Did everyone see an MFM the entire pregnancy?

MelleTX · August 2012

OK, so here's my situation... (and this may turn into a mini-vent so hang in there with me)

Yes, I am AMA and yes I am having twins. But I am self-employed which means I have private insurance which means no maternity coverage which means I am OOP for everything.

Now, I would pay every last cent I had to make sure these girls are healthy and well taken care of. Don't get me wrong, I am not trying to be cheap. I am just trying to be responsible with my money.

I have solely seen my OB for the last 19 weeks. Cervix looks good, everything looks good. I had my anatomy scan last Tuesday and due to positioning, they could not get all the measurements they needed for baby B. So, she sent me to see the MFM today for a Level II ultrasound. He checked B and she looks good. Cervix looks long and closed. All is progressing nicely. Now he wants me to come see him monthly in addition to my OB, all because I am over 35.

Is this really necessary? Truthfully he didn't see anything that the OB's ultrasound didn't see. The babies had moved around so he got tons on B and very little on A, but that's ok because they got A last week.

Right now, I see my OB every 4 weeks and get an ultrasound. I've pre-paid $2500 for my OB's services but I still pay an extra $360 each visit for the twin ultrasound. If I add in the monthly MFM visits, that's another $650. That's over $1000 per month in ultrasounds alone. Plus lab-work. Plus saving up $8000 for the hospital delivery.

Again... I would pay everything I have for these girls if I had too. I'm just wondering if I am the only one who thinks this is ridiculous.

I make a decent living, but what would someone do if they didn't? What about women who make too much for Medicaid but not enough to pay $17k to have a baby.

Mama's going to have one heck of a tax deduction this year!

E&RMommy · August 2012

The MFM wants to see you monthly because it is TWINS not because of AMA. AMA is really a non-issue after the genetic counseling and level II u/s. Some will do weekly NSTs for AMA at 37+ weeks, but you should have them anyways because of twins.

Either get scanned monthly with the MFM or the OB - not both.

HTH.

ETA: $360 each month for u/s....your OB is overcharging you IMO because you're self-pay. Insurance would NEVER pay that much for an u/s.

Rynleigh · August 2012

OMFG that's insane...

I'm among that working-class group where we make too much for Medicaid, and I can't even fathom paying that much out of pocket for a pregnancy and delivery. That's over half my annual income *before* taxes and insurance premiums! Not to mention my bills, food, childcare for the other kids... yeesh...

My insurance is covered through my employer, and I pay $370/mo out of pocket for the kids' medical premium. I have no copay/coinsurance for my prenatal visits with my OB, just $20 copays for ultrasounds/MFM/Specialist visits, and then 20% coinsurance + $1000 annual deductible for anything that goes down in the hospital... and just that is going to break the bank, for me.

Does your OB think you need to see the MFM monthly?? I'm officially seeing mine at least once a month now, but I have Frankenstein ovaries and surgery and all that crap on the horizon, AND I don't have those kinds of insane bills to worry about. That's a horrible situation to be in

Lilystar82 · August 2012

I would not get scanned at the OB and get scanned at the MFM. No need for both, and the MFM is because you have twins. Once I started getting scans at my MFM, I was never scanned again by my OB. She did all my check ins, but no scans or NSTs. Having my MFM is what ultimately saved my duo, but that's a long story

Good Luck!

MelleTX · August 2012

I would stand on my head if they told me to. I just think I need to have a serious conversation with my OB's office about the Ultrasound pricing.

I thought $2500 for my OBs services, including all appointments and delivery was reasonable but they need a punch card for these ultrasounds. Buy 5 get one free!

I'll pay the $650 per visit to see if the MFM so hopefully we can drop the OB ultrasound.

When do you normally switch to appointments every 2 weeks with your OB?

ougrad1 · August 2012

I had Emerson at 36 and the babies at 38. I saw only my OB for my entire pregnancy. There was an MFM in the practice if there was a need. I never needed him.

From my experience, I think that if you trust your OBGYN, she's all you need. I'm sure that you asked about her experience with multiples in the beginning and that is what satisfied me.

I think you're perfectly fine just seeing your OB.

ETA-I agree with E&R-If you're paying cash, that's a lot to be charging. She should be giving you a "deal" for paying cash and not going through the insurance company.

KellyJayD · August 2012

In my case I only saw an MFM at the NT can and level 2 anatomy scan. I won't see them again.

I go to the midwife or OB (same office) every 2 weeks and get an ultrasound every 4 now. At 32 weeks I'll go weekly.

Heather1021 · August 2012

I have weekly MFM visits because of mo/di (one placenta) identicals, even though everything has looked perfect so far and I'm under 35. My insurance is paying $750 to the MFM practice every week, just as a price comparison. I'm seeing the OB every three weeks now, it will increase to every two weeks at 27 weeks, and every week at 34 weeks. Insurance is paying $180 for those visits, but they do not include an ultrasound.

CGoldman96 · August 2012

Yes, I am right there with you on the ridiculousness of seeing both and the charges! I am seeing both weekly! Considering the only problem I've had with this pregnancy is gestational diabetes, which was quickly controlled, I truly believe they are out to squeeze every last dime out of me and the insurance company.

