XP: Did refusing Dr's recommendations or hospital policy effect your insurance coverage?

cecilyandgautam

Hi NB Mamas, I was really active on this board preparing for my first child but my labor ended up being rather abnormal. All the prep still helped me cope with labor and I did labor naturally for the first 18 or so hours. I'm now on the VBAC board more, but thought some of you BTDT natural birth moms might have experience with this. Thanks!

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If my Dr or hospital policy says I "must" do something and I refuse, will that affect my insurance coverage? The practice with the highest vbac success rate in my area (96%) practices in a hospital that requires babies go to the nursery for various tests while the mother transitions to the recovery room. But I didn't send my daughter to go to the nursery while recovering from a c-section (at a different hospital), so I have no idea why sending her to the nursery would be necessary for a vbac recovery. Plus, we declined some of the repeat tests last time and will do the same if the first set of results come out positive again - so I don't want to agree to some blanket "yes, test my baby for whatever you want, see you whenever you're done with her!" 

I plan to refuse - what can they do? Refuse to take me to recovery? I'm thinking of saying something along the lines of "either she comes with me to recovery or we both leave now" but I'm wondering how that will effect billing to my insurance. I mean, they can't keep me against my will and I could walk out if needed, but I'm afraid of what the bill will look like later if I just walked out. Any experience you can share?

(btw - our Ped takes plenty of home birth families so we can get all the tests we need in our Ped's office if we aren't satisfied with the conditions under which the hospital conducts its tests.)  

JCWhitey

I guess I'm just not sure how this would affect your bill in any way.  You get charged for the services given to you at the hospital, which doesn't have much to do with when you leave or what you refuse.  And they shouldn't miss-bill your insurance just because you refuse something.

tokenhoser

Well, the first thing to do is talk to your doctor. That's a really bizarre requirement and not at all in line with current recommendations to support breastfeeding and bonding. It also drives up costs for them (my hospital, the only hospital that does deliveries in my city, has no nursery). If your doctor supports your deviance from hospital policy, it shouldn't even be a hiccup in your experience.

And if your doctor doesn't, then you make sure your husband / other support people know that the baby is not to leave the room without a parent, and then you just don't consent to them taking her. I can't really speak to the crazy American insurance system, but I highly doubt they can refuse payment for that. 

cecilyandgautam

It seems like a lot of medical care is only covered if an in-network Dr deems it necessary, so I guess I'm worried about the reverse. What if I refuse something an in-hospital Ped deems necessary and we leave - would that mean I violated the terms of my insurance and loose benefits? That's more what I'm asking. We can't afford to pay a full hospital delivery bill out of pocket. 

tokenhoser

Can you ask your insurance company directly?

cecilyandgautam

I haven't been able to get answers in writing from them in the past, so I was hoping to hear from any moms who refused various things in-hospital. Was their bill off?

tmrchi

I would think they might make you sign something saying you opted out of their services, but that would be to cover their liability in case something happened down the line and you try to sue the hospital.

I don't see how insurance could bill you extra for refusing a service.  I could see them not paying for a test twice.  I'd check if your doctor's office might know and you can always call the provider to double check.

nosoup4u

What are the tests? I wouldn't think it should be a problem.

jellybeanjean

I can't reply from the position of refusing tests, but I know if you sign out AMA your insurance company has the right to refuse to pay for any and all services.  Or at least that's how it works in NY.  Have had some patients go ahead and sign out AMA, but I have no idea what has happened to their bills.

 

However, I would think that there's a middle ground between sending her to the nursery and signing both of you out AMA.  They cannot TAKE her from you...just say that you prefer to keep her with you during the immediate period.  Ask what tests they are doing, and if you want them done, if they can do them at a later time or even in the room. 

cecilyandgautam

nosoup4u:

What are the tests? I wouldn't think it should be a problem.

Normal newborn tests: PKU, bilirubin (sp?), some other bloodwork I don't remember

We consented to all the tests that could be done in my presence but when the hospital-based Ped came back wanting to do them again, we declined because our Ped said the first round of results looked great.  

This new hospital doesn't do any tests in front of the mother and will only conduct them in a nursery, with a glass wall between the father and the baby. This is completely unnecessary and our Ped will happily complete all these tests while I nurse my baby in his office. So I plan to decline, but I was wondering if that will effect how my insurance gets billed. 

cecilyandgautam

jellybeanjean:

I can't reply from the position of refusing tests, but I know if you sign out AMA your insurance company has the right to refuse to pay for any and all services.  Or at least that's how it works in NY.  Have had some patients go ahead and sign out AMA, but I have no idea what has happened to their bills.

 

However, I would think that there's a middle ground between sending her to the nursery and signing both of you out AMA.  They cannot TAKE her from you...just say that you prefer to keep her with you during the immediate period.  Ask what tests they are doing, and if you want them done, if they can do them at a later time or even in the room. 

