Thoughtful ThursdayYou may have seen a news story this week about a lawsuit in Michigan in which a nurse is suing her hospital for allowing a NICU patient’s father to dictate that no Black nurses care for his baby. Strongblonde and I have been talking about this off-blog, since it’s her neck of the woods as well as her profession (nursing, not white supremacy).

Obviously we both object to the racial prohibition in this case, along with the rationale. However, we’ve both made choices of health care providers based on the providers’ characteristics. Depending on the situation, sometimes I have no preference and sometimes I have a strong preference.

Sometimes I’m put off by very young providers — not enough experience — and sometimes I’m not a fan of very old providers — unsteady hands, and perhaps not up to date on the latest science. As someone who recently moved to a new city, I have also purposely avoided old doctors because I don’t want to lose them to retirement almost immediately.

Sometimes I check where physicians went to medical school and residency, as a proxy (imperfect though it may be) for intelligence.

Sometimes personality also impacts my preferences. One of the dentists at my new practice is quite popular, but I will not be switching over to him based on what I can overhear across the hall: he is such a chatty Cathy. Friendly and personable, but he talks nonstop during people’s cleanings and procedures. For a different kind of doctor I might not mind, but at the dentist I am not interested in extended chit-chat with someone’s hands in my mouth.

I make choices when I’m choosing a doctor ahead of time. When assigned to someone, as I have been in the hospital or with other staff in a doctor’s office, I’ve never refused a provider. I’ve requested someone I liked better when making a return appointment, sure. But I’ve never refused, even when I actively disliked someone. Like the midwife whose cutesy schtick involved blaming pregnant women for premature labor. Ha ha. Hilarious. Even then, I accepted my fate. I was not friendly, but I didn’t demand a switch.

A friend of mine chose a hospital specifically because it was not a teaching hospital, and therefore she would not have to deal with medical students. However, the hospital did have nursing students. After the birth of her baby, a nursing student stuck herself then my friend with the same needle. After that, and the ensuing need to test for HIV etc., my friend banished all nursing students from her room for the rest of the hospitalization. Because of the incident, and because my friend had Dr. before her own name, the hospital respected her wishes, but I wonder if they would obey if a patient just walked in and said, “No students! I don’t like ’em!”

Bringing it back to the news story, a deceased relative who was a Holocaust survivor used to refuse doctors who came from Germany or had German lineage. No one ever seemed to have a problem with that. The two cases are similar in practice but very different in rationale. I wonder, though, where we draw the line: when is it okay to object on the basis of personal characteristics, and when it it wrong? I really have no idea.

Do you ever choose health care providers on the basis of personal characteristics? Have you ever refused to have a certain kind of provider?

Continuing the discussion of wacky health insurance…

When I was in the hospital after giving birth to Burrito and Tamale, I had a hospital-grade breast pump in my room. After I was discharged, there was a pump in their suite in the NICU for my exclusive use. But, I knew that I’d need my own pump when the babies went home. The twin books instructed me to check with the insurance company because they often cover pump rental for preemies.

Here is what we learned when we called, after over half an hour of being shuttled around to different people in the phone tree.

  • The pump is covered for babies born prior to 32 weeks. Burrito and Tamale were born at 33w4d, no good.
  • The pump is covered for babies with a documented feeding problem such as use of an NG tube. They qualified based on this criterion, if we were to get a letter from the neonatologist.
  • If we were approved for the pump, it would be covered for two months of rental.
  • There is a deductible of $120.

The hospital charges $68 per month for the pump rental. Doing the math, this meant that after we’d gone to the trouble of getting a letter from the neonatologist and filing the insurance claim, insurance might cover $16 of the $136 rental fee for the first two months, then nothing after that. Or, they might reject the claim.

It was not worth our time to file the claim for the (not guaranteed) possibility of that $16. I’m sure that’s exactly what the insurance company had in mind.

$16. Maybe.

Keeping in mind that I have what is considered to be excellent health insurance, for which I pay almost $1000 per month for myself and the babies, not counting my husband’s coverage…

Because the Burrito and the Tamale were born prematurely, they are at higher risk of problems from RSV. There is a drug which prevents RSV for one month at a time, Synagis. It costs about $1000 per child per dose. The full course would be about 5 doses for the entire RSV season, totaling $10K.

The neonatologist and the pediatrician each applied for Synagis for both babies. Both doctors felt that the insurance company would approve a maximum of 1 or 2 doses, because of the high cost and because the babies are only at moderately high risk.

