Think you have maternity coverage? Think again.

Welcome to the first entry of the book I’ll be publishing in 2010 entitled: You gotta laugh: Life in the trenches of the health insurance business. Because I think Disruptive Women readers will find it useful, each month I’ll post an example of a health insurance problem that is so maddening and frustrating that we just gotta laugh at its absurdity.

My goal, however, is to find a way to improve health insurance for beneficiaries and I have some suggestions at the end of this post.

This month’s question: What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation: When our client, Ms. R, found out a few years ago that she was having a baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits. Making the call was merely a formality. When she originally purchased the policy, she was single and didn’t opt for the maternity rider. After she got married, she added maternity coverage because she wanted a family.

Indeed, when she called the insurance company, they confirmed she had the insurance she needed. However, after her first OB check-up she received a letter saying she was, in fact, not covered.

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I was stunned to learn that New York City’s Bellevue Hospital was closing its birth center, leaving low income women in the city with no access to a birth center that accepts Medicaid.

Why are childbirthing centers in this country struggling to survive when they ought to be spreading? We know that they provide a wellness-model of pregnancy and birthing (as opposed to a disease model that hospitals have traditionally taken), use best practices in birthing, have excellent clinical outcomes, and save money. Staffed and usually managed by certified nurse midwives, childbirthing centers have been endorsed by the American College of Obstetricians and Gynecologists.

At the end of the Bush administration, someone in the Centers for Medicare and Medicaid Services realized that there was no mandate to pay these centers a “facility fee” that provided support for overhead. So, after years of paying this fee, CMS stopped paying it to childbirthing centers and now pays it only to hospitals.

The numbers I’ve seen suggest that a vaginal delivery in a hospital costs 5 to 6 times more than in a childbirthing center. Ruth Watson Lubic, one of the pioneers of the childbirthing movement, founder of the Family Health and Childbirthing Center in Washington, DC, and a Disruptive Woman, has estimated that using these centers for just Medicaid births could save the nation $1-2 billion each year.

As our nation struggles to figure out how to pay for reforming the insurance industry, we can start to reform health care delivery in affordable, quality ways by ensuring that all pregnant women have access to the childbirthing centers. For those who want to act now, you can sign a petition calling for restoration of the Bellevue Hospital center. Or learn more about legislation to require CMS to restore the facility fee to childbirthing centers.

I am not usually one to take on the Vatican. In fact, I toured its lovely treasure-filled buildings only three months ago and marveled at the wealth and power it denoted. However, the Pope’s recent pronouncements during his travels in Africa that condoms and abortions are morally wrong have filled me with righteous indignation. I too have spent time in Africa. But I wasn’t there to make pronouncements from on high. I was there to make a documentary about the increasing number of married women with AIDS in Kenya. I walked through Kibera slum and watched large families crammed into corrugated metal sheds without plumbing or heat.

Even so, I probably wouldn’t take on the Pope…except for an article in today’s Washington Post. Apparently, the Vatican’s top bioethics official said the two Brazilian doctors who performed an abortion on a nine-year-old rape victim “did not merit excommunication, because they acted to save her life.” HELLO! In my book, that’s called a pro-choice stand. Bravo for Archbishop Rino Fisichella, president of the Pontifical Academy for Life. Perhaps he should have a chat with his boss.

Abortion is not a black and white issue for me, despite having worked for the better part of a decade for Planned Parenthood Federation of America and NARAL on reproductive health issues. That’s why the pro-choice position has also seemed to me to be the reasoned one. It allows individuals to make decisions and encourages each of us to define for ourselves what is reasonable and acceptable. There is a trust factor in being pro-choice. For example, if there is the possibility that a nine-year-old may be raped by her stepfather, you want to believe that the pregnancy will be ended as swiftly and humanely as possible.

Good for Archbishop Fisichella for being able to see that issues related to reproductive health have gray areas! And that it is often possible to be both pro-life and pro-choice while having to accept difficult decisions. Is it too much to hope that Pope Benedict XVI might also see the light? If he truly listens to the people of Africa and other continents, and opens his eyes to their hopes for their own lives – I have faith that he may begin to understand the healing power of condoms and the life-affirming necessity for legal, safe abortions.

On Jan. 26, Los Angeles mom, Nadya Suleman, made national news giving birth to octuplets. Now she’s stirred up controversy and debate about whether fertility treatments should be regulated. It turns out Suleman is 33, single, unemployed, lives with her mother — and already has six children. Knowing this, should her doc have allowed her to try and have eight babies at once? According to her mother, she only wanted “one more girl.”

Since the goal of most fertility treatments is to get one healthy baby — doctors usually implant a smaller number of fertilized embryos.

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The following is guest post from Megan Kamerick, a local reporter from Albuquerque, who shares some of her OB/GYN experiences following her diagnosis of infertility.

Let’s start with some numbers.

* Number of women ages 15-44 with impaired ability to have children: 6.1 million
* Number of women who’ve ever used infertility services: 9.2 million
* Number of married couples that are infertile: 2.1 million
* Number of women using infertility services: 9.3 million

These figures, from the National Center for Health Statistics, are a bit dated, but hopefully all of you OB/GYN practitioners and staff out there get the point. A good number of your patients are likely infertile. We’re not very noticeable because many of us walk around in silence, often with serious mental anguish over our inability to conceive. But we’re here. I’d just like you to keep that in mind.

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For those not familiar with the concept’s history, a demonstration Freestanding Birth Center was established in 1975 on Manhattan’s East Side as an alternative maternity service. It targeted those who were disenchanted with the conventional care which did not treat them as families or honor the social, emotional and spiritual aspects of childbearing. The originators of this model, in concern for the quality and safety of the replications, developed standards and advocated for both its licensure and its accreditation. No state forbids its replication. There is accreditation available through the Commission on Accreditation of Birth Centers which was set up by, but operates independently of, the American Association of Birth Centers.

At the outset, the model honored the wishes of families by providing respectful care which enhanced the normal aspects of childbirth. At the same time, it provided through a coherent system of health care the consultation and special medical expertise needed in some cases. It did this through the formation of professional teams which provide the warmth of personalized nurse-midwifery care along with the availability of hospital-based obstetrical care when needed.

Originally, it was middle class women and families who sought out this care, and some 200 centers around the country were established. Today such Centers have proven they are able as well to lower the disparate outcomes suffered particularly by African American families. Because it differs in concept from the practices of conventional in-hospital maternity care, the Freestanding Birth Center concept has had a struggle to be accepted.

What are the outcomes and savings?

Outcome Data and Cost Savings*

After 5 years of operation, FHBC outcome data showed substantial lowering of preterm birth, low birth weight and cesarean section rates compared to those of the District:

(FHBC aggregated data for 2003-2005 were shown to be statistically significant by epidemiology and biostatistics faculty of the School of Public Health of the University of North Carolina.)

Preterm Birth Savings $619,200

Low Birth Weight Savings $277,716

Cesarean Birth Savings $343,882

Total Savings 2005 $1,240,798

Also in 2005, the total Operating Budget of the FHBC was $1,074,014. Therefore, the FHBC saved for the system a figure greater than its own operating budget!

*Sources:

Preterm Birth-Chapter 12 “Societal Costs of Preterm Birth” in Preterm Birth: Causes, Consequences and Prevention, Institute of Medicine 2006

Low Birth Weight-Cost of Illness Handbook Environmental Protection Agency 3/31/06

Cesarean Birth-National cost as reported in the Wall Street Journal (2/21/06)