10.28.09
Pregnancy and Insurance Discrimination: Turn Up the Volume
Do Insurers Discriminate Against Women?
The ABC story, Pregnancy and Discrimination, was repulsive. A previous cesarean section is now considered a pre-existing condition that prevents women from receiving insurance. Women must pay higher premiums or have a mandatory sterilization if they choose to be insured. No, you didn’t misread the statement. The Golden Rule Insurance Company had the temerity to become “Big Brother.” What a blasphemous name.
Contrary to misinformation and propaganda, there are very few cesarean sections that are done based on maternal request. Most are done because of fetal distress when the baby is not receiving adequate oxygen and faces the possibility of death. Once an emergency is detected, the physician has thirty precious minutes to perform the procedure in order to save the baby’s life.
Do you recall the miraculous landing of US Air Flight 1549 on the Hudson River in New York City? We commended Captain “Sulley” for his heroic feat without hesitation. However, would his passengers now have a “pre-existing condition” because they were involved in an airline emergency? Of course not. Why so for women? Why are women charged up to 48 percent more for insurance than men?
According to ABC, there are only eleven states that prohibit health insurers from gender discrimination regarding the cost of premiums. The remaining thirty-nine states are fair game for continued exploitation. Healthcare reform is not a lofty ideal with a partisan agenda. The future of our humanity lies within sacred wombs.
After the ABC interview and article became public, The Golden Rule Insurance Company changed their ruling and will now insure women with previous cesarean sections.
Thank you, Senators John Kerry and Barbara Miluski for not only bring this issue to the forefront but for introducing legislature to bring these egregious practices to a screeching halt. Let’s keep beating the drums and greasing the wheels. Sometimes when the volume is turned up high, people eventually listen.
10.26.09
An H1N1 PregnancyTragedy
The New York Times story of Aubrey Opdyke, Flu Story: A Pregnant 
Woman’s Ordeal (Donald G. McNeil Jr.) is a compelling example of why obstetricians get sued. Opdyke’s calamity could have been avoided, if someone had not been sleeping at the wheel.
As an expert medical reviewer, reading this case was an exercise in frustration. What on earth was her obstetrician thinking?
Opdyke is a 27 year-old waitress who had one previous delivery and was 27 weeks pregnant when she developed mild “flu-type” symptoms. Although she was a former high school swimmer, she was also a smoker – and that is the operative word. Smoking in pregnancy is a risk factor for multiple complications and has a direct effect on the lungs.
She called her obstetrician with complaints of “flu-like symptoms” and was advised to take acetaminophen. It didn’t work. She called the obstetrician AGAIN and was prescribed an antibiotic. She never developed a high fever but continued to experience body aches and exhaustion. One week later, she became delirious. Opdyke had H1N1 Influenza.
She subsequently developed pneumonia, spent four months in the hospital on a ventilator, suffered six collapsed lobes of her lungs, had a seizure, and an emergency cesarean section. Her baby lived for seven precious minutes then expired. However through Divine intervention and meticulous hospital care, Opdyke miraculously went home but remains extremely exhausted and now walks with the aid of a walker. She didn’t sue her obstetrician. She was simply grateful to be alive.
There were fundamental mistakes made in the management of Opdyke’s case that warrant discussion:
- Patients CANNOT be diagnosed over the phone. The second call from Opdyke should have alerted her obstetrician that an emergency appointment was warranted. Her smoking history placed her at risk for developing lower respiratory infections.
- She was inappropriately given an “antibiotic” without the benefit of receiving a physical exam. What was her obstetrician treating? What was the diagnosis?
- A stethoscope placed on her back and chest might have altered the patient’s outcome dramatically.
- Unless one has recently arrived from another galaxy, any practicing physician should have their antennas upright for the possibility of detecting H1N1 influenza.
Opdyke’s case is a tragedy that should not have happened. These are the types of preventable medical errors that inspired me to write The Smart Mother’s Guide to a Better Pregnancy. Pregnant women must learn how to become vigilant during their pregnancies, even when their providers aren’t paying attention.
Let’s all pray for Opdyke’s continued recovery and that she never encounters this nightmare again.
10.21.09
H1N1 Symptoms and Your Pregnancy!
It’s been approximately six months since the 2009 H1N1 virus was detected, yet the conversations continue to flourish. The gravity of the subject matter keeps the discussions flowing and much can be learned by pregnant women who not only have to protect themselves but their unborn children as well.
When a human face is placed on the name of a disease, it takes on a completely new meaning. Such was the case when one of my pregnant patients showed up at the receptionist’s window requesting an emergency appointment.
She was in her mid-thirties, had two children and was in her early third trimester. She reported having a headache, no fever but was coughing for the past four days. Despite taking Tylenol® and over-the-counter medicines, her cough still persisted and she “felt bad”. The receptionist asked if I could see her because the clinic was extremely busy. My instincts immediately said “yes” despite her not having a tell-tale fever.
