Tuesday, June 20, 2017

Gotta love working with government

Tyler was born overseas, so we already knew there were a couple extra steps as far as citizenship is required when giving birth off of American soil. I started looking into the paperwork required right after I found out I was pregnant. I found out quickly that the kid can't be Australian because Oz doesn't do birthright citizenship anymore, but that's ok. We probably aren't coming back after we leave in August except to visit, so no need to worry about that passport. So I did a quick search on what would be needed to be done to get the kid American citizenship and it didn't seem that complicated so I filed that one under "For Future Amber to do Later" and didn't think about it again till last week when the nesting urge hit and I have no nest to prepare.

It's not going to be all that much work at the end of the day, but trying to find out exactly what is needed just solidifies my disdain for working with government offices.

Surprisingly enough. the Australian government part of the process seems to be the most painless. At least finding out the procedure and getting my questions answered was painless. I even called at 8:30 in the morning on a MONDAY and someone answered the phone AND was polite!

Essentially, we will get a certificate from the hospital that basically says we didn't kidnap this baby and it's actually ours and was actually born in Australia. Then we have to take that certificate to the Registry of Births, Deaths, and Marriages in the city and apply for the Australian birth certificate. And, because it's a government operation and no one can say no to more money, we can pay an extra fee to get the certificate sped up, which is really helpful because we need that certificate to get the American passport.

...along with a whooole lot of other documents, which probably comes as no surprise to an Americans who have ever tried to get anything from the government.

So I check out the consulate website to make sure we've got all the documents and money we need, and to my surprise I don't see anything about an expedite fee. Not charging a ridiculous fee to speed up the pace at which you look at pieces of paper?? That just seems unAmerican! That can't be right. Let's call the consulate up.

After waiting 15 minutes for them to decide to answer the phone at 9:15, despite a recording telling me they open at 9, and then wading through a few automated menus, I get a hold of a human. A human with an American accent, which is aways strange when living overseas.

I launch into my question, and the human politely listens without interrupting. She then tells me that I need to send my question to an email address I could find on the website.

"I'm sorry...you can't answer my question?"

"I'm just a switchboard operator and as of the end of last year I'm not allowed to transfer calls into the consulate anymore, so someone will reply to your email within 2-3 business days."

I paused, mouth agape for a moment, and replied, "Well that sounds about like the level of service I can expect from this administration." She gave me an uncomfortable courtesy laugh and asked if there was anything else she could help me with...which I thought was odd because she had basically told me there was nothing she could help me with, but it was nice of her to ask.

Thus begins my correspondence with the American consulate in Melbourne.

I'm always guilty of talking too much, but I've also worked with enough government offices to know that they assume you haven't looked at the website yet, so they don't listen and just tell you to go to the website. Maybe all the words distracted whoever got to my email first, because this sentence fragment was all I got in response to my two-part question:

It seriously felt like a tweet. I wondered how the training for consular workers has changed since January 20... That phrase "minimum 6 weeks" gave me pause because we have exactly 8 weeks from my due date until the day the baby and I are set to leave Australia, so if the expedited Australian birth certificate takes 2 weeks and the "minimum" is actually government speak for "don't bother us about where your passport is until after 6 weeks, we're obviously going to take longer," we're going to have to make some quick adjustments. So how much do I need to pay you, America, to get things moving?

So I sent this reply and waited. A few days later I received a reply:

Heeyyyy! A complete sentence! And some manners! AND...a different timeline than was previously communicated...I'm definitely working with government employees here.

But the perplexing part is the fact that there is no expedite service!? Really?! This is AMERICA! Money gets things moving! We'll always take your money...what gives?!

Ok, so I can't speed things up, so I started working on a plan B. If it takes too long to get the baby's passport, I can always provide the consulate with a pre-paid envelope and they can send it to some friends here who can send it on to us in Korea. According to the guy handling our immigration into Korea, the baby and I can still fly with just the Australian birth certificate, but will I have that certificate back before we fly, or is it going to to be held by the consulate and all the documents get returned at the same time? See, this is the beauty of allowing PHONE CALLS! I could have taken care of all of this in the course of a 5-8 minute conversation rather than a week-and-a-half-long back-and-forth via email.

See, this is where I went wrong. I tried to limit the words because I am overly wordy in emails, so I probably should have expected this cut-and-paste reply:

No greeting. No clarifying questions. In truly American fashion, the consulate assumed that when I left Australia I would be going back home to America (to be fair, most Australians are assuming that, too). I never said we were going to America, and I guess the majority of people they work with in the consulate are trying to go to America, so that reply shouldn't have bothered me as much as it did, but if there had been a little bit of customer or...I dunno CITIZEN service, this misunderstanding could have been cleared up quickly and I could be worrying about something else in my fragile pre-partum state...haha Oh the drama!!

