Angry at primary care doctor

[AshLegend]

My primary care physician won't sign the referral I need to get insurance coverage for my birth center. Seriously irate right now. I've been his patient since I was 17 years old. I've always trusted him and thought of him as a forward thinking doctor. I have no serious health issues and am not considered a high risk pregnancy. His office sent a note to the birth center that simply said "dr. X won't agree to it " . There was a damn frowny face on the fax! It went on to say that I should get my OBGYN to sign off on the referral. The man has no clue.

In the state of Florida, insurance companies are required by law to cover midwifes and birth centers. In my case, my insurer isnt set up with my birth center. The standard protocol is to request in-network coverage for the birth center with primary care physician referral. Since this is the only birth center in the entire county, they will have to cover it. He will have to sign off on it. If he won't, I'll be forced to switch to a primary care doc who will.

After I cooled off a bit and let the anger subside, I decided to write him a lengthy, positively worded letter explaining my need for the referral. I'd have rather given him a piece of my mind.

 

[bassdesire]

Why didn't he give it to you? Can you get a referral from someone else?

 

[AshLegend]

I sent him a letter explaining why I needed his referral. I'm going to give him a few days and then have the birth center send him the form again. If he still won't sign off, I'll have to find a new primary care physician, transfer my records, and have them sign off. Not an easy task, either.

 

[bassdesire]

Not easy, but maybe worthwhile?

 

[bassdesire]

Why won't he sign?

 

[amjon]

I doubt the MW could accept you anyway if you already have glucose intolerance (and I would highly recommend NOT going to a MW if you do). I went to a MW as I was low risk, but ended up having my daughter die unexpectedly at 27 weeks. I just found out I have insulin resistance and that may have killed both her and our second baby that I MC. That is probably why he won't sign off on a referral. I don't know if going to an OB would have made a difference, but I really think it might as I wouldn't have had the crappy one from the hospital when I was sent there that deleted my NST (from 4 days before her death) after she died. I'm also in Florida.

 

[bassdesire]

I doubt the MW could accept you anyway if you already have glucose intolerance (and I would highly recommend NOT going to a MW if you do). I went to a MW as I was low risk, but ended up having my daughter die unexpectedly at 27 weeks. I just found out I have insulin resistance and that may have killed both her and our second baby that I MC. That is probably why he won't sign off on a referral. I don't know if going to an OB would have made a difference, but I really think it might as I wouldn't have had the crappy one from the hospital when I was sent there that deleted my NST (from 4 days before her death) after she died. I'm also in Florida.

I'm so sorry.

 

[AshLegend]

I'm very sorry for your loss, amjon. I suffered a miscarriage last year at 7 weeks and can only begin to imagine how difficult a third trimester loss would be.

I'm not certain why he wouldn't sign off. He suggested that my OBGYN should do the referral, so I kinda think he just doesnt understand why I was asking him ( i.e. insurance procedure). I really hope he isnt medically opposed to midwife birth or waterbirth in a birth center. If that is the case, I highly doubt I would be able to change his mind.

As to the impaired fasting glucose issue, it is totally under control. Its not diabetes. My 3 hour glucose test indicated levels in an elevated range but not high enough to be type 2 diabetes. I've had irregular cycles since adolescence, and my RE attributes this to the impaired fasting glucose. I have some of the signs of PCOS, but not enough clinical symptoms to be diagnosed with it. After the testing, I went on a strict diet and metformin. I lost over 25 pounds and now have normal blood sugar levels. I still eat a strict diet. I am not concerned with GD as i plan on continuing my diet, metformin, and excercise during my pregnancy. MY RE and midwife do not consider me to be a risk at this point in time. I just wany my damn waterirth

One of the wonderful things about the birth center I've chosen is that the midwife is an RN/CNM/ARNP and her husband, an OBGYN, supports the practice. If I develop any complications in my pregnancy, I would transfer to his care.

 

[amjon]

I'm very sorry for your loss, amjon. I suffered a miscarriage last year at 7 weeks and can only begin to imagine how difficult a third trimester loss would be.

I'm not certain why he wouldn't sign off. He suggested that my OBGYN should do the referral, so I kinda think he just doesnt understand why I was asking him ( i.e. insurance procedure). I really hope he isnt medically opposed to midwife birth or waterbirth in a birth center. If that is the case, I highly doubt I would be able to change his mind.

As to the impaired fasting glucose issue, it is totally under control. Its not diabetes. My 3 hour glucose test indicated levels in an elevated range but not high enough to be type 2 diabetes. I've had irregular cycles since adolescence, and my RE attributes this to the impaired fasting glucose. I have some of the signs of PCOS, but not enough clinical symptoms to be diagnosed with it. After the testing, I went on a strict diet and metformin. I lost over 25 pounds and now have normal blood sugar levels. I still eat a strict diet. I am not concerned with GD as i plan on continuing my diet, metformin, and excercise during my pregnancy. MY RE and midwife do not consider me to be a risk at this point in time. I just wany my damn waterirth

One of the wonderful things about the birth center I've chosen is that the midwife is an RN/CNM/ARNP and her husband, an OBGYN, supports the practice. If I develop any complications in my pregnancy, I would transfer to his care.

That's good that they have an OB ready. My blood sugars were always "normal" too and she still died because of it (or at least my endo thinks so). Being on Metformin should help you though. Don't think that having BS in the "normal" range means you're in the clear though.

 

[AshLegend]

My primary care doctor cooperated fully and my insurance company approved my birth center for in-network rates today!!! I am good to go with my natural waterbirth at the birth center, so long as no complications develop during the pregnancy.