OB-GYN-L Messages for February, 2006: Re: The Death of the Canadian Model

The scope for autonomy is exactly what the patient says it is. If the patient chooses to use her insurance, then the insurance co tells us what they will and will not pay for. If she wants something else, then she pays for it.

I have patients whose insurance co covers prenatal care, labs, US, meds, but not homebirth. So they pay for the birth part out of pocket. It is about the same as the copay for the hospital bill for them and the baby. And I have patients whose "catastrophic" insurance doesn't kick in until they have to have surgery etc, we don't have to follow the insurance co guidelines then. And I have patients who just pay my fee for whatever they want me to do and we don't worry about the insurance. I have lots of women who know what they want and make it a priority. I have others who don't want to pay a copay but smoke a pack a day - they have made a choice. It is totally up to the patient to use their insurance OR NOT.

I am more concerned my practice being dictated by malpractice insurer. But then that is MY choice to be cautious about working "bare." If I really wanted to do whatever, and the patient understands I have no MP coverage for that procedure, it is not generally against the law for me to do it. Of course, I have nothing to sue me for, so I am not in the same position as some of the docs (and others I'm sure) on the list.

In other words, only the patient and our conscious are really telling us what we can and can't do, the insurance co's are telling us what they will and won't cover. If a patient really wants something bad enough, they can get it. If they say they can't afford the fee, then I often see them driving a fancy car or living in a big fancy house and then you know what their priorities are.

Fran Wilson, CNM
Kennewick, WA

From: Ina May Gaskin <midwifeim@earthlink.net>
Reply-To: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Subject: Re: The Death of the Canadian Model
Date: Tue, 28 Feb 2006 00:52:48 -0600

In a message dated 27/02/2006 16:40:37 GMT Standard Time, RModugno@aol.com writes:

Ofcourse here we do it because Aetna, United Healthcare, Blue Cross, etc, say so!

Of course, the medical insurance compaines have you by the short and curlies. Where is the scope for autonomy if you are being dictated to by these companies.

Gail

Exactly.

Ina May

--

Ina May Gaskin, CPM
The Farm Midwifery Center
41 The Farm
Summertown, TN 38483
http://www.inamay.com
http://www.rememberthemothers.net

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