Oooh I know the snark at the end of the first paragraph was not necessary and the autocorrect will probably be one of those lines that gets read out loud to the rest of the office in a "can you believe the nerve of this idiot" kind of way, but it felt really good to press send before I caught the mistake.

I'm fully expecting to get a reply in a few days saying that I will not have the Australian birth certificate back in time, which will lead me to yet ANOTHER follow up question: Will the Mister have his passport back in time to leave for his flight at the end of July?!

Depending on THAT reply, we might have to go to plan C.

Gotta love working with government.

Vicariously yours,

Monday, June 5, 2017

We're nothing if not different

Though we may be your quintessential American High School Sweethearts (Tyler and I started dating senior year), that is about where our quintessential-ness stops. I'm sometimes dragging the Mister kicking and screaming on my march to be different, but he always comes around to my side. In this case, we are both slogging through the uniqueness of this pregnancy, and learning all the various ways we can go about doing what is usually a straightforward, traditional, everybody-does-it activity in the most complicated, abnormal, why-would-you-choose-to-do-it-this-way way possible.

Traditional: Get married, have a few baby-free years (usually just 2 or 3), go on a Grand Vacation, then get to baby-making.

Tyler and Amber: Get married, have almost NINE baby-free years, move overseas with no plans to move back any time soon, spend several of the nine years convincing Amber that motherhood isn't the enemy, then cautiously get to baby-making.

Traditional: Get pregnant. If living far from home, start the process of moving home. Baby's gotta be close to at least one set of grandparents.

Tyler and Amber: Get pregnant. You're already living far from home, so continue to live far from home...can't live further away than you already are, so make plans to move to a country in just about the same time zone as when you conceived, just to bewilder the grandparents (Sorry Moms and Dads!).

Traditional: Baby shower(s).

If THIS was a baby shower, Amber would be on board in a SECOND

Tyler and Amber: NOPE. First of all, Amber is the literal worst at being a gracious recipient of gifts or compliments, so the idea of being showered with gifts for a baby you're only just getting on board with sounds like a nightmare. Secondly, having to support Amber through that kind of emotional trauma sounds like a nightmare to Tyler. Best to avoid it. Thirdly, most of your friends and all of your family--the people traditionally invited to a baby shower-- are spread across 7 or 8 time zones and at least 4 continents, so...there's that.

Traditional: Nesting. Gotta get the house set up with everything baby will need after coming home from the hospital.

Tyler and Amber: Everything. must. go. Sell it all. Is reverse nesting a thing? Because that's what you're doing. Don't buy a crib. Don't buy a stroller. Barely get any baby clothes. You're moving two months after the kid pops out, so there's no time for nesting! RESIST THE URGES!

American Traditional: Gender reveal parties. (Because seriously this is only a thing in America and it confuses everyone else that you would have an entire event dedicated to telling everyone the gender of your baby in a Pinterest-worthy way.)

Tyler and Amber: NOPE. No gender gets revealed till the kid is revealed...even though it would make the paperwork for your impending move to Korea WAY easier and your future employer could purchase a plane ticket for Amber and the baby well in advance and at a decent price...NO GENDER REVEAL! (Sorry future employer!)

Traditional: Arrange with your current employer for maternity leave well in advance.

Tyler and Amber: Let's see, you don't have medicare because you're not an Australian citizen, so you're looking at at least a few grand in medical bills. You're not going to work after the baby is born, so you've got two months of rent and living costs to save up for before you stop working. You've got a shipping bill of at least a couple grand waiting for you if you ever get around the packing for Korea. Oh! And you've also got to keep paying your bills and living expenses while you're pregnant. Sorry, Toots, no maternity leave for you. Cross your legs and hope that baby stays in until at least the due date. In fact, start working your SECOND job when you hit six months and don't stop working that second job until 12 days before your due date, just to confuse everyone.

Traditional: Play it safe, Papa Bear, until the baby is born. No sudden changes in your lifestyle or habits. No need to stress out your baby-brained wife.

Tyler and Amber: OR, and hear me out here, you could sign up for an experimental study at a local university that will require you to adjust your eating and sleeping habits, strap no less than FOUR electronic monitors to your body (two of which are physically attached to your skin), get muscle biopsies three times, AND spend a few hours every night for a week at the university working out while being monitored. All while hoping your wife doesn't go into labor while you're gone because this is all happening in the weeks before the due date. Yeah. That sounds like a plan. You'll do anything for 800 bucks! (Yes, this is something Tyler is actually doing. A local university is studying the effects of diet and exercise on circadian rhythm in men, and my husband, never one to turn down a good story...or $800, signed up)

I hope you all see the humor in our situation and don't find this post to be overly "whinge-y," as our Australian friends would say. We love our life, untraditional as it is, and obviously had to do this pregnancy in the most un-traditional way possible.

I wouldn't have it any other way.

