Can a hospital refuse to admit you if you refuse an induction?- long

NoeK · December 2012

I am at a point where I am pissed off, I actually do know my exact conception date (long story) But they keep basing my EDD on my LMP. I feel like no one is listening to me!

When I took the dating ultrasound she said it "could" be around the date that I think I would deliver but she would rather stick to the date calculated my my LMP.

At first I didnt care either way since I had decided to do a homebirth but since Cigna had flat out refused to pay for the midwife (longer story) unless she bills under a physican (which I understand to be illegal). I am now being forced into an OB/hospital situation.(Sidenote: I would love to be able to pay OOP for a homebirth but I could not find anyone for less then 6K and we just brought our first home about 5 months ago so we just dont have the extra to spend)

Anyway Mr. Almighty OB says that he "doesn't mind" letting me go to 41 weeks (gee thanks!) but after that we would"have to induce". Now I will be honest, my exact reply was "So are they going to drag me out of my house and inject me with Pitocin?" . The only response that he had was its hospital policy. So not only do they have the wrong flippin due date they want to induce me almost a full 2 weeks ahead of when I know I'm really due!!. I also have a history of having late babies. (My son was 42wks2days but I was only in labor 6 hrs total)

So my question is the above title, can a hospital refuse to admit me if I refuse induction?. I know for a fact that my OB will probably schedule me for an induction, I just have no intention of showing up.

Alliebooberz · December 2012

No they can't refuse to admit you! I would do the same thing if I were in your shoes!

eatdrinkstretch · December 2012

Your insurance can also reject your claim for delivery if you refuse an induction AMA.

ncbelle · December 2012

When are you due? Honestly, I would switch providers ASAP - I wouldn't want to feel like I was fighting my provider as that really could get uncomfortable come delivery time. I had a similar due date with Callum - fortunately my providers listened to my charting and not my LMP!

iris427 · December 2012

Do you mean that if you refuse the induction and then show up in labor, can they refuse to admit you? No. Under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), a hospital cannot simply refuse you care if you are in active labor, if it is a Medicare-participating hospital (which almost all US hospitals are). You can Google EMTALA for more details.

Do you have time to find another doctor?

JCWhitey · December 2012

Can I ask where you live? 41 weeks seems ridiculous! I've always heard that it's safe even past 42 weeks. I have a PG friend in Australia right now who is 43 weeks and they are just now starting to talk about induction. This is what I hate about living in America. Our birth system is so messed up.

I have no advice as I've never been there! Just wanted to say that I agree with you and the PPs had some good advice about finding another caregiver. Are there any midwifes that work in hospitals in your area? We have a whole hospital where the midwifes will treat you until the actual delivery and then you will have an OB. Otherwise it's midwifes the whole way through.

NoeK · December 2012

I do still have time to find another provider, (by my estimation I am 26 weeks) so I am going to start looking.

As far as my insurance, I do kow that under NY State law I have the right to refuse any treatment so if they refused coverage as a result of my exercisig my right, I would absolutely bring a lawsuit against them.

NoeK · December 2012

I do still have time to find another provider, (by my estimation I am 26 weeks) so I am going to start looking.

As far as my insurance, I do kow that under US State law I have the right to refuse any treatment so if they refused coverage as a result of my exercisig my right, I would absolutely bring a lawsuit against them.

The problem I am running into is that my insurance is through my job that is based in CA and it is "self funded" so although I work in NY, they dont have to abide by all of the NY state guidelines (at least this is what I am told). Which is why they are refusing to cover a midwife.

NoeK · December 2012

*sorry double post*

AmyRI · December 2012

No, the hospital can't refuse to admit you if you show up in active labor. Getting insurance to cover a birth when it's against medical advice... might be tricky depending on your insurance.

I would look for a new provider ASAP - to correct the due date and to allow you to go to at least 42 weeks (even if you have to do NSTs in the last week to prove the health of baby).

What was the EDD based on the dating ultrasound? I would expect a new provider that is unfamiliar with you to base the EDD on the u/s and not just take your word for it when you say you know the conception date. Early u/s are pretty accurate and I am personally comfortable using that as the basis for an EDD. Just something to think about when looking for a new provider. They'll ask for your records from your previous doc, so you won't be able to just lie about your LMP to get the EDD you want.

jinnymb · December 2012

I went through the same problem with DS1. Based on my LMP he was due December 4th and based on my charting due December 9th. The early ultrasound backed up my chart but they refused to change it saying it didn't matter.

