Fun with Health Insurance

Let me start out by noting that I love and appreciate health insurance companies. And I also think they’re ridiculous at times, because they’re part of the health care system that sees pregnancy as a disease, and claims to be all for preventative medicine while discounting chiropractic care, acupuncture, homeopathy, etc.

Today, we received a helpful booklet from our new health insurance company, walking us through the Company’s how-tos and programs.  Among the actually helpful pages was one helping you determine when something is an emergency and when it’s not. (Hint: ear infection: not life-threatening, don’t go to the ER.)

There was a page encouraging you to ask these questions:

– What do specialty societies recommend for my condition?

– Is there scientific evidence supporting the treatment?

– What approaches minimize complications?

– What steps are taken to minimize medical mistakes?

Yet, I’m certain that UHC does not pay for acupuncture (though I’d need to check because I might be remembering any number of OTHER insurance companies), massage, etc., despite the fact that these and many other non-Western techniques are recommended by speciality societies, have evidence, and minimize complications (not to mention mistakes – hard to make a mistake when you spend an hour with your patients and know them by name).

But my favorite. Oh, my favorite page by far. The page that’s going to have me on the phone tomorrow. Healthy Pregnancy Program. The only picture on the page? A giant bottle. Healthy Pregnancy. Apparently, though, we don’t believe in healthy babies. I don’t think they need a picture of a boob, but could they not include a picture of, I don’t know, a pregnant belly instead??

But, anyway. The Healthy Pregnancy Program.

When you call our Healthy Pregnancy Program, a care coordinator will fill out a pregnancy assessment with you over the telephone. They’ll ask questions about your health, lifestyle, and other factors that may affect your pregnancy. .. We want to give you all the support and resources you need to work closely with your doctor…

Originally, I took exception to the “doctor” above, until I realized that if you’re with a midwife (not a medwife), you will not require the assistance of your health insurance company to work closely with your care provider. And, frankly, your health insurance company probably won’t have anything to do with you, lol.

Everyone who enrolls receives important education materials covering a wide array of topics, including proper nutrition, preparing for childbirth, exercise during pregnancy, warning signs, and things to avoid.

Now, maybe these materials are really great. There is always that possibility. If they were REALLY good, the Warning Signs one would include information like “Warning Signs that your doctor is going to push you into unneeded interventions” and “How to tell if your doctor’s a jerk before it’s too late.” I mean, I doubt they do. But I haven’t seen them, so I can’t judge.

Is it bad that I want to get pregnant so I can enroll and thus have more fodder for my blog? (The other reason is that we’re almost already at our out of pocket maximum for the year, and if I get pregnant RIGHT NOW, which we’re pretty sure Randy’s super manly sperm could do, I could still have a baby this year, and thus take maximum advantage of our insurance. Particularly if future pregnancies are anything like Genna’s. Holy expensive, batman. But these are two of the crappiest reasons to have another baby. The fact that I think I’d go completely insane on our family trip next year with a newborn and a 2 year old should really factor in more heavily than the potential for some awesomely bad literature from my health insurance company. And, really, even the potential to have things 100% covered except the midwife, who’s out of network.)

In looking at their online pregnancy guide, I found how to choose a doctor. Now, keep in mind, this is an insurance company, and they feel their job is to help you minimize your (and their) costs, but the number one criteria is:

Visit to make sure the care provider is covered by your health plan. By choosing an in-network care provider, you minimize your out-of-pocket expenses. And be sure to look for the UnitedHealth Premium® designation, which designates care providers who meet quality and cost efficiency criteria. These care providers have stars by their name in the online directory.

Yes, that’s what I want in a health care provider. Someone who meets cost efficiency criteria. So, are prenatal visits like 3 minutes instead of the usual 8? (Am I jaded??) But seriously, the WORST thing you can do is limit yourself to only the options in your health insurance network. Out of network is sometimes cheaper. Consider a hospital OB birth vs a home midwife birth. Even after insurance, the homebirth could very well be cheaper.

Their online page about delivery features pictures of lots of good patients, with make-up on, lying calmly on their backs with perfectly folded sheets tucked around their chests and over their swollen – and presumably contracting – bellies. Oh, yes, that’s what labor’s like, all right. I know the first thing I did when I felt contractions was go put on makeup. (Well, with Wally, I did make sure I had my hair braided. But that was practical rather than vain. I didn’t want it in my face and knew a bun would bother me if I was laying down. Braids are about the only way to keep hair pulled back in a way that doesn’t restrict your head movement in bed.)

This is from the page on birth plans (interestingly, the only time I saw the word Midwife):

Talk to your doctor or midwife

It’s important to talk about your wishes with your doctor or midwife. Not all medical professionals are comfortable with birth plans; they may feel your plan is a list of demands that could interfere with the safe delivery of your baby. By talking to your doctor or midwife early, you can work out how to include your wishes during labor and delivery.

What? Work out how to include your wishes? Screw that. I think it’s possible they use the word “professionals” a bit too loosely, lol.

Then they redeem themselves:

If you are scheduled to deliver before 39 weeks gestational age, be sure to talk to your physician about the risk and benefits to both you and your baby. Research has shown that babies born before 39 weeks gestational age without a medical reason for early delivery are at an increased risk of complications. Common complications include breathing problems, low blood sugar and the need for the neonatal intensive care unit (NICU) View Dr. Edward Koza as he talks about potential health issues for babies delivered prior to 39 weeks via elective caesarean.

For the record, this information appears on more than one page.

Their info on stages of labor is useful, if a bit bizarre. (during pushing, it instructs you to keep your eyes open. what? why?)

And, honestly, they’re gaining points here, too:

  • A postdate delivery is when the pregnancy lasts more than 42 weeks
  • There is no risk for the mother
  • The baby may be at risk because the placenta becomes less efficient at providing oxygen and nutrients to the baby after 42 weeks

Note that they define postdate as after 42 weeks. NOT after 40. Good for them.

The C/Sect page? Not too bad. Lacking on any real information, but definitely isn’t pro-C/S. They leave out a major reason for having a C-Section: your doctor was inconvenienced by your labor or potential labor.

So, you know, some good and some bad. Overall, the website is of course lacking in any real good details or info, but doesn’t seem to be overly bad. Makes me even more eager to see these important education materials…


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