Advice?

I am having an ultrasound on Wednesday, as I mentioned. I have been having a long discussion with Gwynne, about the length it takes to get an appointment in our lovely university system. I’m wondering, for those of you who have had subsequent pregnancies after loss, when did you get seen?

Dr. M. saw me with our second pregnancy at 6.5 weeks because I was cramping and bleeding a bit. Although we have this scheduled ultrasound and a nurse’s appointment, I will not have a conversation with him until May 23rd unless I call and argue with the nurses and reception. I suppose I could make up a problem for some attention. It turns out the ultrasound is in the ultrasound clinic, not his office.

It seems that if I switch doctors, I cannot get an appointment with anyone else until that point unless I self-diagnose as “high risk.” And then I have to have a referral. If I want to switch to a private practice where I might get seen faster, I also need a referral, which requires an appointment with my PCP, for which I will also have to wait, unless I suppose, I pretend to have a more pressing problem than a history of pre-term labor, like the flu perhaps.

Apparently high-risk pregnancies require referrals but “normal” ones do not according to my insurance. My PCP has not diagnosed me as high-risk yet, because I have actually not seen her since 2005 (I was out of the system for a year and then I went straight to Dr. M since as a “normal” pregnant woman I could self refer).

In some ways it seems it might be easier to stay with Dr. M since I don’t have to fight with insurance then, and to just act as if I’m in a crisis every time I call the office so that the nurses have to talk to him. What do you all think?

Tomorrow I plan to put together a list of questions for my ultrasound on Wednesday. I used to just close my eyes until someone said, “there’s the heartbeat,” but now I want to know more, lengths, widths, movements, everything.

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13 responses to “Advice?

  1. This is crazy. What part of pre-term labor and miscarriage past 10 weeks don’t spell high risk to them?
    Here’s one thing that may help, if you have a decent PCP. Can you talk to her on the phone and get her to refer you as high risk?
    You really should be followed much more closely than being first seen five weeks from now.

  2. I apparently made the mistake 5 years ago of choosing a PCP also at a university health clinic. The day I get HER on a telephone will be a cold day in July. I had a long conversation with a “managed care specialist” at her clinic Thursday morning, where I thought she grasped the urgency but have not yet heard back. I suppose I could see how quickly I can change to a private practice PCP and get in….

  3. Oh, and I have called the “managed care” office again twice and left messages.

  4. It really is nuts how casual so many doctors and nurses in obstetrics are about loss, even very late-term loss. It drives me crazy that prematurity is finally getting a fair amount of press, and yet I find most OB’s to be frustratingly indifferent about it.

    Because I was on the fertility track, I always had at least two early ultrasounds with my RE. One of the benefits of being with a fertility doc. They have ultrasound machines in every room and don’t hesitate to whip out that little wand.

    Unfortunately you may not get much info at your u/s, since techs are usually very reluctant to say much. That drives me crazy too.

    I wish I had some good advice. I really don’t know what to tell you other than to stick to your guns and push for the care you need and want!

  5. NOW I remember why I got out of a university health insurance as soon as I could.
    This just blows.

  6. I was in a university system during my first trimester and had an ectopic scare–even though I had no bleeding, saying “persistent pain in the lower right quadrant” got me seen pretty quickly.

    It seems like you need to find a way for the doc who knows your situation to communicate to the staff about what you need from them. Can you ask him if it’s possible to put a note in your file on the computer? Something?

  7. Your comment on my blog was exactly right. We just have to sludge through and fight for the proper treatment. As long as you’re aware of the urgency, and you remain vocal about it, things should work out. Good luck.

  8. I’ve been offline for several days and am just now reading about your pregnancy. I know I never wanted to hear “congratulations” about this, my subsequent pregnancy, so I won’t offer you that. I do want to say I’m very hopeful for you. Taking it day to day seems hard when all the other pregnant women get to count by weeks or months, but that’s how I’ve found I have to do it. I’m pregnant for one more day today. Trying not to think about tomorrow.

    I’m really surprised that you aren’t being seen as high risk. It’s appalling how hard we have to fight for decent care sometimes. I don’t have any specific advice in this area, other than don’t give up; keep insisting on the proper care you need.