Then of course when I was 40 weeks they started talking induction and I was against it cause I knew they were 5 days off and my bishop score was low. When I hit 41 weeks I insisted on a NST test etc... before I would consider induction and we did it and all was well, so they gave me a few extra days.

I was lucky and went into labor that night on my own, my water actually broke lol. So DS1 was born December 12th which was 3 days past due according to me but 8 according to them.

I say based on what you know, insist on a Bishop Score and a NST before making any decisions. That way you have an educated logical decision to make on whether to fight or go on with an induction.

Good luck!!

I saw you said you are only 26 weeks, then yeah I would go ahead and find a new practice and explain your situation before committing. I just switched and found a practice much more supportive of natural birth.

bdutton0005 · December 2012

Just because you can refuse the treatment under state law the insurance ( and most will ) will refuse t pay for treatment if you AMA. If your Dr schedulesion if you don't sho the hopital will note an AMA in your record. If I were you I would find a new dr. In my state if you are a CNM you have to practice/bill under an OB. I've actually looked into getting mine.

BLPL101 · December 2012

I know my due date is wrong too. I had an early u/s (at 6 weeks) that showed I am due 1/17 which makes complete sense to me because I was charting. My OB went by my LMP so he thought it was 1/12 and wouldn't change it unless it was more than 1 week off. Pure nonsense. I switched to a midwifery group and my main CNM changed it to 1/14 which is still wrong and another one of the midwives said she would have written 1/17 because that's what the early u/s said. I'm annoyed that it's still 3 days off, but at least it isn't 5 days off.

Mrs E in Oregon · December 2012

If going to another Dr. and/or hospital is not an option, try to work with him to change your due date. You could possibly make an agreement that if he accept your true EDD that you will except induction at 41w 1d. (Get it in writing that your official due date is the date you agree on.)

ncbelle · December 2012

If you are only 26 weeks you should totally get a new provider!! If you were say 40 weeks, I could see the hesitation

But no need to stick around with someone who you are already getting confrontational with over something as basic as paying attention to what you know about your due date.

pepomntpat · December 2012

bdutton0005:
Just because you can refuse the treatment under state law the insurance ( and most will ) will refuse t pay for treatment if you AMA. If your Dr schedulesion if you don't sho the hopital will note an AMA in your record. If I were you I would find a new dr. In my state if you are a CNM you have to practice/bill under an OB. I've actually looked into getting mine.

Do you have anything to document this? I am pretty sure this is untrue. I've been trying to research this a bit this evening and have only found this:

https://vbacfacts.com/2008/07/05/does-insurance-pay-when-you-leave-the-hospital-ama/

I am pretty sure they would find it hard to say that labor and delivery is not medically necessary considering the baby has to come out somehow. I would really like to know your source and be sure this isn't just some scare tactic.

However, I do agree that the least stressful and most prudent course of action is to find a provider who is more in line with your birth philosophy. You can also ask for testing to be done to check to see if you need an induction.

ETA: And I found this

https://www.epmonthly.com/whitecoat/2010/05/will-insurance-deny-payment-if-you-leave-ama/

https://www.ama-assn.org/amednews/2012/07/02/bise0705.htm

bdutton0005 · December 2012

I actually had it happen with a procedure ( not labor or baby relate) but the Doc scheduled me for an u/s and I didn't show I atually forgot and didn't reschedule thehospital documented it as an AMA declining. When I went to have it performed the insurance wouldn't cover the u/s because it was the same order from the same dr and then refused to cover the surgery that I needed because at that point it was considered an emergency situation because I had "AMA'd" the original u/s. We fought it but the lawyer and everything said they were in the right so we paid completely out of pocket for it.

sthomas1222 · December 2012

Do your research. From my understanding you have to sign a form for something to be declared AMA. But I really don't see how an insurance will/could deny any bills pertaining to L&D b/c that baby is coming and you need medical help even if you didn't do what your doctor wanted. It's different than showing up at a hospital and then refusing treatment and leaving which is what AMA is typically about. I've also had a doctor tell my pregnant friend who refused a CT that it's bullcrap and that if she continued to have pain and come back, the insurance would still cover it... So who freaking knows, insurances follow their own damn rules and break them all the time. But even if you were further along, I'd still be telling you to switch. I switched at about 26 weeks. Even though I ended up with a high risk OB instead of a midwife DH and me have never regretted leaving my other OB.

nosoup4u · December 2012

Switch doctors!

