MW Referred Ultrasound Near Impossible (Rant, too)

[gratefulmum]

Why is this so difficult?
I was reduced to tears for a while today when I was denied my appointment for an ultrasound this morning. I have been calling around to places that are covered by my ins. and are close to me for weeks now searching for someone who will allow my LM to refer me to their facility for a now 24 week ultrasound. Everyone seems to need a referral from a doctor of some sort. And I am not incompetent or uninformed. I call facilities, I present the situation accurately, "No, she is not a doctor, she is however licensed by the state and approved by my insurance to be my preferred caregiver..." On and on and on with the details. At one facility I called twice, people checked with supervisors, I had the MW fax over the referral which they stated they would need, it's no problem, no problem, and then when it comes time to schedule the appt, "No. We need a Doctor." Okay. Fine I will call someone else. Same run through only they are confidant that this will not be a problem with the whole MW thing. They are however concerned about my insurance covering it. So I call ins. company and get a reference number to the phone call, get approval yada yada yada. I call the facility with the info and fax it over. The night before the appointment I get a confirmation call from the facility telling me how much water to drink before, etc. Then I show up today and it's, "Oh, no we tried to get in touch with you. We need a doctor to send the referral." "Did you get a confirmation phone call?" "Yes." "Oh, that is our fault we didn't say anything, sorry. ". Are you kidding me? Why do you think I go to such measures to check before the appointment? To ask educated questions and cross all my t's and dot all my i's.... Why are you all so incompetant?

Okay rant over. There is a facility that the MW has had luck with but it is an hour and half each direction and it is not covered by my insurance. I'm thinking that to save my sanity I should just go to them, though.

Is this normal? Does anyone have any bright ideas for me? I am not seeing an OB concurrently, I also do not have a personal physician, although I can get one. I actually called one who's office said she would take me on as a patient and refer for me, but I do not trust what any nurse or receptionist tells me at this point. I feel like I will wait for the appt and then she will say "Oh, no. I can only refer you to an O.B." Or, "I am not treating your pregnancy, I can't order an ultrasound." You know the drill.

Oh, and I am fine with no ultrasound, however my dh really wants one, and this is a decision I left up to him as I am stringent on most other decisions regarding childbirth. So it is even more frusterating because I am struggling so hard for something that I am only going along with. Ughhhh.

[AKmoose]

Hi...not to sound snide, but if it's your dh that wants one, why not let him deal with all the hassle? FWIW, I've never had an U/S, even with 2 CNM-based pregnancies. If you don't have a medical need for one, I'd say stop stressing and put the pressure on him As you are obviously aware, there's no need for one unless you are having a problem - in which case you'd probably be referred to a doc anyway, right? Good luck

[jessitron]

Yes, exactly! You have done far more than enough work to try to get an ultrasound just for his warm fuzzies. Let him find a place that'll do one, and how to pay for it. Be sure to give him the list of all the places you've already tried.

[gratefulmum]

You know AKmoose, I had thought of that earlier on in the process, but since I usually deal this sort of thing I just went ahead and tackled it. I did mention today when I was so upset that he could take over. He said fine no problem, but I need to write down all the terminology and details for him, as he is moderately clueless as to the insurance/referral world.

[charmander]

Maybe it's a state thing? Or just your insurance carrier?

My MW referred me for an ultrasound (I wanted one) and it was no problem.

[Jane]

Someone needs to get firm with them. Your midwife is a pregnancy provider, licensed by the state. She is a primary care provider for a pregnant woman. Ultrasound is care for pregnancy - considered the standard of care everywhere. They have no right to deny the ultrasound. I'm sure CNM's order ultrasounds in your state, as well. Ridiculous- I'm steamed on your behalf!
I need to come for an ultrasound to receive adequate care. Are you denying me adequate pre-natal care when it is covered by my insurance?

Thoughts:
We need a doctor. NO, YOU do not NEED a doctor. You need to schedule my appointment. Now, please. I'll hold for your supervisor if neccesary. What's your name, please?
Don't explain that she's a midwife over and over. Just say, "She is authorized to order an ultrasound."

[aylaanne]

Really, that runaround is incredible. I know I'm lucky to have a practice nearby that is friendly with my CPM (we don't license Lay Midwives in Massachusetts because we're backwards) and will do unofficial backup care for them.

Personally, I think that the Divine is attempting to send you a message regarding the necessity of this ultrasound, and that perhaps (if you believe) you may want to listen.

[feminist~mama]

That's just wild. Why on earth do they even care who referred you? Or if anyone did? How is it a problem for them to do an ultrasound -which they will say is absolutely harmless and not going to hurt anyone, ever- on a pregnant woman? Isn't that what they do all day long? And who are they to decide that your midwife's credentials aren't good enough?

Oy, I'd be annoyed too!

[Gray's Mommy]

Have you tried a crisis pregnancy center? I ended up with 3 sono's & that is where I had mine. I paid out of pocket, but it was worth every stinkin' penny.

[alegna]

Wow, what a pain. We're lucky- there's an independent u/s tech in town who works with all the midwives. Easy to get in and only $150. You pay out of pocket though and then see if your insurance can reimburse, but it's easy to set up.

-Angela

[DoomaYula]

Are you anywhere near Mexico? You can get one done there, very easily, very cheap, and usually very thorough. You just need someone to translate it.

[Cadence]

OMG- the EXACT same thing happened to me! Are you in California??

