Don't know if I trust my OB (long) - Mothering Forums

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Old 12-17-2010, 07:49 PM - Thread Starter
 
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Okay, I'm 12 weeks along with #2 after a totally fabulous pregnancy and natural delivery of DD. Healthy me, no risk factors, saw all CNMs with #1, etc. I hired a doula before I even called CNM or OBs! Want a natural birth, prefer the local birth center but I had understood that they didn't take my insurance (yesterday ins. said that they pay birth centers and that previous issues must have been due to poor billing codes - yay!) We are on military Tricare insurance which can be a bit...traditional? As in 1960s traditional, not earth mama traditional. DH is supportive of natural everything but wants major proximity to a hospital. Like preferably down the hall. :)

 

So our doula recommended several local OBs who are on board with natural mamas doing their thing and not interventioning us to death. First appt with one (one of 4 female OBs at the practice, all who are supposedly supportive) was sched. for yesterday. I got the appt. time wrong and we arrive 20 minutes late. The OB only has time to chat for a few minute before she has to get across town to the other hospital. I don't really have any pressing questions; ask for support hose rx, and as we leave, she hands me paperwork for blood work (only had a + urine test at my primary care doc at 5 weeks), including genetic screening (CF and two other ethnic-allied ones) and an ultrasound (I wasn't interested in doppler or an u/s). I tell her that my ins. does not cover 1st trimester ultrasounds and they are all kinda shocked: 

"Well, how do they expect us to diagnose pregnancy?"

"Well, with my first, they do a blood test..."

"But that doesn't rule out ectopic pregnancies!"

"...and a vaginal/external exam to confirm physical symptoms" 

"Well, we can't treat you (maybe they didn't say treat) without confirming the pregnancy!"

"Uhh, I'll call the insurance to double-check."

 

We call, and turns out Tricare doesn't cover ANY u/s. Including the 19-20w big one. Which we had the first time around because we were at a military medical center. Fine, we can cross that bridge in a few months when it's time to count heart chambers and compare limb length. I think the 19-20 is pretty freaking important and we'll pay out of pocket if we can't finagle a billing code.

 

Anyway, so they re-code it as high risk so Tricare will approve it. FIne. But I'm starting to wonder if this is the right place for me. The real appt is resched for Monday (13w), so I'll get a better vibe then and actual answers to my care & birth questions. But I looked up ectopic info, and I have zero symptoms, zero risk factors, and the risk is basically nil after 12w anyway. And I clearly have a nice normal uterine swell. So I'm not feeling so warm and fuzzy there. And I don't really want to "waste" my potential only insurance finagling to get this first u/s which I don't need. Also, insurance definitely doesn't cover genetic screening with no risk factors, which I'm glad I asked them about on the phone.

 

So are they pushing every $$$ option on me or just being cautious? Am I so skewed from a hands-off military approach that this feels a bit weird? I'm worried because at 13w and with Christmas then a vacation to Hawaii and a business trip taking us until 17w, there isn't much time to try to meet a new doc and see if they're a better fit! The "best" midwife around would need to get approved by insurance, which may or may not happen before I'm due. Input welcome!

 

Thanks,

Lindsay

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Old 12-17-2010, 08:04 PM
 
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If it were me, I would find someone else. They don't at all seem interested in what you want and what you do and don't approve of, much less the insurance.  Also, I would not be cared for as high risk for worry that it might affect later pregnancies and how you are dealt with with those.  There has to be a better alternative....and I wouldn't worry about taking your time.  Unless you are set on having every single test in the first 20 weeks, I would take my time to find a place where I felt comfortable.


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Old 12-17-2010, 08:07 PM
 
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I wouldn't worry too much yet- everyone was rushed, you didn't really get a chance to talk to one another.  See how it goes next time.

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Old 12-17-2010, 08:27 PM - Thread Starter
 
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Hopefully Monday's appt will confirm for me if this a good fit or not, but I'd like to have my plan in place for if it's not. Which primarily consists of frantically calling the other docs on my doula's short list and seeing if anyone has an appt. for the Monday after Christmas, which is the only day I have through January 17th. :)

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Old 12-17-2010, 10:07 PM
 
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Aw, lithigin, sounds so stressful. I totally understand how you are feeling. Are there any resources in your area for low-cost out of pocket US? Can you go back to the medical center where you got the first one? I've just recently learned that there are two kinds of US, Level I and Level II. Level II is much more advanced, and out of pocket is more like $200-$400. But I bet there is somewhere near you with affordable Level I. I know there's one near me for $50.

 

It sounds like you know EXACTLY what you're comfortable with regarding antenatal testing. The fact that you only had a couple of minutes with this OB probably made the experience more stressful, and left you less able to advocate for yourself. If have a couple extra minutes next time to go over your preferences, you will be able to get a much better sense of how flexible this OB is. OBs can get really ramped up, especially when people are late (not to say its your fault, I myself am chronically late and know that there are so many circumstances that are out of our control).