Vicariously yours,

Saturday, April 22, 2017

We weren't wrong about Sydney

Most Americans have Sydney squarely at the top of their Australia bucket lists. It's hard to google search the country and not see photos of the Sydney harbor bridge or opera house. Most Americans are surprised to learn that Sydney isn't the capital of the country, that's how well known the city is. However, these two Americans have only been to the city once and came back with a lackluster review.

I'm glad to say that we aren't the only ones!

This week I returned to school after a two week fall break full of laziness on the couch and lots of Netflix'ing. It was glorious. I was talking to one of the kids in my homeroom class about his break and asked if he went anywhere.

"Yeah, my family went to Sydney."

"Oh cool! Do you have family there that you were visiting, or did you just go to see the city?"

"No, just seeing the city."

"How long were you there?"

"The whole two weeks."

Internally I was like, "Two weeks?! Good lord, what did you do for two weeks!? I couldn't get out fast enough after three days!"

Instead I said, "Oh so you got to see everything! What was your favorite part?"

"They have double decker trains! And you can move the seats on them!"

....after TWO WEEKS in Australia's most famous city, all this kid was impressed with was the dang trains!

To be fair, that was also one of the few highlights for Tyler and I when we went.

Sorry 'bout it, Sydney. You just don't ring our bells.

Vicariously yours,

Wednesday, April 5, 2017

You can't always get what you want

I've always taken a weird pride in the fact that Tyler and I don't live in our hometown. I am living out my lifelong dream of seeing the world while teaching overseas. I was so obsessed with this dream that I fantasized in high school about not making it to our 10 or 15 year reunions because I was too busy living in some fabulous exotic location, and my classmates would all be jealous of my life. I've basked in the glow of all the "I envy yous" and "your life is so excitings" every time we've met someone new or caught old acquaintances up on our annual trips home.

But all that basking comes with a price. Babies are born, engagements are celebrated, and funerals are held and our employers overseas don't exactly care that we're missing huge moments in our friends' lives. There is no bereavement leave when the mother of a close friend passes away. We can't rebuild our credit card points stash fast enough for all the last minute flights we wish we could take to show our friends we love them, and as the years go by the old "out of sight, out of mind" adage becomes a looming reality.

That's just the way it goes with this life we've chosen. Doesn't make it suck any less when, like this morning, we discover that one of our dearest friends from high school has died suddenly and we're finding out by piecing together the clues in vague facebook statuses. While we're having all these experiences that no one else gets to have, our lifestyle also means that we're not having the experiences that everyone else does get to have, like getting a phone call with sad news or getting to run to a friend's side to offer comfort. There will be no consoling or grieving with friends. We are powerlessly watching as hearts break back home and all we can do is impotently say, "I wish I could be there." Days like today are the only days that I regret this silly dream I'm living out and wish I had returned home after college. I wish so badly that I could be there.

The fact that her friends couldn't hold in their grief long enough for everyone to get the news personally doesn't surprise me. Kimmie was the most resilient, hilariously irreverent, and kind person my hometown had to offer and she touched so many lives in her time here. Strangers would say she suffered from muscular dystrophy, but the reality is that she made that disease just a detail of her life, no woe-is-me or suffering attitude necessary. To most of our high school classmates she was "that girl in the wheelchair," a moniker she owned like a champ, even making it the name of her hilarious blog.

She was one of the funniest people I knew and was unashamed of her disability, sometimes using it to her advantage. One such case was one time when we went to a Nashville Sounds game (Nashville's minor league baseball team), and as we were leaving the game the Scientologists were outside the gates handing out pamphlets. I watched as Kimmie sort of slumped over in her chair a bit and rolled on by, no pamphlet offered or eye contact made by the Scientologists. After we'd made it out of earshot, she sat back up and said sometimes when she saw people like that she would get a blank look in her eyes and pretend to be nonverbal so they would leave her alone.

She visited my classroom once to be a guest speaker when we were studying adaptations made for people with a handicap. My kids were enamored with her, so much so that they were afraid to ask the obvious questions like, "How do you go to the bathroom?" because they didn't want her to think they were disrespectful. She had recently gotten her modified van, so after her Q&A session she asked the kids if they wanted to see her new ride. As she wheeled herself out to the parking lot she activated the ramp, which caused the van to lower and she immediately sky rocketed in the cool points category as a few of my sweet kids exclaimed, "Ooohhh you've got hydraulics!!"

She picked Tyler and me up from the airport on our first visit home from Saudi Arabia when we surprised Tyler's family and mine were out of town. She was the kind of friend that wouldn't begrudge us calling in a favor after not seeing her for almost a year and then not really devoting a lot of attention to her the whole night because we were surrounded by our family. She was happy to help out a friend with no expectation of a reward.