This is helpful, thanks! So I can decline testing for my daughter but that's not necessarily the same thing as leaving 'against medical advisement'? If I had a letter from my Ped saying that he will complete all newborn tests at our first appointment within 24 hours of discharge, do you think that would ease the hospital-based Peds when discharging us? I don't plan on skipping out on the tests, I just am not willing to separated needlessly from her to have them completed. It's a pretty ridiculous policy IMO and I hope they change it before I deliver. 

tmrchi

That is a crazy policy definitely not best practice.  I wonder if there was some sort of lawsuit in the hospital that caused that policy. The only time baby left us was for his first bath, hearing test, and circ.  DH went with baby anytime he left my sight, except the circ, I kinda wanted him to go for that too but I didn't push when he didn't want to see it. 

 

tantdylf

cecilyandgautam:

jellybeanjean:

I can't reply from the position of refusing tests, but I know if you sign out AMA your insurance company has the right to refuse to pay for any and all services.  Or at least that's how it works in NY.  Have had some patients go ahead and sign out AMA, but I have no idea what has happened to their bills.

 

However, I would think that there's a middle ground between sending her to the nursery and signing both of you out AMA.  They cannot TAKE her from you...just say that you prefer to keep her with you during the immediate period.  Ask what tests they are doing, and if you want them done, if they can do them at a later time or even in the room. 

This is helpful, thanks! So I can decline testing for my daughter but that's not necessarily the same thing as leaving 'against medical advisement'? If I had a letter from my Ped saying that he will complete all newborn tests at our first appointment within 24 hours of discharge, do you think that would ease the hospital-based Peds when discharging us? I don't plan on skipping out on the tests, I just am not willing to separated needlessly from her to have them completed. It's a pretty ridiculous policy IMO and I hope they change it before I deliver. 

I think declining newborn testing is different than AMA and I don't think you need to worry. You and your DH just need to repeat the phrase "I do not consent" over and over.

sschwege

I wouldn't imagine it would affect your insurance.  Keep in mind though that when it comes to your child, you don't have as many rights as you do when it comes to you personally.  My SIL is a pedi in a hospital and she was working with parents who were threatening to leave the hospital before my SIL thought it was safe to do so.  She told the nurse to call security if they tried to leave with their baby.  It probably wouldn't come to that, but it's not as simple as saying, "If you won't work with us we are leaving."  As an adult you can leave, but it's not as simple when it comes to a minor.  

meggie0109

jellybeanjean:

I can't reply from the position of refusing tests, but I know if you sign out AMA your insurance company has the right to refuse to pay for any and all services.  Or at least that's how it works in NY.  Have had some patients go ahead and sign out AMA, but I have no idea what has happened to their bills.

 

However, I would think that there's a middle ground between sending her to the nursery and signing both of you out AMA.  They cannot TAKE her from you...just say that you prefer to keep her with you during the immediate period.  Ask what tests they are doing, and if you want them done, if they can do them at a later time or even in the room. 

This.

I'm in NJ and I went to L&D because I thought my water broke.  It hadn't, but I was past my due date and my doctor wanted me to stay to be induced.  I really didn't want to, but they convinced me.  It was a busy night and after I had been there for 7 hours, confined to a bed and hooked up to a monitor (even though I was not even in labor), I had a meltdown and tried to leave.  I would have except a nurse told me that if I did, it would be against medical advice and insurance would not cover my stay.  It was enough to make me stay.  And apparently it stressed me out enough to put me in labor because within the next 2 hours, I went into labor on my own anyway.  

I have no idea whether  the same would apply for refusing certain tests or leaving after the baby is already born.

nosoup4u

cecilyandgautam:

nosoup4u:

What are the tests? I wouldn't think it should be a problem.

This new hospital doesn't do any tests in front of the mother and will only conduct them in a nursery, with a glass wall between the father and the baby. This is completely unnecessary and our Ped will happily complete all these tests while I nurse my baby in his office. So I plan to decline, but I was wondering if that will effect how my insurance gets billed. 

Can your pediatrician do them at the hospital? How about a letter from your pediatrician explaining that you want them done in his office that's prepared ahead of time? 

You might have a problem leaving the hospital if your baby hasn't had any standard screens. I would definitely follow up and see what the policy is about that. They won't budge about doing any of them in your room? 

After my VBAC, I know DS2 had some tests in the nursery (maybe hearing?). FWIW, he went by himself - I was a lot less stressed about it the second time around. But that's just me, obviously. 

cecilyandgautam

Thanks for all the feedback. This is really helpful. We still have time to think it over and I think phrasing it as "Which tests are you unequipped to conduct in-room? Ok, our Ped is able to conduct those in office and we have an appointment set up with him on such & such date. Here's his contact information if you have any questions." would get me better results rather than threatening to leave. I'll also see if my Ped's office can draft up a letter ahead of time. 

