Who's Gonna Pay If I Leave AMA

So a girl walks into a hospital...

Sounds like the start of a joke, yes?

Let's continue...

So, a girl walks into a hospital 'in labor'. She goes through triage, where they separate her from her birth team for 'a quick few minutes'. The check her cervix, she's 3cm. Her water breaks on the table while they're checking her. An hour later, she's 3cm and her contractions have fizzled. Her birth team still hasn't been reunited with her regardless of  her requests for them.

She notifies her nurse of the fact that she's planning on going home, getting freshened up, meet up with her husband, and they'll probably be back sometime later that evening.

The nurse says they can't leave. She says she's going to leave, even if she has to leave AMA.

The doctor says, that, if she leaves the hospital AMA, her insurance won't pay for her care.

I'm here to tell you that that is a lie.

We have a few possible reasons why they would say this:

  1. they don't know any better and really believe this is true. After all, this has been perpetuated as an urban medical myth for quite some time. 
  2. they know better but use this as a coercive tactic to keep mom at the hospital. 
  3. they know better and have every intention of writing in the file to not bill insurance later so mom is footed with the cost in order to 'pay her back' for not following the doctor's orders. 
The truth of the matter is, I have seen all three as reasons in action. Once, I provided proof that insurance would indeed pay for a clients care even if she left at 24 hours postpartum 'AMA'. He was genuinely surprised and happy!

Many other times, I have seen them back pedal defensively when I bring up the same information with clients who want to leave AMA... getting angrier and more coercive.

And yes, I have actually seen it notated on one nurses file electronically after a mom asked the doctor for the paperwork to leave AMA. The doctor went to the nurse, said something in low tones to her, and left the room. The nurse typed in the notes section, "do not bill insurance as patient is leaving AMA". I called her out on it and the nurse blushed the deepest red. The doctor came back in and blamed it on the nurse, who erased the notes. Later, when mom had birthed and received her bill from the hospital, none of the stay had been sent to her insurance claims department; she called her insurance and confirmed. She called the hospital and they attempted to give her the run around about AMA and insurance declination. She had to have her insurance call the hospital to get it covered.

So, bottom line, yes, insurance will still cover you if you check yourself out AMA. For more information see below:

  • http://www.ncbi.nlm.nih.gov/pubmed/22331399
  • http://thehappyhospitalist.blogspot.com/2011/05/will-my-insurance-pay-if-i-leave.html
  • http://www.amednews.com/article/20120705/business/307059997/8/
  • http://www.epmonthly.com/whitecoat/2010/05/will-insurance-deny-payment-if-you-leave-ama/
  • http://www.uchospitals.edu/news/2012/20120203-billing.html
  • http://patients.about.com/od/atthehospital/fl/Choosing-to-Leave-the-Hospital-Against-Medical-Advice.htm


It's Just Going To Hurt - And I'm Sorry

My husband and I went to a local comedy joint, as we often do, and had the privilege of watching the act of inspirational comedian, Darryl Lenox. Darryl is a man who's personal struggles, both physical and emotional, have provided him with the substance needed to bring his audience to chuckles and tears, motivation and amusement.

At one point, while talking about his eye surgery, he begins to explain how his cataracts were extensive enough that his pain medication wasn't touching the discomfort he was feeling. 

His doctor offered to stop the surgery, or to put him out with general anesthesia. Darryl replied that he didn't want to be put under general anesthesia because, in the event the surgery went awry and he lost his sight completely, he wanted to 'watch the lights go out'.

So his doctor made a very profound statement:

"This is just gonna hurt, and I'm sorry." - Darryl Lenox, 'Blind Ambition'

How many times in our lives would that statement have been helpful? Darryl expounds upon this by giving us a bit of humor.. It would be helpful to have this advice in high school, during our wedding vows, and so many other times... 

And what about birth? There are times when I hold a woman's hands while she is piercing me with the 'look beyond the birthing room' stare. She breathes heavily on my face and gasps, "but it hurts!"... and I do, I hold her gaze and earnestly say, "this is just going to hurt, and I'm sorry." 

Sometimes labor's just uncomfortable, but sometimes it hurts. I'm always honest with my mamas, but sometimes my best tool is to give her this type of honesty.  Breath awareness, counterpressure, massage, mantras... sometimes they all fall to the wayside and we are left with the root of it. 

This is just going to hurt, and I'm sorry.

How much freer could some mamas be, could we all be, if we were given that raw honesty so that we could accept, and surrender to, it? 


Small-Minded Birth Workers

Some of you might know, or it may come as no surprise to you that don't know, that there are a number doula support groups on Facebook.

The intent of these pages are many-fold. Some are intended to help you grow your business, others are on ethics and peer review, while others are for mentoring and local/community support. Most of these are a combination of some sort.