If you hate this OB you can ALWAYS switch. It is stressful but your gut will tell you if you have to. Just so you know, HB midwives are typically half the cost of OBs if you're paying out of pocket. (Still a lot of money I know, but that's what we're ending up doing.) If you have any out of network benefits you can work hard at getting reimbursed and usually can.


That said, granted you had a low-risk pregnancy and birth with your first, chances are you're going to have a great and easy experience with this one. OBs look at it that way as well. In terms of risk-managing OBs, the MOST important birth in my opinion to be managed by midwives is the first and/or first VBAC. Once you have a "proven pelvis", OBs typically stay off your back and you can just do your thing and have a baby. OBs love multips, especially multips who had their first babies delivered by midwives! lol

 

Good luck !
 


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Old 12-17-2010, 10:35 PM
 
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Well, it sounds like maybe things were rushed. You're still early in your pregnancy. Try another appointment and see how it goes :) If you're not feeling any fuzzier...then try someone else :)

 

I've had Tricare for multiple pregnancies and they've covered US--lots of them. Unless this change is very, very recent, I'd say you were misinformed. They don't cover US's SOLELY for gender prediction (as the one around 18-20 can be), but the 'big' one/anatomy scan they most definitely cover! I also know many, many military wives that have US covered by Tricare as well.


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Old 12-17-2010, 10:52 PM
 
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I will preface by stating that I have yet to read any replies.  What Tricare are you on?  Tricare covered (BEFORE my primary insurance, BCBS) my homebirth and that forced the hand of my primary insurance to pay out the 80% cost share.  We did ZERO preapproval or any steps.  They just covered.  Then after all the fighting I did with BCBS only to be told that even though they paid before they wouldn't pay again, when Tricare paid, BCBS had its hands forced.  

 

I would be very clear about your wishes and if the docs cannot confirm pregnancy through means not to include ultrasound or doppler, they need to return to school and get an actual medical degree and not whatever it is they currently claim to hold. 

 


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Old 12-17-2010, 10:55 PM
 
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Quote:
Originally Posted by Max'sMama View Post

 

I would be very clear about your wishes and if the docs cannot confirm pregnancy through means not to include ultrasound or doppler, they need to return to school and get an actual medical degree and not whatever it is they currently claim to hold. 

 

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Old 12-17-2010, 11:05 PM
 
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I too have tricare and recently had a baby (oct) Which tricare are you on?  I have tricare prime and have never had a problem with U/S getting covered.  Its all a matter of billing.  Tricare DOES cover U/S if they are "medically necessary" which really is a big black hole.  What one hcp feels is "medically necessary" another may not.  but a early u/s to confirm uterine pregnancy would fall under that.  Tricare does not cover "routine" u/s but again thats another black hole because it only needs to be billed as medically necessary.  Ahhhh!!! dont you love tricaredizzy.gif

 

 

And they do cover the 20ish week u/s its called an anatomy scan and is considered medically necessary to check the babies anatomy.  Gender is a bonus of that u/s.  I have literally tons of u/s for various reasons with all my pregnancies and have never had a problem with getting them paid. 

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Old 12-18-2010, 06:57 AM
 
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I just wanted to say that your medical care is YOUR decision.  If you don't want an ultrasound, you do not have to get one. Period.  At this point in your pregnancy it would not be very likely that you have an ectopic and absolutely no symptoms. If you feel uncomfortable refusing an ultrasound, I would look for someone else. 

 

You can switch providers at ANY point in your pregnancy.  I dropped my hospital midwives and decided to go with a homebirth at 27-ish weeks along last time.  The 3rd trimester is long and filled with appointments - you will easily be able to 'get to know' your provider in those weeks.  There is nothing wrong with shopping around, either.  Maybe just schedule a meet and greet with one or two more providers and see how it goes?


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Old 12-18-2010, 06:13 PM - Thread Starter
 
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Originally Posted by CrunchyClark View Post

Well, it sounds like maybe things were rushed. You're still early in your pregnancy. Try another appointment and see how it goes :) If you're not feeling any fuzzier...then try someone else :)

 

I've had Tricare for multiple pregnancies and they've covered US--lots of them. Unless this change is very, very recent, I'd say you were misinformed. They don't cover US's SOLELY for gender prediction (as the one around 18-20 can be), but the 'big' one/anatomy scan they most definitely cover! I also know many, many military wives that have US covered by Tricare as well.

 

I'm on Tricare Prime Remote (>50 miles away from my MTF, same as Tricare Prime - HMO style, no out-of-pocket costs as long as we follow the rules and get preapprovals and such).