I was also getting an U/S mostly for my husband, and started trying to schedule it around 19 weeks- didn't actually get the U/S until 25 weeks or so. I don't advocate what I did- it did not feel right, but after being turned down so many places, I got a bit freak-ish.

Once the direct U/S connections (hospital and private freestanding) turned down the MWs referral, I called OBs covered by my insurance to set up a consult. 2 out of the 3 covered OBs would NOT consult with a patient of a LM who intends a homebirth. Is this not crazy??? What if it were something more drastic? Anyway, with my last OB option, who was the most natural birth friendly (in practice with CNMs), I pretty much lied- not outright, but was more evasive than I like to be. I faked that I wanted co-managed care, had all my records sent from my MW (she knew what I was doing), and explained the situation. The OB did not agree right away to co-manage, but called me later that week to agree, and ordered the ultrasound (and a GTT, which I did not do). But- when I showed up for my appt., with a full bladder- no order had been faxed! Luckily, they did end up faxing down after a phone call, but I really thought it wasn't going to go.

Anyway, I never set up a follow-up appt, and they didn't call me for one until 6 weeks later. I just "forgot" to call them back. I feel really silly over the whole thing, since I did not need the U/S for any medical reason, and it's possible that I've just burned a bridge with that OBs office- but I'm not going to worry about it anymore. Now we figure if we need anything else as the end nears, we'll just go in through the ER (assuming it's some medical problem). The whole thing was WAY more traumatic than it should have been- and I totally feel your pain!!

If your dh will take over- just let him!! It's so silly to have to jump through so many hoops for one test.

I hope it all works out, and best wishes to you and your family!!

Be well,

Candace

[feminist~mama]

So your LM doesn't have an MD that she has a friendly relationship with who would order the test for her/you?

Just wondering...

[ebony_vbac]

i had the same problems. i called all these places in my town and they said they couldnt do ultrasounds without a doctor ordering it. i said what if i pay out of pocket, they said no. i never called my family doc to see what he could do for me though. he's very supportive of homebirths, his wife is a cnm at the birthcenter and 3/4 of his babies were born at home. anyway my mw found a place 2 hours away and i went there and they would not give me an official bill to send to my insurance and they would not tell me anything other than the sex of the baby, no measuring of fluid or organs or size, i had to ask her 3 times where my placenta was and she didnt want to tell me it sucked and wasnt worth the hassel. if you dont need an us dont get it. tell dh to buy an us machine and he can do it himself

[2+twins]

I was able to get one by calling this independant place, setting up the appt., then giving them the name of my OB (they looked this info up online) - however, my OB did not order the test and didn't even know I was pg. I was working with a homebirth mw who's name I needed to keep off the u/s records. So it was actually very easy. I got a call from my OB after that (b/c the u/s company sent my records over - I tried to get them to just give them to me (they did give me a copy) that I could bring to the OB but they said they had to send it to her), I assume to tell me I had twins in there. I have caller ID & knew it was her so I just pretended not to be me and then never returned her call. So maybe you could do something like that?

[gratefulmum]

Wow, thank you for all the great ideas. And yes, I do live in California. We are progressive enough enough to license midwives and state that they are fully competent to manage our pregnancy and then this. Amazing.
The crisis pregnancy center is a good idea, I never would have thought of that. My MW has a few different doctors who she consults with should there be something out of the ordinary, but for this type of a thing they stay out.
I finally called her for advice because I couldn't take it anymore. She sympathized and said that the best thing to do is to call the center 90 minutes away and schedule with them. Instead of argueing with centers that clearly have no idea what they are talking about I called my insurance co. one last time. Luckily, I got one of the informative representatives. (Isn't it odd how some of them have no clue what's going on and some seem to have written the benefits book ) I was hoping that since the MW is covered as a preferred provider, then the only imaging center that will take her referral would also be. No, but she did say that they would reimburse me 50% and the other 50% would go towards our deductible. That's good since I just want to hurry up and meet this darn deductible since we will with the HB, anyway. All in all it will only cost us $75 out of pocket.
I totally hear you all on the "perhaps it isn't meant to be," thought process. And believe me, I did consider it. It's just that I had to really push for the HB as it is and I feel like if I make nothing go dh's way, then he will start to resent that. Like, we didn't get an u/s b/c of the hb. We're still going to cross the line on things like circumsicion, which I will not do, and would rather save my steam for that. KWIM?
Great out of the box ideas Moms, hopefully it will be helpful to another thread searcher in future.

[DreamsInDigital]

My CPM referred me for an ultrasound and I didn't have any problems either. I paid out of pocket though.

[HeatherB]

The other option I've heard of is u/s schools. I think there must be one around here because I'm pretty sure some friends of mine have gotten free u/s when they needed moms to come in.

I, personally, have gone through the independent tech here in town that alegna referred to. We've had to drive a good distance both times, but to be able to just call her, say, "Hey, I want an u/s. Where and when?" has been great! I know she takes a machine to some mw's offices, besides working in a number of ob's offices where you can go and see her without going through the ob. We even got a DVD this time, at no extra charge! Plus lots of pics.

Anyhow, it's surprising that there aren't more of that sort of tech around, since this particular one is used by so many offices. Maybe the yellow pages for Ultrasound Tech?

Let us know how the visit at this clinic goes! Hope it's all worth it for you!!

[~Megan~]

Do you have a primary care physician? If so have them call it in for you.