When the patient walked into the exam room, I immediately requested protective masks. She looked extremely lethargic and was coughing uncontrollably. She stated that her 9 year-old-son had caught “it” first, and now she was affected. I tested her for H1N1 based on CDC’s recommendation but did not wait to get results back before I treated her for what was a presumed diagnosis of a seasonal flu and possible Bronchitis.
Two weeks later, her tests confirmed the 2009 H1N1 virus but she had fully recovered. I was very grateful that we all wore masks and that the medication worked. I advised her that because she’s already had the flu a vaccine was not necessary. Her body has produced antibodies that should protect her as well as her unborn child from any future infections.
There are lessons to be learned from every patient:
- A pregnant woman can have the H1N1 virus despite not having a fever
- Older pregnant moms are probably more susceptible to developing pneumonia and should be treated with an antibiotic in addition to antiviral medication
- Treatment should NOT be delayed until the lab results are available
- Pregnant women should see their healthcare practitioner immediately if they have a persistent cough, running nose, body aches and/or headaches
- Most infections resolve if given the proper treatment and attention
- Check with your local pharmacy to make certain that Tamiflu® is available in the event that you need it
For more information on H1N1, please visit http://www.flu.gov and look for my in-depth article regarding the H1N1 flu and pregnancy on LifeScript.com in the immediate future.
10.19.09
The Gift. A Day in the Life of An OB-GYN
During a routine prenatal visit, I noticed a nineteen year old pregnant mom had lost weight which is unusual in the second trimester. When I asked why, she lowered her head, said that she had paid a traffic ticket and hadn’t been eating well because there wasn’t much food in her freezer. She presently lived with her brother and sister and I’m not certain what happened to her parents. She was on a fixed income, receiving a monthly disability benefit and the traffic ticket affected her budget for the next two months.
I inquired whether she had visited any food pantries or applied for food stamps. Yes, she had applied the previous week and was waiting to receive a response. I offered to write a letter to expedite the process but knew I had to make a deeper decision. Do I passively listen to her complaint or become a pro-active physician?
I reflected on the fragility of my own life at age 19 and my difficult navigation into adulthood. I glanced at her pregnant belly and told her that before her exam was over, she’d have some money for food. My medical assistant of thirteen years rolled her eyes, sucked her teeth and muttered a sigh of frustration in Spanish. “You know she’s playing you,” she mumbled underneath her breath. “You’ve got a kind heart Dr. Galloway but you’re too nice. Let her go to a pantry. Somebody will help her.”
I’m a native New Yorker so I know the drill quite well. Yes, there are people who mistake kindness for weakness. And yes, there are patients who tell lies. However, I couldn’t ignore the patient’s weight loss or her unborn baby who needed nutrition, so I bought her a $30.00 gift card from the local supermarket.
Was it a scam? Who knows for sure? All I know is that the true gift is what comes from our heart.
*A Day in the Life© is a copyright series written to illustrate the challenging cases of pregnancy and the importance of receiving quality care. No part of this blog may be copied or reproduced without the express permission of the author, Linda Burke-Galloway, M.D.
10.14.09
Twin Pregnancies and IVF: Not a Benign Act
Stephanie Saul’s New York Times’ article, The Gift of Life, and Its Price, affected me on a personal level. As an obstetrician and a victim of infertility, I am well versed with the inherent risks of IVF. Saul describes the exorbitant costs of fertility treatments and the increased complications of multiple births. We are still recovering from the aftermath of Nayda Suleman’s controversial delivery. It’s miraculous that neither Suleman nor her eight babies died.
In Saul’s article, we follow the Mastera family who conceived twins through in Vitro Fertilization after four failed attempts using artificial insemination. The twins subsequently delivered prematurely at 32 weeks and were in the neonatal intensive care unit for approximately 51 days at a cost of $1.2 million dollars. The average cost of an IVF cycle ranges from $12,000 to $25,000. Is there any wonder why there is a low compliance to follow the prescribed guidelines and attempt conception with just one embryo when the chances of a live birth are improved with two? Unfortunately, the greater the number of embryos, the greater the risk of preterm deliveries, therefore having a twin pregnancy is not a benign act. Even WITHOUT the benefit of IVF, a twin pregnancy is a high risk condition.
Twins are notorious for delivering prematurely, have an increased risk of the placenta separating too soon, increase the mother’s chances of developing hypertension and 30% end up in the NICU. Twin pregnancies should be managed by high-risk obstetricians (aka maternal fetal specialists), yet I am amazed at how many of my OB colleagues attempt to manage these pregnancies alone.
Coping with infertility is an emotional roller coaster, a ride I know all too well. In the end, my husband and I chose adoption and are the proud parents of two rambunctious little boys.
For those who are considering IVF, less is sometimes better than more. Should you opt to use more than one embryo and successfully conceive, PLEASE place your pregnancy in the hands of a skilled maternal fetal medicine specialist. I promise you won’t regret it.