 

Everyone I know on Tricare has always had the big U/S and only high risk  mamas have gotten earlier ones, all of which I support. But we spoke to two separate people yesterday who reiterated that they cover none without medical necessity:

https://www.hnfs.net/common/benefits/ultrasound_policy_040106.htm

 

For the big one, I suppose you just say the fundal height is suspect. It seems like the closest fake code without outright lying. 

 

Anyway, thanks for the reassurance that I'm not being wacky. The first time around, our midwife clinic at the hospital on post (Womack at Bragg, for the other military gals) was great. There was one bad one, two terrific ones (the crunchiest baby catcher there was a man!), and with most appts, everything just felt right. Now that I'm more informed and firmer in my beliefs, this first snippet of an appt just felt wrong. And thanks to Max'sMama for mentioning what I was thinking, that any decent provider, and especially one who purports to support low intervention, should damn well be able to confirm a pregnancy without a first tri u/s! So I have good questions to ask of them on Monday before I have any blood work sent through to them.
 

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Old 12-18-2010, 10:39 PM
 
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Out of curiosity, what's with a vaginal exam to confirm pregnancy? What do they do, check the cervix for a particular texture or something? I've never had a vaginal exam during pregnancy (had a few during labour, but I got the reasons behind those). In New Zealand, they tend to just do a HPT and confirm with a blood test while they're checking your iron levels and stuff. (And a good thing too - I hate internal exams!). Is it an American thing, or what? It seems unnecessarily suspicious.

 

(Also, with neither pregnancy was ectopic pregnancy even mentioned. I did have a dating scan with DD, but it wasn't to check for ectopic pregnancy, and I wasn't offered any early scans with this baby except for the 12-week abnormality scan, which would have been too late to routinely do an ectopic check anyway.)


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Old 12-18-2010, 11:00 PM
 
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Out of curiosity, what's with a vaginal exam to confirm pregnancy? What do they do, check the cervix for a particular texture or something? 

I don't know, I think it's supposed to be because the fundus is so low and they push up and feel from the inside and outside at the same time.... but I think it's totally unnecessary.  This Dr sounds nutty to me.
 


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Old 12-19-2010, 06:06 AM
 
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Unless this doctor was the only option available to me I would never go back. In my experience a practitioner that starts off heavily managing pregnancy with bizarro reasoning doesn't magically change for birth. 


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Old 12-19-2010, 12:12 PM
 
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Quote:
Originally Posted by CrunchyClark View Post

 

I've had Tricare for multiple pregnancies and they've covered US--lots of them. Unless this change is very, very recent, I'd say you were misinformed. They don't cover US's SOLELY for gender prediction (as the one around 18-20 can be), but the 'big' one/anatomy scan they most definitely cover! I also know many, many military wives that have US covered by Tricare as well.


 

 I have Tri-Care and the cover all "medically necessary" US, which usually includes an early 6-8 week US to date and confirm pregnancy, the 18-20 week anatomy scan, and then one more at the end of your pregancy especially if you are "over due". I haven't had any problems having these paid for, and I don't even have a copay. Maybe you should get them to explain things a little better to you... bc I feel like they are giving you bad info!
 


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Old 12-19-2010, 01:07 PM
 
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I didn't have time to read all the other replys so I may be repeating what others have said but, can you call the other OBs and do a phone interview with them and then make a appt. with the one that sounds the best to you and has the appt. time that you need? Then you could make your 1st appointment with that doctor. You can still go to the Monday appt with the other one and give that doctor a second chance and then switch to the other after the phone interviews. I hope you find someone that will work for you and your insurance needs!

 

Good Luck!!

 

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Old 12-19-2010, 02:29 PM
 
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Unless this doctor was the only option available to me I would never go back. In my experience a practitioner that starts off heavily managing pregnancy with bizarro reasoning doesn't magically change for birth. 



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Old 12-19-2010, 04:45 PM
 
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I too was Prime Remote :)  The 'routine' US they are talking about is you want to know the sex of your baby, you want to 'see' the baby, you just want an US kind of thing. If you go to those places where you can get the 3-D/4-D scan just by walking in, they aren't going to cover it. Any other reason your provider sends you will be coded with a 'reason'--anatomy scan, confirm pregnancy, r/o ectopic, large for dates, small for dates whatever. I used to be a medical coder, what Tricare is saying is that they won't cover an US with a V22/V21 type code which just means a routine pregnancy. It's a silly insurance-ese difference. If your doctor thinks you need an ultrasound, Tricare will cover it as 'medically necessary' (including a 3D/4D during the 20w US if the place your provider sent you does those!).