Our annual lunch at Cracker Barrel never focused on Kimmie's health or disability. We usually spent the hours with her catching me up on all the trashy reality TV and pop culture gossip I was missing and telling me about the joint Halloween costume she and her boyfriend were already planning, 4 months before Halloween (the woman loved a costume party). When we couldn't make it to the restaurant, I would invite myself over to her house with take out, and if she was bothered by that rudeness she never let on.

I can't imagine a visit home without Kimmie. She was everyone's bright spot in their day and I'm a better person for having had her in my life. I'm glad to see that none of the facebook memorials so far have said anything like, "Now she is whole and walking the streets of heaven." Mainly because crap like that would have made Kimmie roll her eyes permanently to the back of her head, but also because the fact is that she was perfect exactly the way she was, shitty lungs be damned. I can't express how much she will be missed and I want so badly to get on the next plane home so I can join the masses that will be gathering in my hometown soon to help each other grieve. This is just another example of the fact that as expats we can't always get what we want.

Vicariously yours,

If you're up for a laugh and want a small taste of how awesome it was to be Kimmie's friend, read a few highlights from her blog:

Saturday, March 18, 2017

Lesson learned: Don't have a baby in Australia pt. 3

Let's recap. Here's what I knew after that phone call:

1. I had two weeks to find $4.000-5,000.

2. The amount depended on what my insurance said.

3. The money was for the "management fee," though I couldn't get a straight answer on what exactly that meant. I asked during the phone call from the OBGYN's office and was told that it is just a fee that has to be paid.

4. A doctor has to make a booking at the hospital for my delivery. Because it is a public hospital and mothers are seen by whoever is on staff, they want to have a rough idea of when everyone is going to be busting out kids so they can have enough people scheduled to work and on call.

I tried to play it cool until the phone call with my OBGYN's office ended and then I immediately fired off a panicked email to our insurance representative asking what the hell was up. I had purposely asked multiple people about costs of all this stuff months ago and was told to defer to my insurance company. My insurance company said I should fill out the form and it would all be taken care of. I filled out the form...WHY WAS IT NOT BEING TAKEN CARE OF!??

The response from my insurance was basically that the form has worked before, don't know why it's not working now. Maybe it's because an OBGYN made the booking for my delivery. If I switched to a GP as the manager of my antenatal care then I would be booking in like public patients do and wouldn't have to pay a management fee because the bulk-billing GP would be covered by my insurance.

I sure wasn't going back to the original GP because his receptionist would be able to successfully manage my bookings or communication. So I went to a GP at the university health services because we had chosen our insurance at the university's recommendation and they said the GP would be covered.

After meeting with one GP who didn't feel comfortable enough with OB matters to take me on, I had to wait another week to meet with one of the "baby doctors" at health services and pled my case. He was happy to take me on as a patient, but asked if my OBGYN had agreed to let me leave his care.

"...can he do that!? Don't I have the right as a patient to decide who manages my care?!"

The doctor shrugged. He asked if I had signed an agreement or contract or anything.

"Can a doctor do that?! What if after signing something I had become creeped out by him or uncomfortable with his judgement? That's not the case, Tyler and I like him very much, but doesn't a patient have the right to refuse a doctor at any time?"

I was flabbergasted. I moved on.

"What exactly does the management fee pay for?" I asked because this man seemed to be the most informed on how things work here compared to everyone else I'd spoken to on the subject.

"Basically it covers the doctor's malpractice insurance. Doctors get a salary from the private offices, but it isn't enough to cover the extreme cost of the insurance they have to get in order to keep practicing. Private doctors don't get subsidized by the government, so they have to get that money somewhere."

"So, I've only seen this doctor two times in my entire pregnancy. I'll probably only see him maybe two more before I deliver. The world says American health care is super expensive, but even going to a private hospital without insurance at home I wouldn't pay anywhere near $1,000 an appointment! I realize he has to cover his own costs, but shouldn't I get more of a service out of him if I'm paying through the nose?!"

He shrugged again. I moved on.

The doctor said that he hadn't had a patient in about 8 years that had been able to deliver at this particular hospital without entering as a private patient and being supervised by an OBGYN. I told him that a couple days before the appointment I had received a piece of mail that said I had an appointment with a midwife at the hospital. Didn't that mean that I was being considered a public patient? He seemed to find that encouraging and said he'd not had any patients get that far before, but I should double check with the hospital and my insurance. He gave me the phone number for the hospital patient liaison office and sent me on my way.

After leaving, I clarified once more with my insurance company that they would cover the fees from here on out if I was managed by a GP.  The next day during one of my planning periods I called the liaison office to clarify the hospital's stance. Remember how I said perviously that Australians don't like to talk on the phone? This woman was a classic example of that behavior.

"Hi, I am a pregnant non-citizen without medicare that has been booked in to deliver at your hospital and I have lots of questions."

