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OB office rant
Ok, I totally need to rant... I just left my OB's office in tears. I literally cried in my car for like 15m straight. This is my first emotional breakdown of this pregnancy so I guess I am doing ok. I gained 6lbs in 4 weeks and 5 weeks. I've gained a total of 13lbs in 23 weeks (which is about the same as with DS, maybe even a pound less if I remember correctly and I gained a total of 29lbs with him which is within the normal range). Granted, I ate at Melting Pot last night, so I'm probably a pound or so more than I will be in a few days. The OB, whom I've never even met before in my life (it's a giant practice with 15 docs) told me I was only supposed to gain one pound per week and that I really need to A) get a handle on things moving forward, 
make sure I'm monitoring what I eat (WTF!??! OVER ONE POUND!?) and that C) the office will be monitoring me to keep me on track. I weigh 135lbs more than half way through a pregnancy. Are you kidding me that you're going to say that to me!?!
Then, when I go to make my next appointment, I'm told I have an $1000 bill to pay. Of course I'm like WHAT, how is that possible? They tell me that Tricare (my insurance) has denied all my sonogram claims and that I need to take it up with them and they won't schedule another appointment with me until I fix this. So I get home and call Tricare, and they tell me that they would be happy to cover the claims if there is a medical reason but the OB office has submitted them all as screenings that are not medically necessary or routine. Again, WHAT? I understand the NT scan, that is voluntary and I will pay out of pocket if need be. How is your anatomy scan not medically necessary?? Ok, it probably isn't "medically necessary" or whatever, but who doesn't get one of those and this doctor's office REQUIRES it, so I'd like to take that as medically necessary. Tricare says all that need to do is resubmit it as something that is necessary and they'll cover it (although I have a feeling it won't be that simple). But, my gut tells me this office will NOT go out of the way to make this right. I'm 23 weeks pregnant and I really want to switch OB practices, and possibly go back to the practice I was at when I had DS but they handled my PPD so, so poorly. I feel so trapped
make sure I'm monitoring what I eat (WTF!??! OVER ONE POUND!?) and that C) the office will be monitoring me to keep me on track. I weigh 135lbs more than half way through a pregnancy. Are you kidding me that you're going to say that to me!?!Then, when I go to make my next appointment, I'm told I have an $1000 bill to pay. Of course I'm like WHAT, how is that possible? They tell me that Tricare (my insurance) has denied all my sonogram claims and that I need to take it up with them and they won't schedule another appointment with me until I fix this. So I get home and call Tricare, and they tell me that they would be happy to cover the claims if there is a medical reason but the OB office has submitted them all as screenings that are not medically necessary or routine. Again, WHAT? I understand the NT scan, that is voluntary and I will pay out of pocket if need be. How is your anatomy scan not medically necessary?? Ok, it probably isn't "medically necessary" or whatever, but who doesn't get one of those and this doctor's office REQUIRES it, so I'd like to take that as medically necessary. Tricare says all that need to do is resubmit it as something that is necessary and they'll cover it (although I have a feeling it won't be that simple). But, my gut tells me this office will NOT go out of the way to make this right. I'm 23 weeks pregnant and I really want to switch OB practices, and possibly go back to the practice I was at when I had DS but they handled my PPD so, so poorly. I feel so trapped
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Re: OB office rant
Gosh, I'm so sorry. I have to say, though - it sounds like you need a new OB office immediately. I would not go back there.
Regarding the medically necessary, your office could have easily submitted the claim as such. My OB submitted a claim that my BREASTPUMP was medically necessary 2 months before I even gave birth so that my insurance would pay for it, and nobody even asked questions. It's just paperwork!
If your OB office knew your insurance wouldn't have covered it (which they most likely did, since they do this EVERY DAY), they should have told you as much. My OB only did an NT scan because he knew nothing else would be covered. He was open about that, and I was grateful.
I think you should perhaps tell your OB that if they cannot submit the claim as medically necessary for you (since this is their greedy fault to begin with), then you are going to consider switching practices all together. See who the practice manager is and request a face to face meeting next week. Dont do it over the phone. It'll be a LOT harder to tell you no to your face than over the phone.
