Anyone ever done shadow care with Kaiser HMO?

[msmiranda]

I recently switched insurance to Kaiser Permanente HMO -- meaning that I see their doctors for OB care at their facility. I haven't been yet -- and I'm not pregnant yet, so I have a lot of time to think about this stuff -- but I am wondering if anyone out there has used Kaiser for their prenatal care and then had a home birth. Here are my questions:

- Because it is not a private practice in the traditional sense, could they drop you if they knew you were planning a homebirth or would they have to continue your prenatal care? Since they are my "only choice" in terms of doctors, they could not refer me to anyone covered by my insurance, therefore would the 30 day rule apply? I would think they are not allowed to drop patients the way a doctor in a traditional private practice can -- anyone know?

- In a general way, would it be better for me just to use them as shadow care for ultrasounds, testing, etc. and then not show up for the birth? I will be paying out of pocket for my midwife. Last time I tried to do shadow care and then I stopped going after 34 weeks because I found it too stressful. I would prefer to be honest, but I don't know how Kaiser feels about liability issues. You would think that as a large organization they wouldn't be as concerned as a physician in a small practice, since I imagine that they get a pretty good deal on malpractice insurance because they are so huge.

- If I was honest about my plans and they didn't like it but weren't allowed to drop me, they would probably just lay on the dead baby stuff at every appointment, right? (Ok, I am prejudiced against OBs. So I dream up nightmare scenarios in my head and the whole thing stresses me out even though I'm not even pregnant yet).

Here's my thing: I know I will have a homebirth if I can ... but in the back of my head I think, what if I end up with a breech baby? what if I develop pre-e? what if I have placenta previa? in situations like that (I might consider breech at home, but I might not ... not sure now) I would like to have developed a relationship with someone and not be treated like a pariah at the hospital if I needed to avail myself of their services. Obviously if I had an emergent transfer there would be no avoiding that, but in the case of a complication that developed before labor ... then I think, is the likelihood of that too small to justify the hassle of shadow care? aaarrrrgggghhhh ... I think about this too much! Any wise words?

[St. Margaret]

I have an HMO and there is one practice my medical group refers to (and PCP, med grp, and hospital are all Scripps), so I'm sort of in the same boat. I've interviewed HB midwives and one said I would just transfer care at 36 wks, but I'm with you... I want my established relationship to keep going and to just call after the birth and let them know! Just in case something developed where I needed them (and with this pregancy, enough has gone wrong that I'm no longer happy to bet that it won't!). I'm still working out how I'm going to handle it... but I do know I won't be saying anything to my OB/CNM practice until MUCH later, no matter what. I figure we'll all have a better sense of things by then-- I'll know if my sciatica has cleared up, I might have a better sense of the CNM and she might also with me-- to the point where I feel comfortable talking about it ahead of time and just saying what my plans are, but not terminating my official relationship as established with them. It really does matter-- my physical therapist, who works for the Scripps system and has that insurance, was billed for a birth where she came to the ER with the baby's head coming out and a doc saw her for one push, and then she went to materinity-- and that particular doc didn't contract with Scripps. She had to fight it. So having established care is key for me

Looking forward to BTDT responses!

[smpayne]

If the Kaiser where you are works anything like the Kaiser here, I wouldn't even worry about it. Most of the time you will see a nurse practicioner and not a doctor, even if your labled as mildly high risk. The hospital staff isn't usually the same people you see during your pregnancy.

The Kaiser here has the lowest C-section rate, highest VBAC rate and highest breastfeeding rate of all the OC hospitals. We even had a lactaion consultant on the hospital staff, she was there 3 days a week and her clinics were all covered under the HMO.

[msmiranda]

Originally Posted by smpayne

If the Kaiser where you are works anything like the Kaiser here, I wouldn't even worry about it. Most of the time you will see a nurse practicioner and not a doctor, even if your labled as mildly high risk. The hospital staff isn't usually the same people you see during your pregnancy.

The Kaiser here has the lowest C-section rate, highest VBAC rate and highest breastfeeding rate of all the OC hospitals. We even had a lactaion consultant on the hospital staff, she was there 3 days a week and her clinics were all covered under the HMO.

I suspected that Kaiser might have lower C-section rates than private practices, since they are both the insurer and the provider, but I wasn't sure. All that is good to know!

[GOPLawyer]

It is my understanding that the east coast Kaiser and the west coast Kaiser are *very* different.

I went through my 2nd pregnancy & birth w/ Kaiser in NoVa and *HATED* it. Just about every.single.solitary.second of it. I actually cancelled all appointments after 37 weeks as I didn't want to deal w/ the stress. They are *very* medically oriented...completely non-crunchy. For example, I was going for a VBAC and when I met w/ a CNM, the first thing out of her mouth was, "Why don't you just schedule a c/s?" When I mentioned that I was going to a chiro a doctor actually said that it was just a bunch of hocus pocus.

I *strongly* recommend NOT mentioning homebirth at all. Not even a peep. I'm not 100% sure but I don't think that Kaiser can drop you; however, they can make appointments very hellish.

WRT breech...there are CPMs in the area that are experienced w/ breech babies. I know of one who definitely attends them and I think there's another. My wonderful, awesome, amazing CPM (I'd be happy to send you her name) just brought in the 1st CPM I mentioned if the baby ended up being breech. Breech babies can definitely be safely born at home. :-)

[msmiranda]

Wow, GOP Lawyer ... I am in your area, and yikes. So disappointed to hear they are so backwards. PMd you to talk further.

[Monarchgrrl]

I'm on the west coast, so I don't know if it's the same, but I have Kaiser HMO and it's been easy-peasy. My OB knows I'm having a home birth and she wishes I would come in more than just for a couple of ultrasounds, but she's cool with it. I'm not going in for regular prenatal appts or checks or anything. The only reason I'm even doing shadow care (if you can call it that in my situation) is for the free/cheap tests and ultrasounds. Personally, I wouldn't do it if I didn't tell them my real plans. I'm not ok with having to do prenatal appts with both practices and lying to one. But if that works for some, then that's cool.

They can't drop you. I can go in for any tests that I want and use them whenever, for whatever the midwife wants. I'm paying totally out of pocket for the midwife, but at least whatever blood tests and ultrasounds I get are free or my usual copay. It's great! If I have to transfer to the hospital for any reason, then I just show up. It's not likely I'd get my OB on call anyway. My midwife would go with us to the hospital for any reason and stay with me/us the whole time, so I'm not worried about being treated like a pariah by the staff. DW is very strong and wouldn't allow that anyway.

Good luck!!

[nia82]

I dont think Kaiser can fire you at all, cause they will not pay for any other doctor... So you can either tell or not, whatever makes you feel better or might be less stress for you.
You can refuse whatever and they still can't do anything about it... I started with Kaiser in CA and switched at 16 weeks since my insurance changed. The private obgyn practice was way more pushy and annoying. At Kaiser I saw them for 5 minutes, nothing fancy or good, but I'd say I don't want this and done. Granted, that wasn't like refusing the GD testing or such, but you will be fine still since there is no way they can fire you.

[cristeen]

Also w Kaiser in CA. For my first pg, i didnt tell them. I refused whatever tests i didnt want and when i refused the GTT, the NP "fired" me and i had to be referred to a perinatologist. They did use scare tactics, but backed off when i said it wasnt open for discussion.

For my 2nd, i was up front about it. Nobody said boo. I saw a peri once to discuss my care, and the rest of the pg just left him messages asking for this test or that paperwork. Never had a problem.