Without finding out what any of my questions were, she dove right in. She told me all the things I knew already and was in the middle of saying, "Thanks for calling" when I interrupted her to ask a question.

For a patient liaison she sure was clueless about the hospital's policies. I asked explicitly if I switched the management of my care to a GP if I would have to pay the management fee. She said that I would have to clarify that with my insurance as the management fee wasn't set by the hospital. "If you want to come in as a private patient you have to pay the management fee." She got curt with me when I asked for clarification on the difference in services. I asked again if about the whole form-from-my-insurance-that-was-supposed-to-make-everything-ok thing and she said that I would have to ask my insurance about that.

At this point a colleague had sat down across from me and I was tearing up because I was hormonal and this woman was being so rude with a patient for whom she was supposed to be liaising. My colleague patted me on the hand and told me to hang up the phone, she could help me. That's when I found out that the whole public vs. private healthcare thing is a bit of a touchy subject in Australia.

"You don't need an OBGYN. An OBGYN is a doctor. Doctors are for sick people. You aren't sick, I presume, you're just pregnant, and that is what midwives are for. If you want to pay for an OBGYN that's fine, but it is an unnecessary cost because a midwife is just as qualified to deliver an uncomplicated baby." She said that if I didn't trust the midwives I could pay the extra money to meet with a superfluous doctor, but that was just a waste of my money.

I had to explain that I don't have a dog in the whole midwife/OBGYN fight. I didn't care who was between my legs when the kid comes, just as long as it was someone who had done it more times than I had. I am comfortable being delivered by an OBGYN because that is what would be happening at home. Midwives are a luxury in most States, so I didn't think it was strange to meet with a specialist. I most certainly did NOT want to pay for an OBGYN, what I've been trying to do is figure out how to get this baby out of me without having to pay a surprise multi-thousand dollar bill.

But the unhelpful lady that worked for the hospital told me to defer to my insurance, and my insurance said that I needed to switch my care over to a GP and the multi-thousand dollar bill would go away. So I called my OBGYN the next day and cancelled my care with him. I apologized profusely and explained that is was nothing personal, we just couldn't afford the management fee.

Imagine my surprise when, less than an hour later, I got a call from the hospital wanting to double check that I didn't want to deliver my baby there.

"...umm, no that's not the case. Why would you think that?"

"We just got a phone call from Dr. So-and-so's office that you wanted to end the management of your care with him."

"Yes, but I still need to deliver my baby at a hospital."

"You can't do that without an OBGYN attending to your care, though."

That was when my temper and tears rose at the same time. Why was the story changing again?! Why, after SIX MONTHS of asking this question can I still not get a straight answer!? Why, when I called someone AT THE HOSPITAL, was I told that I should defer to my insurance and I'd be all good?!

In her defense, she was a very patient woman and apologized for the miscommunication, but there is no way for a non-medicare patient to be seen at the public hospital without an OBGYN. Public patients are seen by midwives, private patients are seen by doctors.

"Ok, so what was that form I filled out for my insurance company? They told me it would be the way for the insurance company to establish a public relationship between me and the public hospital."

"No, that's not the case at all. That form just arranges for the hospital to bill your insurance directly for the cost of your delivery. All the other costs are between you and the doctor. Your insurance will probably cover the costs of the appointments, but the management fee usually falls to the patient."

I was full on crying at this point because I was so frustrated that I had been trying to advocate for myself my entire pregnancy and be responsible with my budgeting and now I'm getting yet another answer about what I'm supposed to do. If I wanted to deliver at a hospital that was fully set up to take care of my new family in a worst-case scenario, I was going to have to decide between paying for the doctor fees or paying for CLOTHES for my new baby. And doctor's bill was due in 6 weeks. I had specifically been asking this exact question for MONTHS and hadn't been able to get a straight answer. I could understand feeling this stupid if I had just been bee-bopping along with my head in the sand hoping no one sent a bill, but I had been trying to make sure all our financial bases were covered and no one could be bothered to stay on the phone with me long enough to help me!

Because Tyler is doing his counseling clinical practice at the same school where I am working, he saw my tear stained face as I went to teach my next class and went into Papa Bear mode. He called and firmly spoke with our insurance lady and told her to handle things. This was all on a Friday before a long weekend, so not much was accomplished, but I love that my usually docile husband got so uncharacteristically assertive when his new baby was involved. He's going to be a good dad.

I think the ultimate resolution is going to be that we have to pay the ridiculous bill. We'll be able to swing it, and we'll have enough left over to pay for the basics of what we need after the baby comes. We're still going to see if we can book ourselves into the public hospital across town as public patients, but I'm not hopeful about that route as the website says they won't make any bookings after the 20th week.