10.12.09
The Art of “Gentle” Persuasion
My lab tech looked exasperated and I was growing impatient. She explained that the reason for the delay was the patient sitting in the lab that was afraid of needles and she was unable to draw her blood. The patient was chagrined and very apologetic. She had just relocated from another state and was in the clinic for her initial interview. My eyes quickly darted to her feet that resembled two balloons stuffed into a pair of flip flops. I immediately requested a blood pressure that confirmed my suspicion of pre-eclampsia and she also had protein in her urine. “Forget about the blood” I told the lab tech. She was at risk for having a stroke and needed to be delivered.
I dropped everything, examined the patient and then contacted the high-risk physician at the women’s teaching hospital. I requested an admission but warned her about the patient’s needle phobia. When our fax machine spat out her prenatal record, it was an “OMG” moment. The notes stated that the patient required six security guards to restrain her during a previous delivery in order to give her an IV. I gasped and then groaned.
The patient’s subsequent admission was not a pretty sight. She was combative, refused the IV and anything involving a needle. Meanwhile, her blood pressure was still elevated and bouncing off the wall. And did I mention that she had an abnormal uterus? Five sedatives did not knock her out. Risk management had to get involved. And Lord only knows how the baby was doing.
A phone call was made to her boyfriend who was hundreds of miles away up North. He got in his car, drove all night and reached the hospital the next day.
“If you don’t let them give you an IV, I will leave you . . . AGAIN” he threatened as he stood by her bedside. Within five minutes, the IV was inserted, the c/section was done and the patient delivered a healthy baby.
I wonder if her boyfriend is for hire?
*A Day in the Life© is a copyright series written to illustrate the challenging cases of pregnancy and the importance of receiving quality care. No part of this blog may be copied or reproduced without the express permission of the author, Linda Burke-Galloway, M.D.
10.07.09
SMART Tips on Reversing a Denied Health Insurance Claim
I’ve had more than my share of frustrations in the past when I’ve had to battle insurance companies about needed services for my patients that were either denied or “not covered.” My daily intake of blood pressure pills is a constant reminder of the stress that accompanies my job. However, I have recently looked at insurance companies through a different set of lens and I was a little surprised at the view. Sometimes the denials are not the result of stonewalling, but on the incompetency of a provider’s billing clerk.
I had a $600.00 dental bill for services that was denied by the insurance company. Because I took the denial on face value, without further investigation, I made payment arrangements, assuming that the services were not covered. I was wrong. While researching my son’s services, I discovered that my dental services had been erroneously denied because (a) the dentist’s office erroneously billed for my upper teeth rather than the lower teeth and (b) they failed to submit information regarding my recent extraction that would validate the procedure. The same thing happened when my sons’ pediatric services were denied. I contacted the insurance company directly and discovered that their pediatrician’s office had used the wrong billing code thereby giving me a liability of $814.37. Both billing errors could have cost me $1400.00.
The lesson learned was that insurance companies will pay for services if you follow their rules of engagement.
S–Seek answers. Never accept a denied insurance claim based upon its face value.
M–Monitor the “procedure” codes used on your billing statement in your provider’s office
A–Assume someone made a billing error when you receive an insurance denial.
R–Respond to denied claims immediately. Don’t let them sit on your kitchen countertop unattended
T–Talk to your provider’s billing department as soon as you discover your denial was based on their error.
An insurance denial is not written in stone. Most insurance companies are quite willing to pay the claim, once the error has been corrected. Following these steps might save you significant aggravation and money in the future, not to mention the disappearance of an uninvited headache.
10.05.09
Top Ways to Manage Obesity and Pregnancy
The “O” word has taken center stage within the media and medical community and no, I’m not talking about Oprah. Obesity has become an epidemic and pregnant women are directly affected.
I witnessed the side effects of obesity through the eyes of my late mother. Social isolation, discrimination and low self-esteem were an everyday occurrence. Behind every obese woman is often an untold story.
According to medical statistics, 66% of Americans are either “overweight” or obese. This includes ten to thirty-six percent of pregnant women. Obesity is discussed using the Basal Metabolic Index (or BMI) and is calculated based upon a patient’s weight and height. A BMI of thirty (200 pounds) or greater is reason for concern.
Ideally, obese pregnant women should seek the professional care of a high-risk obstetrician who is also known as a maternal fetal medicine specialist. Obese women are at an increased risk of gestational diabetes, high blood pressure, cesarean delivery, increased post-operative complications and stillbirths. There is also an increased risk of birth defects but it is not known why. Because obese women have a greater chance of having twins, an early ultrasound should be obtained.
How much weight should an obese woman gain during her pregnancy? No more than 11 to 20 pounds according to the Institute of Medicine. And pregnancy is not the ideal time to lose weight. The body requires a daily minimum of 300 additional calories. And it’s the quality of the food that’s important. Not the quantity.
Obese women should seek the services of a clinical nutritionist during their pregnancy and maintain a daily food diary. Every state offers the WIC (Women, Infants & Children) program that has a nutritionist or dietician on staff. I strongly encourage pregnant women to take advantage of their services.
Although obesity poses additional challenges, with proper support and guidance, the outcomes for most women are safe deliveries and healthy babies.
