lay miwives~ questions about labs/newborn screening/birth certificates

[rajahkat]

I am in Oregon, so if you are practicing in Oregon, all the better. What do you do about providing lab testing? STDs, hemoglobin, Hep B, blood type, etc etc? And do you know of labs who will provide services to unlicensed midwives?

Since I'm considering practicing without a license, I can't bill clients insurance. I'm thinking it might be helpful to those clients to order tests (like through Quest Diagnostics) and have them go to a clinic for lab tests that their insurance will pay for instead of doing the tests myself and then sending them to the lab......

I'm just curious if anyone has any advice, experience etc. I've contacted Quest because that's the one lab I know of. But I'd love info from other midwives as to what works for them.

Also~ A question about registering births in OR as a lay midwife~ I've gone over the oregon.gov site and it says that lay midwives can register births if they are registered with the vital records department, but no word on HOW to get registered with the vital records department. I've contacted them too, but again, I'd love to hear from someone who has done/is doing it.

AND~ on the newborn metabolic screening kit order form there is a provider code # to fill in. What's the process if you are a lay midwife and don't have a provider code. I THINK a lay midwife can do the metabolic screening....am I wrong? I know you can't use oxygen, iv's, drugs, etc, but the metabolic screening is okay, yes?

Kat

[Reha]

I can't answer all of your questions, as I am apprenticing with a licensed midwife.

But, I'll throw what I know out there.

I do know that (some) unlicensed midwives do indeed bill (private) insurance, and while they are usually denied, occasionally they are paid. One midwife I know says that about 50% of the time she is paid! So, it is still worth trying.

As far as labs, my understanding is that some insurance companies will not cover any tests ordered by a provider that they do not pay, even if the labs you order are something they would normal cover. Sometimes, of course, they do cover them, but imo, it would seem no different to the insurance company whether or not you draw the blood or the lab does it. The lab will be doing the insurance billing either way, and if the insurance company turns out to NOT cover the test, then at least you have saved your client $25 or so by drawing the blood (or whatever) yourself. Does that make sense?

We recently just started using our local hospital lab, because Quest's customer service is horrible (in Salem, at least). The hospital lab, surprisingly, is very nice and very fast. I don't know if that would be a possibility for you or not, though. Probably depends on the hospital.

As far as registering for birth certificates, I'm not too sure myself. My preceptor recently has had me just start signing the b.c. myself, as a DEM, thinking that vital records would contact me to get all of my information. So far, I haven't heard anything from them, though it hasn't been 6 months yet, so we'll see.

As far as th metabolic screening, just give the lab a call. I bet they can set you up with a code. I know that the state is VERY determined about getting as many babies screened as possible, so I don't think they would exclude you from doing them.

[rajahkat]

Thanks Lennon.

Yes, the midwife I've been apprenticing with is unlicensed and a bit.....well, unorthodox. She seems to get in the backdoor with many things by asking her friends who are licensed to order tests, ultrasounds, get her drugs etc. So her way of doing things doesn't necessarily help me much.

As to registering births. I don't know if it will help you any, but I contacted Kelly Paige (she's the field liason for vital records) and she got back to me super fast. She's sending out a packet of info with an application to be registered with vital records.

Kat

[mountainmidwife]

I can try to help. I am a lay midwife in Kansas. Here is kansas we are unregulated so we may be a bit different. As for blood tests. I know a CNM that will order tests for me, same with ultrasounds. One thing you can think about with ultrasounds (if you have a client that wants one) is using a 3D/4D ultrasound place. They are technically not a diagnostic ultrasound but, the technician is trained to do diagnostic ultrasounds and can/will see anything abnormal and will refer to a doctor if need be. Blood typing...you should consider using the Eldon card at birth, they are really cheap. With the PKU test you can order those from the state. They usually assign you a number and put your personal bar code on the card. When you call to register with them ask them about the PKU cards.

[pamamidwife]

Do you need the number for the Newborn Screening lab? LIcensed or not, you can order cards and provide this service to your clients. IT's up to you whether or not you'll pay for the cards up front and have your clients reimburse you or you'll have your clients order it with your provider number (they'll give that to you when you sign on).

Because licensure is voluntary in Oregon, I've never assumed that my license would allow me priveleges with a lab or radiology clinic. I know even before I was licensed, I had set up an account with the lab service and with a good radiology clinic for ultrasounds.

I think the key is this: you approach it like you're entitled to this service (which you are). YOu make contacts, you get the requisition forms, you move on. It really is super easy - and getting intimidated only conveys that somehow you aren't allowed to do these things.

With a couple sonogram clinics, I just faxed over a letter stating I'd like to order and ultrasound for such and such patient, this is the reason why (size/dates/gross abnormalities for the mid-preg screening usually), my contact information, my signature along with the patient's information.

If you haven't already gotten an NPI number, you should consider getting one now. This is a common number used for all healthcare providers and will help if the lab or other facility wants one. https://nppes.cms.hhs.gov/NPPES/Stat...tatic.npistart

I've never been asked if I was licensed when doing any of these things. Heck, they always assume I"m a doctor and call my cell asking for "Dr Powell" - which is why they get confused when I don't answer the phone with anything but "hi" and there are kids screaming in the background!!

If you'd like more info, I can totally help you.

I'd also like to respectfully disagree about the Eldoncards. They are inaccurate and people should use two, if not three, to ensure results. Getting cord blood typed at a lab is fast, cheap and accurate. Not to mention that if you need to get Rhogam from a doc or other HCP, you're likely going to need a lab result stating both mother and baby's blood type.

(then again, if Eldoncards are your only source for typing, they're better than nothing, I just don't trust them to do only one for an issue like Rh sensitivity)

[rajahkat]

I do know the Eldon cards are notoriously inaccurate which is why I planned to do lab testing for blood typing unless for some reason the mother really preferred a finger stick to drawing more blood.

I just came across the NPI suggestion yesterday, and did apply for a number. Thanks for mentioning it, Pam. And I'm sure I can hunt down the number for the Newborn Screening Lab.

Thanks for the advice and encouragement, ladies.

Kat