I know that one day-- probably in just a few months-- we will look back on all this stress and laugh at how cute it is that a little financial trouble was the biggest parenting crisis we had to deal with. I know that there are people in Australia and America who pay a lot more than we are currently paying to safely deliver a baby. I also realize that health insurance is a pain in the ass no matter where in the world you live. I am so grateful to be delivering in a fully developed country where women's health is a priority and hope that this little series of posts does not come off as entitled. I just want to record all this for posterity and thought that anyone who wants to know "how the pregnancy is going" might want to hear the long story. Because the truth is I am so incredibly lucky that I am not having any of the other symptoms associated with this womanly stage in life, so it's only fair that I get a little hassle from outside the womb to even things out.

Vicariously yours,

Tuesday, March 14, 2017

Lesson learned: Don't have a baby in Australia pt 2

So here's what I knew about having a baby in Australia by the time I went to my first appointment with an OBGYN:

1. A doctor had to refer me to the hospital in order to meet with doctors at the hospital.

2. I needed to get a form filled out by my doctor so that the insurance company could arrange for the hospital to bill them directly for the costs of my appointments and I could stop having to file claims and wait for reimbursement.

3. Uhhh that was about it. That's all I knew at this point.

I just knew that I was approaching the tenth week and all I had done to ensure the health of my baby was take prenatal vitamins and had some blood work done. I wanted to meet with an OBGYN because, as anyone who knows me will be unsurprised to hear, I had a million questions and wanted to talk to someone who knew the answers. Tyler and I went to a obstetrics office just across the street from the hospital to meet with a doctor that was on the list of OBGYNs that work at the hospital. I wasn't entirely sure what the difference was between meeting with the doctor at this building versus the building across the street, but I didn't want to wait any longer to speak with an expert and just make sure everything was ok in there.

The OB was delightful. He was very helpful, did not rush us at all, entertained all of my questions and did a quick ultrasound to show us the proof that there was in fact a baby cooking up. It was lightyears more comforting than any of the appointments I'd had in Kuwait with our first pregnancy and I was so glad to feel at ease and supported as a woman who advocates for her own health. At the end of my litany of questions I asked, "So, how does all this work?" meaning how does the whole having-a-baby-in-Australia thing work.

The doctor said that there were a couple of options. I could go the public route and I could meet with a doctor of a midwife at the hospital. Or I could go the private route, I would meet with an OBGYN in an office and deliver at the hospital of my choice.

So, like, the hospital right there? I thought to myself.

Then there was shared care, where I would meet with the OBGYN at his office for all the pre-delivery appointments and then go to the hospital for the big event and deliver with whoever was on duty at the time.

I asked a few clarifying questions. If I went the public route would I have him as my doctor? He explained that I would likely meet with a different doctor or midwife at each appointment and when it came time to deliver I would be helped by whatever doctor was on duty that day. That didn't sound too crazy to me, I'd heard about similar things happening in other countries with public healthcare. I liked the fact that I could choose to be delivered by a doctor or a midwife and that a birthing center and a team of midwives was attached to the hospital and was also a possibility for public patients. That's a luxury in most states back home, so I was impressed with how progressive healthcare here was.

If I went the private route I would have the same doctor for each of my appointments and that same doctor would deliver me at the hospital when it was show time. That also sounded nice because, as a Woman of Large Size (a term I've made up to say that I'm fat), I was concerned that meeting with a different doctor each time could lead to some obesity-related complication getting missed. I also liked the idea of being able to communicate my birth plan to one person and having it agreed upon well before the due date rather than having to possibly negotiate things while in labor.

So my understanding when I walked out of the consultation room was that I would have choices. Choices are nice. I like choices. Ultimately I didn't really care which choice we went with because they all made me feel comfortable about this whole giving birth thing.

Aaaand then I got to the reception desk to pay the bill. After the nice lady got over the shock that I didn't have a medicare card, she handed the bill. Thankfully I was working full time at a school and getting a full teacher salary and had just had a pay day because WOW the bill was not just $50! I tried to hide my sticker shock when I was handed the invoice and told that I had to pay before leaving. Tyler and I exchanged a couple panicked looks as we both did some mental math to see if we could still afford to eat that night and when the receptionist came back from processing our payment I asked, "So, um, how can I find out how much all of this is going to cost, just so I can budget and make sure we can pay at each appointment?"

I was handed five pieces of paper, all of them with a chart with lots of numbers and was told it would depend on what my insurance would cover, but essentially it could cost nothing or upwards of TEN THOUSAND DOLLARS!

"Wow. That's quite a spread." I said mostly to myself.

"Yeah, you'll need to get in touch with your insurance right away because it can take a long time for all of that paperwork to process and until that is worked out you'll be responsible for paying for each appointment."

I knew what that meant. I was in for many more phone calls to our insurance and much more frustration, and the insurance company did not disappoint. Once again I connected with various call center employees and once again I was told, "That is confusing, you must be frustrated."