 

In my frist pregnancy, I had a doc in the office where my OB I loved was. I had to see him on an emergent basis and I *hated* him. He was cold, callous, and made me feel awful. I even talked to my OB about it and said I'd never let him see me again!  He ended up being the one covering for my doc for a vacation. I went in for my appt and had no idea he was there, and I had to see him again and I actually liked him that time, and he nearly delivered my second baby :)  I think if the office is highly recommended and seemed like a good fit, I'd definitely try another visit and see. If you still don't get that warm fuzzy feeling, or even 5 visits from now you get bad bizzaro vibes again, you can always switch!


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Old 12-19-2010, 05:50 PM
 
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Just to lend some perspective...I've seen a Registered Midwife for all my pregnancies and *no one* has ever felt the need to "diagnose" my pregnancy. I got a positive HPT + lack of period...that's enough for me! They do request bloodwork, but none of it includes a pregnancy test. 

 

I would *run* the other way. If this OB already wants to dispute whether you really are pregnant or not, imagine the fun as you get near the end - all the reasons she will have for induction, all the u/s to check size, all the reasons to change your due date, all the reasons to give pitocin when you aren't progressing at 1cm/hr, etc. Run, don't walk. Or, prepare for a fight unless you are ok putting yourself completely in her hands.


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Old 12-19-2010, 09:41 PM
 
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The "diagnose the pregnancy" question perfectly illustrates the difference btwn OB and midwife. My first midwife visit was at 12 weeks, where she listened to the LO's heartbeat with doppler (I know this is how most midwives do it.) That is a diagnosis of pregnancy! For the US, she said we could get it or not. As for an ectopic, if it is tubal preg then it will become apparent very early on. Ectopic pregs almost always involve bleeding, which of course requires follow up. Other things that would be picked up by US (twins, placenta previa, etc) become apparent during the preg through other means and symptoms (fundal height, bleeding, etc). Sometimes I think midwives are smarter and more intuitive in that they can diagnose with their hands and fingers what OBs need machines to figure out. One of the best midwives I ever worked with was an Indigenous midwife in Guatemala who never had a formal education. She delivered 2000 babies, 98% of them at home and never had a baby die in her hands.

 

Dh and I, though we are of limited means, are ending up having to just say "screw it" with insurance and we are on a cash payment plan. I have Cigna with no out of network benefits and the only midwives they cover are the ones that work at Planned Parenthood. duh.gif


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Old 12-20-2010, 07:34 AM
 
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I have to say that I don't think it's necessarily a MW/OB difference, it may be that this particular OB or practice is just psychotic? LOL If you're 12 weeks, IMO, there is really no need to "diagnose" the pregnancy. It should be obvious via feeling your abdomen, seriously. I was with an OB at the beginning of my first pregnancy, and I had an intake appointment at 8 weeks where I just talked to a nurse and had a blood workup. Then at 12 weeks I had a vaginal exam for a Pap smear and the Doppler and everything. No ultrasound was ever mentioned, and I think it's ridiculous that your OB thinks you "need" an ultrasound to make sure you're actually pregnant, and she should know that if you're not having symptoms, it's too late for an ectopic.

But I also agree that you should give her another chance, especially since you were late the first time and everyone was rushed. Let us know how it goes!

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Old 12-20-2010, 09:24 AM
 
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I have to say that I don't think it's necessarily a MW/OB difference, it may be that this particular OB or practice is just psychotic?


I agree with this. I've been the patient of some intervention heavy midwives as well as having my most recent birth attended at home by an obstetrician. There are always exceptions and I don't like to see anyone stereotyped.  


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Old 12-28-2010, 07:39 PM - Thread Starter
 
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So I saw a different OB at the practice the Monday after I started the thread, and she was responsive and reassuring with my questions. I got a Pap, declined the Doppler, and an internal/external exam. To answer the Aussie poster's question, the HCP is feeling externally for size and softness of uterus and (last time, I think, but not this time) often has a finger or two inside to push upwards to compare. This has never seemed weird to me. Anyway, she mentioned that my uterus was soft and estimated 12w (I was right at 13w).

 

We also toured the hospital where this practice delivers and the (nurse?) that gave us a quick tour estimated 2800 births a year and "one or two" per month don't get an epi. Off the cuff numbers, to be sure, but that puts the rate at 0.9% no epi, maybe. And she seemed a bit befoozled at my inquiry for c-section and MRSA and other such rates. *sigh*

 

Then we talked to the billing people at the great birth center near here. I am kicking myself for not fully investigating earlier than now, as they are full for June, but may make an exception for a 2nd time mom with an easy vag delivery for #1. Anyway, I had thought that Tricare would not cover it, but they do, as long as they are willing to file a non-network provider thing and it gets approved.

 

So right now we're in a bit of limbo. Not really feeling hospital #1, although apparently the two terrific hosps. here are both very high-tech, new, and considered great. But very hospital-y, with C-section rates near 30%, no tubs, no bed or pullout for dad, typical . It could be worse. I'm just crossing my fingers that the BC will work out and not worrying about it until we get back from Hawaii.

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