I wanted to cut back on the MFM appts and the OB wasn't having it. I'm quite sure they get some sort of cut for referrals to MFM. MFM charges my insurance over $2000 an appointment and I have a large portion to pay out of my pocket myself in addition to all the OB charges. I will say I believe my OB charges similar prices to yours in regards to the ultrasound, but that is before insurance discounts.

nuttycoconut · August 2012

I would see the MFM. I'm solely seeing an MFM this pregnancy and should have done the same last time. Of course, many people are just fine with their ob but there are others who aren't. You just never know.

lmydogally · August 2012

I didn't see one. My OB consulted with one regarding my case and I saw the same one only for the NT Scan.

tarajayne · August 2012

I never saw an MFM until I was in the hospital at 34 weeks with cholestasis. Even then I only saw them in the hospital. I trusted my OB's though and everything turned out fine. I don't see the need to see both docs when you are out of pocket. If an MFM is needed I don't see why you need to continue with the OB. Good luck!

projectbaby2012 · August 2012

I'm 38 as well. I only saw the MFM for my anatomy scan - and my dr said that the only reason why is because of AMA, not because twins (mine were conceived spontaneously). My OB said that she will only send me back to the MFM if there is reason for concern. I trust my OB, there are a lot of twins delivered through her practice, and she won't hesitate to send me back to the MFM she sees a reason.

It's complete BS that you can't get an U/S rate closer to the insurance negotiated rate, but I suppose that's a topic for a completely different post.

Side note: When DH and I first starting trying, I had individual health insurance too. We priced things out and set money aside should I get pregnant. Fortunately my company offered group insurance before I became pregnant this time - we never even entertained the possibility that we could have twins.

GypsyEsq · August 2012

I saw both - but my pregnancy started as a triplet pregnancy with a second tri loss. So I was always on PTL watch. OB did "comfort" u/s to check heartbeats and position and MFM did the BPP and growth scans.

Mrs. Alice · August 2012

That's a really tough decision...

If your girls are di/di there are less risks for complications. In my case, seeing an MFM likely saved my babies lives but their complications were from being a mono/di pregnancy. My OB didn't seem very comfortable with a high risk twin pregnancy. I think if you have an OB with lots of high risk/multiples experience and who has a high tech u/s machine, you could probably get by with just him or her at this point. However... chances are you will continue and have a smooth pregnancy, but there is always the risk of the unexpected - hospital bed rest, complications, premature delivery where costs are out of control. My babies ended up costing a couple million (not paid out of pocket of course!). Worth every penny though.

everam01 · August 2012

All of my u/s were done at the MFM. Can you decline u/s at your OB visits?

mirnb · August 2012

I only saw my OB....I think unless complications arise and if you trust your OB I would stick to them....it is crazy to me that you have to pay out of pocket (I'm canadian!) What an extra stress on top of everything else!

elizabeth0705 · August 2012

I am under 35, and I have been seeing my MFM once a month since around 10 weeks. He comes in after the ultrasounds just to make sure everything is looking okay.

MelleTX · August 2012

I think maybe the MFM thinks I will be seeing him regularly because I saw him once, but I don't think that was my OBs intention so I do plan to clarify with her.

The MFM specifically told me I was seeing him for AMA, not twins.

I'm no idiot, I knew my insurance coverage before I got pregnant. I knew I would be OOP. I just had no idea it was that much. I budgeted about $6-$10k for maternity care and delivery (after a lot of research). I did not expect it to be double.

At least they will be born in 2012 so all my expenses are in one tax year.

bhardesty · August 2012

I only saw my ob during my pregnancy.

tombomb84 · August 2012

All of my u/s are at the MFM and my internals are at the OB. I was totally OOP for fertility treatments...all of those doctor's appts really add up so I really feel your pain. If I were you I would definitely talk to the OB about being treated exclusively by them if they feel that is safe for you and the babies.

chickaboo1974 · August 2012

Yes I saw a MFM from week 12- and much more often than once a month. Once I was getting ultrasounds at the MFM I stopped getting ultrasounds at the OB. I too was AMA, and had di/di twins- with no other issues until 31 weeks when my BP was high. I really think that seeing the MFM was worth it.

ERRN07 · August 2012

I am 40 and see MFM every 4 weeks for an U/S and my OB every 4 weeks for Amy regular appt! Money/co-pays etc are not an issue, as my husband is retired military and we have TriCare.

DelaBella · August 2012

I saw the MFM doc at my NT Scan at 13 weeks, Anatomy Scan at 20 weeks, then at 24 weeks, 28 weeks and 32 weeks. I'll see the MFM for Biophysical Profiles each week until week 35.

I used to see my OB once a month until about week 24, then started going once every two weeks. Since reaching 32 weeks, I think I am once a week now.

I don't think it is necessary to be scanned by your OB and your MFM. My MFM's equipment is far more sophisticated than my OB's, and frankly, I can't tell you what the point of my OB visits have been for the past few months. The OB checks my fundal height, listens to the heartbeat and asks my if I have any questions. I go because all the OB visits are included under my insurance in my delivery costs, but if I were paying for each visit OOP, I would seriously cut down the number of visits until I reached 32 weeks.

jessican08 · August 2012

Yes, I've been seeing an MFM and OB since I was discharged from my RE. I'm so sorry you're having to pay OOP though - that definitely sucks!

I guess my advice would be if your OB is ultimately leaving the decision up to you and you feel comfortable just seeing the OB, then go that route.I'm a worrier and have had some issues already so I'd probably continue to see the MFM but again, if you're comfortable just seeing the OB, then do that.

angelfire02 · August 2012

We saw only a MFM doctor after my 8 week appointment when we found out they were id twins. We had an ultrasound every other week from 14 weeks on, and a Non Stress Test twice a week from 30 weeks on, in addition to the weekly ultrasounds. It was a lot.

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