable."

I clarified to her that although we went over my birth plan which could simply be summed up as "I'd like to have as natural a birth as possible", my number one goal was to avoid a repeat cesarian delivery because the recovery from the first one was so horriffic. She reminded me that it's possible that if I did have another c-section, that my recovery could be easier the second time around. Not wanting to sound like a negative-pants, I held the thought that, yeah, and it could be worse.

So, we wait patiently through this week. If nothing's going on by my appointment next week, we'll wait another week and start to monitor that everything's going okay with baby, and at the end of 42 weeks we start to try to get her moving. This could include breaking my waters, starting a pitocin drip, and anything else we can do to get her moving before finally going in to surgery. We don't want to start any of those steps now, because both of these measures put us on a path to surgical intervention if they don't work, so best to wait until we're staring at the likelihood of surgery anyway before we try them. My doctor understands that I mean to push her to the edge of her comfort level as far as trying everything and waiting as long as possible before we finally give up and head over to the OR, and she's willing to go for it.

On c-sections generally, CNN posted this helpful article last month on steps to take to avoid an unnecessary birth-by-surgery. The five steps are:

1. Don't get induced unless medically necessary (check)

2. Labor at home until you're approximately 3 centimeters dilated (check - I'll go for 5)

3. Choose your hospital, and your practitioner, carefully (check)

4. In the delivery room, ask questions if your practitioner says you need a C-section (check)

5. Get a doula (check)

The article goes into each of these points with helpful information. The scariest thing, though, is the statement from the Office on Women's Health at the U.S. Dept. of Health and Human Services, that "many experts think as many as half of all C-sections are unnecessary ...."

As to how NAMC will be treating my appearance for a VBAC, they will have me sign a form waiver advising me of the risks of VBAC that my doctor has warned me about, because apparently it reads like a "what the hell are you thinking even TRYING to deliver this baby vaginally" manifesto. Unfortunately there's no similar document for women who are going in for elective c-sections warning them of the risks of long-term pain, infection, respiratory complications to the baby, and even death.

The other thing that NAMC does, which I may oppose because I don't think they have a right to do this, is to collect on my entire remaining insurance deductible prior to discharge - before they have filed their claim with the insurance company giving them a right to these funds. Because other providers will have likely filed their claims ahead of the hospital (the hospital's own billing coordinator confirmed this for me), it's likely that some of that deductible will be allocated to the other providers whose claims are filed first. So I'll have to pay the other providers as well, and then go back to NAMC to get them to refund the monies paid to them in advance that they, in the end, did not have a right to.

This "deposit" on discharge thing is a new practice that apparently most hospitals are starting to adopt for their maternity patients. Which means there are no laws addressing the practice, whether it's lawful, how and when the hospital must file its claims with the insurance company, how quickly the hospital must refund monies that it required to be paid at discharge that weren't allocated to it by the insurance carrier in the final processing, or even requiring the hospital to present me with an itemized invoice showing me that the charges are even in excess of my remaining deductible at the time that they tell me I have to fork it all over (NAMC won't - I have to specifically ask for it, and then they'll get it to me at some point later - whenever it damn well suits them, I guess.). Do they really have a right to force me to pay without presentation of an invoice, and without having obtained an EOB (explanation of benefits) from my insurance provider confirming their right to these funds? I've been going along with them on this because I don't want to have any problems when we show up to deliver, but I'm seriously considering telling them to file their paperwork like every other provider and I'll happily pay them after my insurance company approves charges and confirms their right to however much of the deductible is left to them.


shares said...

Just happened upon your blog through a google search! How did you find out the c-section rate at NAMC? My doctor also delivers there, and I called NAMC until my face was blue, got transfered a million times, then finally got a "we don't know or can't release that information to you".

Liz said...

My OB/Gyn mentioned the c/s rate to me while we were going over our VBAC strategy at one of my many post-due-date appointments - I didn't realize it was secret information! Your doctor should also know NAMC's c/s rate, and hopefully can tell you what their own is, too.

good luck!