GOOD LUCK!!!!
HUGS
i'm so sorry you are going through this. i hate to hear about mamas leaving prenatals in tears.
first, since your OB office required the exam, you need to tell them that in no uncertain circumstances, they need to resubmit the claim as medically necessary. it is necessary for you to have this scan to be a patient there, they are medical professionals, therefore it was medically necessary. there really shouldn't be any reason not to do this. FWIW, while i didn't have many, all of my u/s were covered by insurance.
second, as long as you are pregnant, it's not too late to change your provider if you are not satisfied. you are a consumer, a customer and you should expect decent customer service. because you are a consumer of maternity services, you should expect that customer service to be delivered with more than an ounce of humanity. if you aren't getting that, you should absolutely leave.
going back to your old OB may be a better solution for maternity care. i totally understand your concern about their handling of your PPD, but there are other resources that can help wtih that (and if i recall, you are part of a study now?) and you don't HAVE to see them for PPD issues. there are many providers who specialize in that area - both medical and alternative therapists. also, consider this for avoidance of PPD. worked wonders for me. no PPD wtih #2, not even baby blues.
and finally, MORE HUGS!
I'd get the billing situation figured out and then switch practices. When you posted before, I didn't think this practice was right for you.
My weight was all over the place during my pregnancy. At 20 weeks I hadn't gained enough, sometime after that I gained WAY too much - like 8 lbs in 2 weeks or something. The doctor said something like, oh you should just keep track and I asked for a nutritionist rec because I didn't want to keep gaining that fast. I ended up gaining close to 40lbs in the end, but I lost it all after DD was born. Don't worry about the weight.
really, that is not a lot of weight!! a lb a week average for a total of 40lbs is totally normal and you are way below that!
I agree, figure out the billing situation, have them resubmit and go back to your old practice.
I am so sorry!!
While your previous practice may have handled your PPD poorly, this one seems to be handling everything poorly. I wouldn't have much faith they would handle PPD much better.
Like PPs said, definitely get on the practice about the billing for the sonogram; that's ridiculous. Of course they are medically necessary - in this day and age every single person gets sonograms to check for problems that could potentially be fixed in utero. My doctors office only does three, unfortunately, but they are all covered (including the NT scan).
I would get that taken care of, then switch practices ASAP. I'm happy to recommend mine (they are in FFX and deliver at Inova FFX), but I can't speak to how they handle PPD. They have never once said anything about my weight, however, and probably could have. And the billing staff are very knowledgable and friendly.
Whatever you decide, good luck!
I remember your earlier post about this OB practice and your old OB practice and what to do. This would be the icing on the cake. Get a new OB practice. Your weight gain is FINE, they should never have said anything to you about it. Since they file insurance claims all the time with your insurance they should have been up front about the costs and allowed you to decline as necessary. My OB ordered Tay-Sachs bloodwork on me and then later realized, after it was done, that they shouldn't have (DH is not Jewish) and they refunded me the amount I paid even though my insurance covered most of it. If you really want to go back to your old OB, seek out other avenues to deal with the PPD. If not, find a totally new doctor. It is not too late. It really seems like you would do better in a smaller practice. Hugs to you.
I can't believe the OB did that to you.What an ass.
As PP said, I would figure out the billing issue and then LEAVE.
FWIW, I've gained weight in fits and spurts this pregnancy--some months, no weight. Other months a little, and then....well, this month I gained almost 10 pounds (eep!). So far, I've gained a total of 30 lbs. It's more than I wanted to gain in total, but I'm focused on a healthy baby.
Thanks ladies for your support. I love this board. This was definitely the icing on the cake with this practice. It's the most un-personal experience you can probably get with an OB practice, which I'm sure is fine for some people, but really isn't for me.