  9. I think blogger ate my comment on the other post…not sure.

    Anyway, i was not seen until 8 wks with this pg and with Chloe i was seen by a nurse practitioner earlier, but only because i had a UTI. I actually didn’t want an u/s before 8 weeks because i didn’t want to flip out unnecessarily if it was too early to see a h/b. But that’s just me…and yeah, i did have to flip out on them to get the dr’s appt at 8 weeks, they didn’t want to give it to me. I always have trouble with the nurses/office staff at first, before they figure out who i am (and not to mess with me 😉

    It’s just a nightmare, all of it.

  10. Okay, I’m not used to the US system, but up here, I see the doc whenever I feel like it.

    For emergencies, she has a block of times set aside every day for last minute if needed, and the deal is I pre-book regular appointments way ahead of time. My RE took care of regular weekly US during my first trimester, until the 12 week nuchal scan, and then I transferred to my regular Doc or an OB.

    That said, most OB’s and midwives won’t see the average pregnant woman until 12 weeks unless she has a history of previous problems. You do, so it would be automatic.

    My recommendation? Fake agonizing crippling pain, or bleeding. Go to an ER.

    As for the tech, I think it’s good to be at an U/S clinic because they do a more thorough job. The key is to state that you will sit and wait to speak to the Radiologist in person to get the report. If you say you aren’t leaving then sooner or later, it will happen.

    And I’d freak on the nurse and the doc, and get some rules straightened out. If this is going to continue to be an issue, tell him to get you a referral. He can do it as well, right?

  11. You asked for advice, so I will share my thoughts…

    I haven’t had a sub pregnancy yet, but I do know what my peri has planned for when I am.

    She said that she will see me at 8 weeks, and then every two weeks for most of the pregnancy–unless my cervix starts to change. I will have a cerclage after the start of the second trimester.

    The ultrasounds will be done in her office, so the doctor will always be close by to go over the results and explain them to me. After having a very scary level II ultrasound at 20 weeks on a Friday and having to live through an entire weekend before talking to the doctor, I will never have one again unless there is a doctor (OB) within range to speak to. The techs can’t say anything and the Radiologists are not a lot of help, either.

    It just doesn’t seem right to me that you might have to argue or cry or exaggerate/fabricate symptoms in order to get the care that you deserve.

    I won’t pretend to understand the insurance issue. It doesn’t make sense to me that the PCP is the one to diagnose you as high-risk. My OB referred me to the peri for a consult, and the peri has dignosed me as high-risk. It seems to me that the actual specialist is the one who knows best what your diagnosis is. Even my OB–who treats some high-risk patients–couldn’t say for certain that I have IC. Again, I don’t understand the ins-and-outs of your particular insurance and what hoops you need to jump through. I do think it sounds like it will be worth it for you to pursue seeing a doctor who will give you a higher level of care, though. And I am not necessarily referring to your doctor’s level of expertise. You need to be treated by a doctor and nurses (etc.) who respond to your concerns in a way that shows that they care about your pregnancy/baby as well as your emotional well being.

    I know this is a long comment, and I apologize for that. But I am wondering if you ever got any solid answers about why you went into PTL?

  12. I’m late…so a belated ‘i’m hopeful for you’. It’s horrific that you are getting the runaround with your insurance/doctors.

    An acquaintance once told me, ‘my son is going to the emergency room tomorrow with a heart condition’ and i thought, wait, he’s planning to go to emergency? are you open to having a ‘crisis’ that you can go to emergency and get an u/s?

  13. It’s funny because you’d think, for liability reasons, the university would want to get you out of the “normal” track and refer you out to a high-risk ob as soon as possible.

    I would make sure you mention your previous losses, stress that your pregnancy is high-risk, and generally make as much of a fuss as you feel comfortable making.

    Often there are emergency appointments you can get solely for the purpose of getting a referral, especially if you’re willing to see someone other than your PCP and stress that you need to see someone immediately (switch PCPs if you need to just to get a faster referral).

    I had to deal with similar issues with my health care and it was only by calling constantly and insisting that I needed an immediate referral that I was able to get one.

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