Midwifing in the For Profit Health System: Part 1

I’m just going to lay it out there: attempting to coordinate a patient’s care under the for-profit health system with hundreds of different plans that cover some things and not others, need prior authorizations, and further documentation to prove “real medical need” is slowly but surely, killing my soul. 

In the past week alone, I have had to call numerous pharmacies and patients requesting different medications than I ordered for them (you know, because I’m the one with a degree), because health insurance companies have decided that they are the all knowing arbiters of health care. 

And is there any time built into my schedule in order to deal with haranguing insurance companies and trying, once again, to see if my patient’s health insurance will cover this specific pill versus that one? I’ll give you one guess. Did you guess no? Well bingo. 

I am angry, friends. I am angry that I have to practice midwifery in a country that makes me jump through hoop after hoop to provide my patients care. I am angry because even though health insurance companies are now required (BY LAW, mind you) to cover ALL forms of birth control, they have still managed to weasel their way out of covering certain pills, almost all private insurance plans are refusing to cover the Nuva Ring, and don’t even get me started on my patients who want to take their pills continuously (ie: not get a period.) There are insurance companies that make me fill out forms stating that my patients have medical conditions that require her to skip her periods. Yeah, you know what that’s called? Making your own damn choices for your body. 

I am sick and tired of seeing abortion patients who are desperately trying to scrape together the money for a termination because their private insurance, the one that they were forced to get with the implementation of the Affordable Care Act, doesn’t cover abortions. 

I wasn’t in practice long before the roll-out of the ACA, of which I will have many more posts, but you know what I see, day in and day out? Insurance companies dictating health care. Requiring prior authorizations and putting up road blocks to long acting reversible forms of contraception (like the implanon or intrauterine devices) for women, even though they are more effective and cheaper in the long run. 

My last patient today was from outside of the United States, and she was looking to get hooked up with a primary health care provider. I told her I had a list, but that that might not be helpful. She looked at me quizzically. 

“I want a primary care doctor. You have a list of primary care doctors. What’s not helpful?”

I glanced down at her insurance plan, a private one. 

“Well….not all of these providers might take your insurance, and I don’t know which ones will. You should check the website of your health insurance and they can recommend some doctors.” 

“But you know these doctors, they would be ok with taking a patient referred from this clinic. I want a good recommendation,” she continued. 

I nodded. I would much rather see someone that one of my other care providers directed me towards. 

“I am still really getting used to this…ummm….system you all have going here.” she finally said.

“You and me both,” is all I could muster without launching into a tirade about our disjointed and non-sensical excuse for a health care system. 

There are some days where talking about what an insurance plan will or will not cover takes up half the time I have with a patient, instead of being able to focus on her full health care needs of the day. I’m damn tired of the first question when I suggest a medication or a treatment being “How much does that cost?” or “Will my insurance cover that?” 

I just want to have one whole damn day in a fairy tale land where no one is concerned about cost, everything that is recommended by me is covered, because the health system I work under knows that medical providers, not for profit industries, know what’s best for patients. 

What’s that you say? I don’t have to imagine a fairy tale land? Oh, that’s right. I could just go visit any other industrialized country in the world.

Stay tuned for more well-researched, less snarky analysis of our health care system in the age of Obamacare in the future.


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