Tyler was able to find a living human that he could meet with face-to-face and she was VERY helpful and actually empathetic to our situation. She explained that that form we'd been told about not only arranged for the hospital to bill the insurance directly, but it would also allow the insurance company to basically negotiate a public relationship with the hospital so that we could choose to go the public route and essentially pay nothing for the whole thing.

I like paying nothing. Let's pay nothing. We would get the OB to fill out the form at our next appointment. I had my 12 week ultrasound a couple weeks later and would meet with the doctor again after the results came in.

You all know how that 12 week ultrasound went. That was when we told my parents that I was pregnant and got to see our little guy or girl swimming around in there. I continued with our vacation and about a month later, after my parents had gone home, I realised that I hadn't heard anything about results from the ultrasound. According to our Australian friends, that's how things work here, it's up to the patient to call and find out about results, but generally no news was good news. I went to my second appointment with the OBGYN and was glad to hear everything looked good. I got the form filled out and I made my appointment for my 20 week ultrasound.

It all was going swimmingly! We had taken care of the paper work and was waiting for the insurance company to do its thing. The 20 week ultrasound went well and I had my appointment for my third meeting with the OBGYN, but all indications were that the second ultrasound showed no defects or reason for concern. I was nailing this whole being pregnant thing!

And then, of course, it hit the fan. I had started a new teaching job and it was during a planning period that I got a phone call telling me that at my next appointment I would need to pay my management fee.

"Ok, and how much is the management fee," I asked.

"Well, depending on your insurance, it'll cost $4,000 or $5,000," she calmly said like that was a completely normal amount and shouldn't shock me.

To be continued...

Vicariously yours,

Monday, March 13, 2017

Lesson learned: Don't have a baby in Australia pt. 1

I mean, it's not like we don't understand how biology works, but we were a little surprised when I got pregnant a few months ago. Pregnancy certainly wasn't high on our list of plans when we first moved to Australia and purchased the health insurance required to get our visas. But boy should we have looked closer into all the logistics and coverage because we are kicking ourselves now!

We were well aware that Australia has a socialized healthcare system, and a pretty good one from what we'd been told. When we signed up for our insurance, we were told that our insurance card would serve as a medicare card (what they call the ID the citizens use to get access to the public healthcare), we would just need to go to doctors that work with the medicare system. So essentially we could go to any public hospital or any doctors office that advertised that it would do "bulk billing."

We're relatively healthy people, so we didn't make use of the insurance until I got pregnant and I found out that public patients have to get a doctor referral to the maternity ward at a hospital in order to see an OBGYN when pregnant. I found a general practitioner (GP) down the street from our apartment that advertised bulk billing and made an appointment.

Here is where I learned one of the more annoying cultural quirks of Australians: They hate being on the phone. I can understand this in the age of text messaging, but WHEN YOU WORK IN A CALL CENTER OR AS A RECEPTIONIST YOUR LITERAL JOB IS TO BE ON THE PHONE! When I called to make the GP appointment, I was barely able to give the woman my full name before she was trying to hang up on me.

"Wait! I'm not an Australian citizen, so do I need to bring documentation to the appointment," I asked as I imagined the receiver quickly descending back onto the base.

"Do you have insurance?"


"Bring your insurance card. Goodbye."

So imagine my frustration when I arrived and she had not made note that I was not a citizen ("What do you mean you don't have a medicare card?!" has become the most repeated phrase in my pregnancy) and therefore I could not be seen by the doctor. She dismissed me with a wave of the hand, as if I was going to be like, "Aw shucks. Welp. I'll just give birth at home unassisted, then."

"But you said on the phone that I just needed to bring my insurance card."

"Why didn't you say you had insurance?!"

"...you didn't...Um, I guess I didn't think of it?" No need to piss off the woman who stood between me and the doctor I needed to get to an OBGYN. I handed over my insurance card.

"What is this?" she said with a sneer. Literally a sneer, I'm not exaggerating!

"It's my insurance card."

"We do not work with this insurance. Goodbye."

This woman was a piece of work. Bedside manner was not a key selection criteria in her job description. I was starting to get mad at this point because if she had spent more than four seconds on the phone with me when I'd called to make the appointment we could have cleared all this up and I could be taking the day off from work to go to a doctor that DID work with my insurance!

We finally established that if I wanted to see the doctor that day I would have to pay the full fee.

"Well I guess I don't have much of a choice, then, do I?" I snarked back.

She looked up in surprise, "You're going to pay?!"

What, did she think I was just going to be like, "Well thanks anyway, bye!" At this point I was 7 weeks along and still hadn't had any blood work to officially confirm the pregnancy and see if I had any deficiencies or anything! I braced myself for an exorbitant fee.

"Fifty dollars, please."  ...maybe there's something to this government subsidized healthcare thing!