I'm going to address the billing thing first thing Monday morning. I've had the 3 required ultrasounds so far - the dating ultrasound at 8 weeks (which is also good for me since I've had a 1st tri loss before), the NT scan at 12 weeks and then the anatomy scan. Not one time did anyone explain these as optional or not required. Granted, the bloodwork associated with them was optional and I think I signed forms stating such, so I have zero problem paying out of pocket. But again, they CAN bill it as medically necessary - like Tricare told me, they'd be happy to cover it.
I do the same thing for people I work with. While I'm not an in-network insurance provider (what I outlined above is a great example of why I don't work with insurance companies!) I bend over backwards to make sure that everyone gets reimbursed, and I don't *have* to do that at all, but I *want* to. So annoyed.
So yeah, I guess I will be going back to my former OB practice. I did request a copy of my medical records, which they handed to me at my appointment yesterday, so thankfully, I'm set with that! So now I just have to prepare myself for really long wait-times at the office and rude office staff, and I'll be pleasantly surprised if somehow that is not the case this time around...
I am indeed participating in a clinical trial at NIH. So, I guess my history with PPD is also why I need to switch. I feel like even though I might be a low-risk pregnancy, I'm high-risk psychologically and I need to be with a practice who really understands that... or even knows who I am when I come in.
I'm on Tricare Standard and switched just because of being pregnant and wanting to avoid the naval hospital again. So this is my first time getting care off of Prime and I'm no expert. But the only thing I've been charged for so far is a $23 urine specimen thing that was standard care and shoudl have been covered (my midwife practice runs them at every appointment). There were too many other things going on at the time for me to deal with the Tricare run-around, so I just paid it. Of course, I could get slammed with a huge unexpected bill after the delivery (which I'm not supposed to be, but I'm still nervous). But my prenatal care has been almost cost-free so far. I had a dating ultrasound at 12 weeks and the anatomy scan around 20 (both with an outside radiology provider), and I'd think that if I was going to get billed for them, it would've been done by now.
I'm guessing it's all in the coding, since I also went in circles between my practice and Tricare to make sure that my Rhogam bloodwork and shot would be covered. They couldn't agree on a code, and Tricare kept telling me that they were pretty sure it would be covered but they couldn't confirm 100% unless I gave them a billing code to run. It was a hassle that shouldn't have existed, but in theory it should be an easy fix for you.
Anyway, that's my long two cents about my Tricare experience. Having left several prenatal and postpartum appointments with DS in tears, I know what an awful feeling it is to not mesh with your OB care and why I sought out other options for #3. Definitely switch and don't look back.
Well, at least now I realized that the doctor's office lied to me about participating with Tricare- we're on Standard as well (my DH is retired). Guess it was my job to check (although again, I flat out asked if they accept Tricare before I started going there), but I incorrectly assumed that having to pay 25% of all my bills was just the way it was with Tricare (in fairness, we get the insurance completely free). Turns out, as I am reading on Tricare's website (again, boy do I feel dumb for not doing more homework) that seeing out-of-network providers is 75% covered, and 25% OOP. So not only do I have this 1k outstanding bill to deal with, so far, I've been paying 25% of all OB bills, which has been about $500 give or take so far. My last pregnancy, I paid a grand total of $212 my entire pregnancy including delivery (we had Blue Cross as well then). I guess I should have realized something was up since I've never paid a bill when taking my DS to the pedi. I just thought that it was because well visits were free. Crap.
I'm not familiar with Tricare and retirement and whether the rules are different. However, Tricare Standard handles maternity care differently than all other care. "Global Maternity" coverage or something. It covers more than regular Standard - like little to no OOP expenses, co-pays, etc. That's why those who switch to Standard just for a pregnancy swear by it. I don't have any links handy, but search the Tricare site for it if you haven't come across it yet. Also, I've found that calling Tricare and speaking to three different reps can give me three different answers. It's always much better for me to go into the closest Tricare service center and speak with someone directly. If you have one convenient to you - or just a local one you can call if you can't visit, so you can always speak to the same person - I recommend that. Sometimes they've given me helpful paperwork I've never seen before on the Tricare site, or they expedite forms or processing.