Do you have any early first trimester u/s? I had one around 5-6 weeks, and then another at a different hospital at 20ish weeks. The second one dated me ten days ahead of when I knew I was due, and luckily my MW understood and went by the early date. I would push any earlier u/s dates you have when you switch.

I'm with pepomnt about AMA and insurance, I don't think it actually happens.

iris427 · December 2012

nosoup4u:
Switch doctors!
Do you have any early first trimester u/s? I had one around 5-6 weeks, and then another at a different hospital at 20ish weeks. The second one dated me ten days ahead of when I knew I was due, and luckily my MW understood and went by the early date. I would push any earlier u/s dates you have when you switch.
I'm with pepomnt about AMA and insurance, I don't think it actually happens.

I believe that it happens sometimes. Insurance companies love to find reasons not to pay out on a claim. But I wouldn't agree to an unnecessary induction just because of it.

It is kind of weird for them to say a spontaneous labor was AMA because you weren't induced. How can *birth* can be against medical advice? The baby has to come out, and it's not like we're talking about elective cesareans (which I also think insurance should cover FWIW).

nosoup4u · December 2012

iris427:
nosoup4u:
Switch doctors!
Do you have any early first trimester u/s? I had one around 5-6 weeks, and then another at a different hospital at 20ish weeks. The second one dated me ten days ahead of when I knew I was due, and luckily my MW understood and went by the early date. I would push any earlier u/s dates you have when you switch.
I'm with pepomnt about AMA and insurance, I don't think it actually happens.
I believe that it happens sometimes. Insurance companies love to find reasons not to pay out on a claim. But I wouldn't agree to an unnecessary induction just because of it.
It is kind of weird for them to say a spontaneous labor was AMA because you weren't induced. How can *birth* can be against medical advice? The baby has to come out, and it's not like we're talking about elective cesareans (which I also think insurance should cover FWIW).

Yeah, I dunno. It just seems like it wouldn't hold up under legal scrutiny - if a mom and baby are on record as being healthy, exactly what you said. Women have got to start taking hospitals/insurance providers/doctors to court over birth rights, man!

iris427 · December 2012

nosoup4u:
iris427:
nosoup4u:
Switch doctors!
Do you have any early first trimester u/s? I had one around 5-6 weeks, and then another at a different hospital at 20ish weeks. The second one dated me ten days ahead of when I knew I was due, and luckily my MW understood and went by the early date. I would push any earlier u/s dates you have when you switch.
I'm with pepomnt about AMA and insurance, I don't think it actually happens.
I believe that it happens sometimes. Insurance companies love to find reasons not to pay out on a claim. But I wouldn't agree to an unnecessary induction just because of it.
It is kind of weird for them to say a spontaneous labor was AMA because you weren't induced. How can *birth* can be against medical advice? The baby has to come out, and it's not like we're talking about elective cesareans (which I also think insurance should cover FWIW).
Yeah, I dunno. It just seems like it wouldn't hold up under legal scrutiny - if a mom and baby are on record as being healthy, exactly what you said. Women have got to start taking hospitals/insurance providers/doctors to court over birth rights, man!

Totally. I think VBAC bans are BS from a legal POV too. How can you tell a woman she *can't* allow a normal physiological function of her body to happen? It's all crazy, all of it.

NoeK · December 2012

Thanks for all the input, I made some calls and scheduled an appt with a new OB who seems very natural birth friendly. So I guess we will see how it goes.

ErinOC · December 2012

Just FYI, I kept getting the run around from Cigna when I would call too. My CNM billed them, and they covered her as an out of network provider for my home birth. My insurance is also in CA.

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Can a hospital refuse to admit you if you refuse an induction?- long

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