Healthcare billing: He's pregnant, so they billed Workmen's Comp

In getting my son off to college, I just ran across this story, which occurred just before he was born, when my wife Daryl was pregnant.

Ken's story, Sept. 15, 1989:

We've kept Daryl's pregnancy confidential until recently, hoping to restrict the news to a small circle of our parents, closest friends, doctors, nurses, technicians, receptionists, and medical records technicians. Imagine our surprise when the first bill was sent promptly to her employer!
Telephoning, I learned that of course, this information was not released maliciously; bills for Workmen's Compensation are always sent to the company. But wait! This wasn't an accident; it was a planned pregnancy. And the process that brought it about was definitely not industrial, mechanical, or manufactured. In short, it wasn't a Workmen's Comp claim, as should have been obvious from a cursory reading. Apparently, the billing clerk at the doctor's office somehow entered Workmen's Compensation as the payer. When the computer did not immediately reject the claim, the clerk assumed it was okay, as did the laboratory staff and hospital staff. The computer didn't express any surprise that my pregnant insured wife Daryl was "male," nor that a urine sample was claimed as an inpatient procedure, nor that Workmens Comp will not pay for pregnancy (which my wife, I hope, did not incur on the job!).

During my phone call, I tried to reach the only person whose name appeared on the bill, but she had left the hospital staff. Instead, I reached a clerk who had initialled the bill. Her spoken English was modest, so I explained: No, my wife does not have a baby. No, we didn't have a baby that died. Yes, my wife is fat, but I don't mean that she is at high risk because of it; she is getting fatter, and in a few months she will have a baby and then she will not be fat. And so on.


The story has a happy ending: our HMO was billed, so neither Daryl's employer nor we had to pay. More importantly, our son was born several months later, and is now a fine young man of 21.

I wrote this story on the birthday of my father, may he rest in peace, and I can hear his ready laugh.

Ken's Advice: Dispute your bill if you have to, and keep your sense of humor.

Read more stories in my book, Getting Your Best Health Care: Real-World Stories for Patient Empowerment.

Out of state on vacation: C-section and medical advice

Dr. Linda Burke-Galloway's story:
My patient was a 20-something female in her 34th week of pregnancy who complained of decreased fetal movement for 2 days. I sent her to the hospital to be evaluated with specific diagnostic tests. Six days later, I received her report and it was alarming. I assumed she delivered her baby but called the hospital to verify what had occurred. There was no record of her delivery and she had TWO reports written by the same radiologist that were conflicting. The first report suggested that she should have been delivered immediately, the second suggested that she be kept overnight for observation or at minimum, return to the hospital the next day for a repeat study.

I called the patient assuming she delivered at another hospital but did not receive a response and left a voicemail. She returned my call the next day advising me that she was out of state on vacation. I asked her to please go to the nearest hospital immediately because her baby might be in trouble. She followed my advice and was immediately admitted and had an emergency C-section because there was no fluid around the baby.

Had this patient not be sent home inappropriately, she would not have traveled out of state. Had I not been proactive, there might have been a sad ending. The purpose of my book is to prevent sad stories. Many patients unfortunately fall through the cracks and I'm attempting to reduce that.

Advice to pregnant women: Find a pro-active obstetrician for the sake of your unborn children.

Read another birth story. Thanks to Dr. Linda Burke-Galloway, who wrote Smart Mother's Guide to a Better Pregnancy.

Birth is sacred and a joy: Home birth

"For a normal, healthy pregnancy, the hospital environment is overkill," says Jessica Reid, 27, a stay-at-home mother in Pasco, Washington.

Jessica had her first baby in a hospital, but plans to have her second – due in late August – at home. "Interventions that neither the mother nor father wish to occur are more likely when surrounded by people who view pregnancy as an illness or labor as inherently dangerous," she says. "I consider birth sacred and a joy, and I intend to birth my baby in a way that reflects that."

She used an experienced midwife for her prenatal care and delivery. The midwife was equipped with a fetal heart monitor, oxygen tank, blood pressure cuff, etc. Jessica soaked in a small birthing pool to relieve her labor pains.

Midwives assist most planned home births. Midwives generally accept only low-risk pregnant women, excluding those with diabetes, high blood pressure, or multiple births. Even so, they travel with basic emergency equipment, including resuscitation gear, oxygen, and medication to stop hemorrhaging. They emphasize that they practice prevention, and know how and when to get a woman to the hospital.

Advice to pregnant women: Think carefully about how you would like to deliver your baby, and make sure your medical provider knows and will heed your preferences for pain relief, C-sections and other options.

Read a very different midwife's story.

Thanks to Ada Calhoun for the source story in the August 18 issue of Time magazine.