The insurance company has approved 0 doses.

In the rejection letter, the insurance company states that for babies born at this gestational age, approval would require two additional risk factors (the American Academy of Pediatrics sets the bar lower at one additional risk factor). Risk factors include having a sibling under 5 at home (each baby has his/her twin, which counts); attending daycare; and having a smoker in the home.

If I decide to take up smoking, the insurance company would pay for the drug.

I understand how the actuarial system works, but c’mon. Talk about penny-wise pound-foolish.

Stay tuned for Part 2. It gets more absurd.

Edited to add: We can’t afford to pay for the drug ourselves. The neonatologist says no one pays for it themselves. So, we’ll take as many precautions to shield the babies from RSV as possible, but ultimately we just have to hope for the best. RSV is the #1 cause of re-hospitalization for preemies; one day of hospitalization costs more than the drug would have cost the insurance company. They’re rolling the dice, and so must we.


August 1, 2008

Mentsch tracht, Gott lacht.
Translation: Man plans, G-d laughs.
–Yiddish Proverb

As part of IComLeavWe, I came across a great post called Best Laid Plans on Kirke’s blog Maybe I Will Have a Glass. She wrote:

And can I just say, one of the biggest pains of infertility is that you are always planning for something that might never happen. Oh, I have to have a house with all the bedrooms on one level. For the baby….. I need to be in a position that will work well around the daycare schedule and will pay the daycare bills. For the baby….I feel like so many of my life decisions revolve around this big event that just might never happen.

I commented:

I can absolutely relate to all of the planning around potential/future babies that comes with infertility. I used to make all sorts of plans like that. Now I’ve cut down, but whenever I’m tempted to not sign up for something in 6 months in case I am pregnant at the time, or not buy an article of clothing now because I might not be able to use it for long, I just have to remind myself that I’ve been thinking that way for over 6 years and all it’s gotten me are missed opportunities and having only a single pair of jeans.

I still do have to make long-term plans about health insurance, though, because pregnant ladies are totally uninsurable!

I would like to expand on what I wrote. When I started TTC — even before, in the pre-TTC phase — I started planning for pregnancy and having a child. Key areas:

  • Travel. Usually I go to a lot of conferences for my work; they require submission of your proposed presentation between 4 and 10 months ahead of time. When I started thinking that I might not be able to travel in the near future, I stopped submitting to conferences. That ended pretty quickly, when I realized that it had dire career consequences. You can always cancel or have someone else sub, anyway. In 2008, I will have gone to 6 conferences, including 4 internationally. I do have to plan around them for IVF cycles and occasionally postpone a cycle or switch around dates of testing, but so far, I haven’t had any reason to cancel.
  • Medical care. I had an obstetrician and doula lined up within the first few months of TTC. That was silly. But I also have had to plan my health insurance around the possibility of pregnancy this whole time, both in terms of maternity coverage from the insurance plan and in terms of not being uninsurable if I switched plans when I was pregnant.
  • Jobs. On a related note, I just sought out and accepted a new job, mostly because of the health plan, since soon I will be ineligible for my current plan, and I will be uninsurable under most plans if I ever get pregnant. This is the first time that I have made a career decision on the basis of reproductive issues (or health care in general). Sometimes, I am very unhappy with the policies of the United States government. Well, to be more accurate: I am often very unhappy with the policies of the United States government, but sometimes I am absolutely livid.
  • Purchases. As mentioned last week, I purchased my car specifically for transporting my hypothetical future baby. Early in the TTC process, I also purchased a rocking chair, many books on pregnancy and childbirth, children’s books, toys, and…
  • Clothing. When I first started TTC, I bought some clothes that would be versatile for maternity purposes. Translation: they are baggy and unflattering. Then, I stopped buying clothes in case I became pregnant and the clothes might never fit again. This approach to shopping has continued on and off for the past 6 years. I have bought clothes sometimes when events like weddings or circumstances like moves to new climates have dictated, but for the most part I have bought far fewer clothes than I normally would. In particular, I have bought very few pants. I have some old pants that are out of style, a few decent pairs of dress pants for work, a couple pairs of casual pants, a couple of disposable pairs for pottery, and one pair of jeans. At this week’s Show and Tell, I’ll describe another article of clothing that I have been refraining from buying.

Sometimes, as with health care, these plans are necessary. But in many other areas, as IF has continued through the years, I have realized that it’s dumb to make plans around such an uncertain event. Yet, I keep doing it.