I was feeling very vulnerable and frustrated at this point so I paid the fee with tears in my eyes because this woman was being so unnecessarily rude and sat down with a huff as I waited for the doctor.

He called me back, I explained that I was pregnant, that it was my second pregnancy, that I had miscarried around this same point last time, that I knew I was pregnant because I had taken 4 at home tests, "But that's why I'm here. You're the doctor, so I'm looking for you to confirm the suspicions," I tried to joke.

He didn't think it was funny.

He shoved a plastic cup in my hand and directed me down the hallway to the bathroom. I had yet to make eye contact with the man because he had yet to look at me, even when calling my name in the waiting room. He had just said my name and walked back to his office like he was calling a puppy for dinner.

After I delivered the cup of warm liquid, he literally opened an at-home pregnancy test and dipped the end into my urine. We waited in awkward silence for the test to come back -surprise- positive and he said, "You're pregnant."


"Good to know."

"You haven't done the blood tests yet?"

I was tempted to look around me to see if there were hidden cameras or Ashton Kutcher waiting behind the exam curtain. Was this guy serious!?

"...no. You're the first medical professional I have talked to about this."

So he wrote up an order for the full gamut of blood work and tried to send me on my way, but I stopped him and said, "So I'm not Australian, and have never been pregnant in Australia before, so I'm not sure how all of this works."

"Which hospital do you want to go to?" He asked. I repeated the fact that, being from out of town, I didn't know anything about how all this works, including which hospital to go to. What did he recommend? He asked if I wanted to go public or private and I explained that my insurance would only cover public hospitals. So he narrowed it down to the public hospital that has a maternity ward on our side of the city. He told me that after he got the results of the blood work that he would put in a referral to the hospital and I would have all my appointments at the hospital from now on. Sounded simple enough.

I popped over to the pathology lab down the road and got my blood drawn. I was told that the results would be sent to my GP and he would take it from there, so I went home and I waited.

And waited.

And waited.

About a two weeks passed and I was quickly approaching the 12 week mark, but I hadn't heard back about my blood work. Everything I had heard about countries with public healthcare is that things take longer than they do in America, so I thought maybe it would be normal for blood work to take two weeks. I waited one more week before I got worried that maybe something had gotten lost, and I called the doctor.

"Oh yeah, those results came in weeks ago!"

...WHAT?! Why hadn't I been contacted?! Was everything normal? Had the doctor made the referral yet??!

"Yeah, we got those results about three days after your appointment. The doctor looked at them. The note here says that everything is normal and no further action is required."

"See, that's the darnedest thing, because there is further action required. I need him to make a referral to the hospital so I can go see an OBGYN," I said through gritted teeth.

"Oh! You haven't had an appointment at the hospital yet?!" the receptionist said. This was a different, much more pleasant lady than last time, but her pleasantness was not cancelling out my frustration with her lack of helpfulness.

So she asked the doctor to make a referral for me.

A few days later I got a piece of mail asking me to come in to the office...why didn't they call, you ask? Because the first receptionist hadn't made note of my phone number so they didn't have a way to contact me. So I go in to find out that the referral got bounced back and that a GP cannot make a booking for me at the hospital, an OBGYN had to.

"...but I thought I had to go to the hospital to see an OBGYN," I said.

"You do," said the doctor, "This is the first time I have seen this. They said that since you are not a public patient that an OBGYN has to make the booking for you."

"Right, but how am I supposed to go see an OBGYN if all the OBGYNs are at the hospital?"

"You'll have to go see a private OBGYN."

"But my insurance won't pay for a private OBGYN."

"You'll have to talk to your insurance about that, but you'll need to hurry because you should really have seen an OBGYN by now, you're almost 12 weeks along."

I seriously could have ripped his face off at that remark! I hadn't seen an OBGYN yet because of HIS office's incompetence! HIS receptionist hadn't written down my phone number! HIS office didn't call to tell me the results were in. HIS note on my results said no action was required when there was in fact action required! NONE of this was my fault!

Eventually I was able to make an appointment with a private OBGYN. I called my insurance immediately to ask how this whole pregnant-in-Australia thing works. I got someone in a call center. In Detroit. I'm not kidding.

I hung up and called again. I got someone in a call center. In California. Who specialized in travel insurance, so she didn't know anything about antenatal care in Australia.

I hung up and called again. I got someone in a call center. In Australia! He was very sympathetic and read his approved script very well, but he had clearly never spoken to someone in my situation before so when I went off his flowchart and asked about the whole public OBGYN vs private OBGYN situation he responded with, " Yeah, I don't know, but that does sound very frustrating." You're not helping things, CRAIG!

All this before I was able to meet with an OBGYN for the first time at the 10 or 11 week mark.

So, if anyone asks, tell them NOT to have a baby in Australia. Unless they are a citizen and have a medicare card, of course.

Vicariously yours,