Now, recently a doula friend of mine, who is a member of one such board, sent me a screen shot of a current conversation.

The focus of this group is outlined as such:
" We are strong business women. This group was formed because _____ saw a need in the doula industry.  ____ trainers wanted a place where doulas could discuss the business side of doula work.
This is a forum where we will be sharing marketing ideas, business strategies, answering questions and facilitating discussions. The purpose and intention of this group is to spread the  _______ message.  _______ is dedicated to helping women turn their passion into a paycheck.  _______ believes that Doulas should be paid for the services they provide and believe it is counter-productive to the industry when other Doulas provide these services for free or low cost."
Ok, duly noted that they don't promote or believe that doulas should offer their services for free or low-cost.

And duly noted that they say in their description that they are a group about the BUSINESS of doula work, But... 

But what I don't understand is how these 'professionals' can pretend that they are professional when they make disparaging remarks and ridicule others in the same profession for having differing business practices.

If we lose site of the heart of what a birth worker is, even/regardless to how it pertains to being a 'business', we cease being community changers. 

Now a side note, many of my fellow doulas and friends, both IRL and online, are a part of this group. Just because they are a part of this group does not mean that they partook in the very unprofessional behavior that you will read herein, or that they support this type of ethic. 

Another aside, I received these screen shots from someone not a part of this conversation - so none of the doulas involved sought me out - I sought them out for their side of the story.

Along the left hand column of this post, you will see a conversation that has since been deleted from the group (per an individual involved in this conversation). Also, since this conversation began, at least two of the women ganged up on have been forcefully booted from the group.

Yes, it's a closed group. Yes, it's a moderated group. And yes, they are allowed to keep whomever they want in the group. That is not the point. The point of this post is the unprofessional, unethical behavior and bullying that occurred in this thread. 

The conversation started with an innocent enough question: "do you see doing a discounted or free birth here and there as your business 'giving back to your community'? I don't."

From one individual who was a part of the conversation, there was some conversation immediately after that initial post that talked about how free and discounted services discounts the work we do as a doula. To which a doula came on and said, "It's making a difference.. it's impacting the community."

The next doula who came on replied a little more directly: "['discounting the work of a doula' poster's name], just because someone has the desire to give freely of THEIR services, THEIR skills and knowledge, THEIR time - does *not* mean that they do not value doula work as a 'profession'. 

That is just small-minded to say, I'm sorry but it is. I see is as less likely for someone who *only* does doula work to be able to do low-fee/free births than someone who offers various services/has another source of income. But those birth workers who *choose* to do that work, shouldn't be put down for it."

Snarky, derisive, rude, and condescending comments begin at that point and blossom into a conversation that is almost too painful to read. These remarks are made by both members and admins of the group, alike. Always lobbed at those who support the right of a doula to choose to give free or discounted services, regardless of their reasons for offering.

I have posted before on my feelings about people asking for low cost or free doula services, but I don't care what side of the fence you are on regarding free and low-cost doula services, the behavior of these moderators and members is completely unethical. 

Ethics: moral principles that govern a person's or group's behavior.
synonyms: moral code, morals, morality, values, rights and wrongs, principles,ideals, standards (of behavior), value system, virtues, dictates of conscience"

It is never professionally ethical to treat someone so disparagingly. Never.

One person asked what principles and basis a dissenter to the 'popular opinion' might be referring to when she said "I cannot disregard the principles and basis of what a Doula was meant for."

Let me expound on that dissenters response... As I pointed out in prior posts, and specifically in the history of birth partnersdoulas and midwives were not only meant for those women who could afford them. A doula was never a luxury item, although the term we use for our profession is one of luxury.

Doulas and midwives, godsibs and sage femme, historically went to every woman - not only those who could afford one. We trudged through hell and high water to ensure she had a good, supportive birth because we believed in a woman's right to have it - not because of what she could provide us.

The moderators and contributing members have completely missed the point of this calling. From their own words, it is easy to see that, to them, it is only a business. To them, the 'principles and basis' for what we do for women and why we do it has been lost.

get wanting to be valued in the community. I get wanting to be seen as a professional in the community. I get it because I wrote about it and continue to write about it. But the militant, aggressive, close-minded, and callous version that they believe? No way, I don't get that.

Hell, midwives in this area take state insurance and, as a default, offer reduced-fee services. Doctors do as well. Chiropractors and massage therapists in this area give reduced fee services and do community services and classes for those who cannot afford it.

Restaurants give free food to the homeless and grocers give food to the food pantries. A local man I know offers car services for the price of parts only on certain Saturdays for single mamas and spouses of deployed partners.

It takes a special kind of business owner to not see the merit of giving back to their community through their services in some capacity. And one I wouldn't want to do business with.

Shame on you, moderators and others involved in this disparaging and bullying thread. Shame on you for doing the very thing that you claim to be avoiding: making the doula profession unprofessional in every regard.

