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,

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