Saturday, January 25, 2014

Week 18: Endocrinologist, Round Two

My husband and I recently decided to switch to Christian Healthcare Ministries, rather than signing up for a new insurance plan. This affects the way I seek medical care, because all preventive and/or maintenance care for pre-existing conditions is not covered. (Medical emergencies related to the pre-existing conditions are). This means that trips to the endocrinologist, prescriptions, and routine bloodwork are not covered, and I have to be careful about the way I spend my dollars on these expenses.

Since my endocrinologist has asked me to come in to see him every month ($190), and also have blood drawn each time (not sure how much this total is, but at least $55 or more) for an A1C, this will be a significant burden. I've never thought it was necessary, though I played along as long as someone else was picking up the bill. But that is no longer true. 

Since my endocrinologist fired me at the end of last pregnancy when I wouldn't come in on his monthly schedule, I decided to be up-front this time, and explain my situation. I'm not sure how he'll feel about it, but the diabetes educator I met with at his office today said, "I don't think he'll budge." So here's the note I sent to her explaining our situation, which she said she would discuss with him:

"We signed up for a health insurance alternative called 'Christian Healthcare Ministries.' They don't cover maintenance or preventive care for chronic or pre-existing conditions. If I were only coming 4 times a year, like normal, we calculated the cost and figured this might actually save us money, but coming once a month will cost too much.

"As my doctor knows, I feel very comfortable managing my blood sugars, since I've learned a lot in my last three pregnancies. I would be happy to come every other month (or, perhaps I could come every month, we could do bloodwork every other month, and he could cut the charge of the office visit in half). My OB could also order whatever bloodwork is required, and I imagine Medicaid would likely cover the charges submitted from my OB's office.

"Alternatively, I could see him on an as-needed basis, with whatever waiver/disclaimer he needs me to sign for legal purposes so that he is not on the hook for a bad outcome with my health or the baby's. He knows me well, the office staff is friendly and competent, and kindly accommodates the strangely high number of toddlers who accompany me to my visits. It's always nice to have someone to call when you have strange symptoms or need some diabetes advice. 

"I understand that both of these situations might leave your staff inadequately compensated for the time spent reviewing my blood sugar readings every week, so I am content to forego that service.

"Hope to see you again soon! If neither of these situations works, I'll probably try to find another doctor just during the duration of the pregnancy. But if he'll have me as a client again in July, I'd happily come back."

I tried to understand where they were coming from, but also give a reasonable explanation for how I think things could go during this pregnancy. I really hope he doesn't drop me again, but I finally decided that it would be better for me to be dropped and have to find someone else than continue to pay for services where seem rather unnecessary to me.

UPDATE: They did not drop me, but they did make me sign a waiver releasing them from all liability regarding my outcome or the baby's.


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  2. Hi there, I've been aware of your blog for some time but didn't realize you'd been writing here recently! I'm a 27-year-old type 1 diabetic (for the past 2 years) currently pregnant with my first child - due June 28th so I am also at the 18-week mark! This is a valuable resource for me. I got married at 25 and then became very ill the month after my wedding (hyperglycemia) - I knew I was probably diabetic because my mother is also a type 1. After my 2 hour glucose tolerance test my sugars were at 35 mmol or 630 mgdl. We had to wait to conceive while I learned to control my sugars tightly, and that was hard. We'd like to have a big family with as many children as we can reasonably have, and I know I'll encounter resistance as we go along because of my diabetes. Before I was diabetic I had always been set on having all-natural home births, and now doctors tell me it just isn't possible. My OB says that a scheduled c-section or an induction at 38 weeks is standard. I just don't want to be induced and I really don't want either a scheduled or an emergency c-section. As long as no issues arise in the pregnancy, I want to be allowed to go into labour naturally. That is my biggest concern at this point, the pregnancy has been fine so far. Anyway, forgive my rambling. Thank you so much for providing this resource. All the best to you and your beautiful family.

    1. Thanks for commenting, Sonja! I would strongly recommend discussing induction/c-section very carefully with your doctor - don't be afraid to post objections, tell him you're not comfortable with the c-section rate for inductions, not comfortable with the idea that a c-section is necessary without even a trial of labor, not comfortable with the risks of c-section v. the risks of labor, etc. I know I'm not a doctor, but especially for first-time moms, induction often ends in c-section (50% of the time)! And a c-section is not really the ideal way for a baby to come into the world and for a mother to give birth to her child. It should be avoided, if possible. So if you push him on any points, I would push on that one. Submit to all the third-trimester testing in the world to assure him of yours and baby's good health, but I would definitely try to avoid induction and the c-sections which so often come from it!

      Good luck. I have suggestions for induction if you are simply unable to avoid it, but my suggestions are more suited to a multipara, and not a first-time mom in labor.