I will think of you next time I spend my time sending packets of information and resources and free samples to the 18 year old who is working her ass off trying to graduate with her class at the end of the year regardless of the fact that her mom and dad have all but disowned her and her baby's daddy is nowhere to be seen.

I'll think of you when I send her the name and number of an amazing midwife in the area that does offer her time and services free of charge just so that she can get out of the care of the only provider that her state insurance will cover that is within walking distance of her home because no one will drive her to a better doctor further away.

I'll think of you when I send her to a stellar up-and-coming doula who has a heart for these situations and plans on, someday, getting her midwifery license and traveling to third-world countries to help train birth professionals in every village.

And I'll think of you when she births her baby, on her own, into her own hands, surrounded by women who cannot disregard the principles and basis of what a Doula was meant for.

- actual situation in my professional past

*edited to black out their pictures ;) after receiving numerous 'requests' (well, threats) from a number of the women involved,. Only one woman contacted me and actually asked. Most of them cited Exploitative Law. But this doesn't fall into that category as seen here. As I told them, my intent was to draw attention to unprofessional behavior in our profession, not to individuals... As is apparent through my blacking out of the offenders names (insert roll eyes).. so I obliged. 

Some said it was yellow journalism. Some said I was muckraking. Some said was unprofessional for calling them out. But here's the thing: I didn't sensationalize or exaggerate it in the least. Hence the screen shots. It's only muckraking if I a) SOUGHT it out (which I didn't seek out this information b) it's considered 'scandalous'... to which I asked if they thought their behavior was scandalous? and c) they'd have to be famous. :/ 

And would you consider me a bully if I stood up against bullying? That's what's happening here. So there you have it. 


Rather than end on that note, tell me birth workers, how are you giving back to your community. Mamas, what are you doing to give back to those in your sphere of influence. 


From Two to Three Kids

This is a guest blog post from a local mama who is also a movie producer. Thank you, Maria, for your contribution. 
A windy day brought us together in Acapulco Bay, 19 years ago. Little did we know that we'd be sharing a life and a bed together with three angels. My husband and I joke that having our third child has made us into adults. I think before, we thought that we had time, we could afford mistakes, debt, a few extra pounds, and not worrying about writing a will. But since our son’s birth in June, we've refinanced our home, my husband is going to the gym (for both of us) 5 times a week, and we are currently writing a will. Not because having a third child will kill you, but because going from two to three kids is serious stuff. There is no more joking around. The kids now outnumber us and we need to have a plan.
I’m 41 and he is almost 50. We've been adults for a long time, but it just hasn't felt like it. We took 11 years to have our daughter, and in that time, we worked, fought, made up, drank margaritas, went to sunny beaches, and built a solid foundation on which we now have created a precious little family. I am thrilled to be a mom of three. But it’s not as easy as people say.  “Going from two to three is not a big change.” Those people are liars. Let me tell you why… 
There is never enough time to get anything done. We seem to always be running late. There’s a spill, a missing shoe, or a last-minute potty emergency. Going to the grocery store is an ordeal. You simply don’t have enough hands. Getting a shower feels like a treat. Eating out has never been this unpleasant. Also, we had to get a new car to fit everyone, and change rooms around in our house to accommodate the new addition. 
Then there’s the guilt, knowing that you can’t make everyone happy. Your older child feels like you’re giving them the responsibility of helping with everything because they’re older. The younger child is no longer the youngest. You can’t help them go to the bathroom, eat, or play with them as much as before because you have a tiny being dependent on your boob for food. You are always feeding the baby, or changing the baby, or rocking the baby to sleep. 
At least both of my “older” kids are out of diapers. And it also helps that they can express their emotions. My 6-year-old daughter has told me that I love the baby more than I love anyone. And my 3-year-old son has told me that he wants me to hold him like I hold the baby. Everything seems to revolve around this new family member. And it does. But I try to make it seem like it doesn't.
I make sure I have some sort of quality time with each kid. Even if it’s just for 10 minutes. I want them to know that they each have an important part of my heart. That they matter, are wanted, needed and loved as much as the other. 
I have been an adult for a long time. But I have never been this happy. If what Elizabeth Gilbert writes is true, that the number 3 "is the number representing supreme balance", I have found my equilibrium, my stability, my raison de vivre. I’ll take the messy house, the sleepless nights, the missing shoes, and the certainty that I must be crazy for having another kid. All for the pure smiles, and the 3 hearts which remind me daily that I was born to be their mom.

Maria Sotolongo stays at home to raise her three kids, 6, 3, and 3 months old. She left her TV job to enjoy her little ones full-time. In the few minutes she has of freedom, she loves photography, blogging, cooking, and is now producing a documentary about home births. You can find her and a short trailer of her documentary atwww.mariasotolongo.com
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