This post is a little more personal than most I write. Jay and I are expecting a baby in the spring, and have been seeing a midwife for the past couple months for prenatal care. We’re planning a home birth and are covering the cost of the midwife ourselves, since our health insurance doesn’t cover direct entry midwives. There are no individual health insurance plans in Colorado that do, but there are a few large companies that are progressive enough to include coverage for home birth midwives for their employees. The midwife we’re using does take insurance, although the vast majority of her clients are in the same position that we are – insured, but without coverage for home birth midwives.
Early in my pregnancy, I was talking with a girlfriend who gave birth last year in Denver. She sighed and said something about how I would get to experience the joy of non-stop vaginal exams now that I was pregnant. Apparently, her ob/gyn did lots of them during the course of her pregnancy.
At a prenatal visit a few weeks later, I asked my midwife about the practice of doing vaginal exams on pregnant women. She said she will only do them if something doesn’t seem right, and since the vast majority of pregnancies are uncomplicated, she rarely does pelvic exams. Then she mentioned something I thought was very interesting. She works with a medical billing company that takes care of EOBs and billing for her when she has a client with health insurance that covers her fees. (for the rest of us, who pay her directly, the medical billing people don’t get involved). When they set everything up with her, they gave her a list of usual and customary fees that she can charge and get covered by health insurance. On the list was a $250 reimbursement any time a pelvic exam is done. This is in addition to the base charge for a prenatal visit. So if she does a pelvic exam during a prenatal visit, a health insurance provider will pay her an additional $250. So let’s say she does four pelvic exams on a woman during the course of a pregnancy – that’s an extra $1000 on top of the usual fees she gets paid. We assume that our midwife is not being singled out for extra cash – presumably any provider who does a pelvic exam during a prenatal visit can get extra payment from the patient’s health insurance company.
Our midwife is wonderful, and is our partner in this whole process, rather than the director. She doesn’t do pelvic exams when they’re not necessary, even if she stands to get an extra $250 (I doubt most providers would be so honest about their insurance reimbursement rates). A quick search online turns up lots of data that indicates that routine vaginal exams during pregnancy don’t really do much good and can possibly do harm (eg, increased risk of infection and prematurely ruptured membranes).
So why would health insurance companies be willing to pay my midwife an extra $250 if she does a pelvic exam? I guess that explains why my friend’s doctor did so many pelvic exams while she was pregnant.
tags: maternity coverage