The midwife practice is separate from the in-hospital Ped's group, obviously, so I don't know if they can tell us ahead of time which tests are available in room, if any, and which can only be done in the nursery. It's just so ridiculous because I *know* everything accept the hearing test can be done in-room since it was done in room for my last delivery, at another hospital. I don't think I'd be doing myself any favors by pulling the "I know you're lying to me" card, but I just wish this awesome midwife group could practice somewhere a little more baby friendly. 

jellybeanjean

cecilyandgautam:

Thanks for all the feedback. This is really helpful. We still have time to think it over and I think phrasing it as "Which tests are you unequipped to conduct in-room? Ok, our Ped is able to conduct those in office and we have an appointment set up with him on such & such date. Here's his contact information if you have any questions." would get me better results rather than threatening to leave. I'll also see if my Ped's office can draft up a letter ahead of time. 

The midwife practice is separate from the in-hospital Ped's group, obviously, so I don't know if they can tell us ahead of time which tests are available in room, if any, and which can only be done in the nursery. It's just so ridiculous because I *know* everything accept the hearing test can be done in-room since it was done in room for my last delivery, at another hospital. I don't think I'd be doing myself any favors by pulling the "I know you're lying to me" card, but I just wish this awesome midwife group could practice somewhere a little more baby friendly. 

This is what I'd try. I wouldn't worry abt billing issues unless you signed both of you out AMA, which is totally different than refusing tests.   And it's not that you're refusing them, anyway - it's that you have plans in place to do them in an environment more suitable to your wants and needs. I don't see why it should be an issue, especially with the ridiculous policy they have.

I work L&D and not usually postpartum, so from what I know PKUs are usually done in the nursery. However, if dads can be there for circs and baths and everything else, I KNOW they wouldn't have an issue with mom and/or dad being there for the heel prick, too.

Lawson6510

Definitely call the hospital and ask for their policies. I work in a hospital that does mother/baby staffing, meaning that a nurse takes care of mother baby couplets rather than different nurses for moms and babies. If this is the style of nursing there the nurse should be able to do the baby's assessment and testing in the room because she will be doing your care once you get to postpartum anyway. However, if there are specified baby nurses it may be difficult for a nurse to leave the unit where all of her other patients are to be in a room doing assessment/care for any extended period of time. In those cases it is best for patient care and safety for that nurse to do bath, care, etc in the nursery to be available to other infants if needs/emergencies arise. I have worked in this style hospital as well, and as a NICU RN I've seen how frustrating it can be for a parent if their infant has a medical emergency and they can't find their baby's nurse because they are on another unit. Also, some hospitals have portable hearing screen machines to be able to complete those in the room, but other machines are stationary. Refusal of testing should not affect your coverage, but leaving AMA could definitely affect your coverage. Also, imagine being a nurse or doctor caring for a patient that is threatening to leave it is difficult to be willing to work with someone and go out of your way to make them happy when they are acting that way. It's much easier to say "that's fine, I'll bring in the paperwork" than try to appease someone who sounds like they don't want to be there when you have a full patient load and a 12hour shift ahead of you.

atcwag

Is there a reason why you haven't called your OB/Pedi/hospital to discuss these issues and see what, if anything, they will budge on or work with you about?

sooner1981

It may not affect your insurance to refuse all testing, but some refusals will cause a mandatory child welfare consult.  Things like PKU testing and bilirubin testing are minimum standard of care for infants and they are not particularly invasive, so refusal of those tests when you have had a hospital birth may trigger a child welfare consult.  It is not that the pediatric docs at the hospital want to ruin your bonding time with your baby--it is just that if they have a policy re: mandatory testing and you don't comply, their first and only interest is the health of your baby and by having the baby in the hospital, that baby is considered by law to be their responsibility.   It is different with home births, as those tests usually just need to be completed within a certain number of days after the birth because there is no pediatric doctor who is tasked by law with responsibility for the baby's health until your first pediatric visit.

Now, with a consult, usually you would usually just have to explain your reasoning and tell your after care plan for getting those tests completed, but it can very much create undue stress on that first 48 hour period after birth. 

CDMay2006

jellybeanjean:

I can't reply from the position of refusing tests, but I know if you sign out AMA your insurance company has the right to refuse to pay for any and all services.

This is my understanding as well.

JCWhitey

JNL$LSM:

A couple in CA I believe left with their child because they wanted a second opinion. Long story short the hospital called CPS and the child was removed. The child was return to the parents but it was a process. Just something to think about.

https://www.foxnews.com/health/2013/04/30/baby-taken-from-parents-who-sought-second-opinion-removed-from-protective/

Yeah... I think I'd rather lose custody of my child for a week than have him go through unneeded open heart surgery!  Those parents absolutely did the right thing in my opinion!  It also sounds like the CPS call was more because of a butt sore hospital upset they were losing a patient to a rival and the judge didn't really take it seriously.  This baby was also five months old and experience flu-like symptoms, which is a much different situation than what the OP is talking about.

SweetPeaK26

pretty sure if you leave AMA your insurance doesn't have to cover your treatment.