Help me help my very pregnant sister through a tough situation! (DC/MD)
May 24, 2014 11:51 AM   Subscribe

My sister is 33 weeks pregnant. She's miserable and what's worse, she's recently moved from Florida (where her husband was completing school) back home to Maryland. As such, she's lost her doctor. She's pretty much a mess, and I am hoping to figure out a way to help her. Particulars inside...

A few things that make this difficult:

- My sister was laid off from her job and then found out she was pregnant about two weeks later.
- She's been on Medicaid (in Florida) and recently got Medicaid in Maryland. Her husband's insurance at his new job doesn't kick in for 60 days. She is working in Maryland, but only part-time for now. She'll be going back to work after the baby is born, but there is no chance of immediate insurance for either of them.
- So far, she's not been able to find a doctor who is wiling to take her on. She's only missed one appointment (while she moved.)
- She told me she cannot go to the ER as Medicaid doesn't cover ER visits.

I've suggested she go in person to the local Medicaid office, but I don't know if that will result in anything. I also suggested she drop the 'I have Medicaid' statement and see if she could get in anywhere to be seen, and we'll figure out a way to pay out of pocket for the visit.

I am sure this is compounded by the fact that there is a smaller pool of OB's that take Medicaid. She's called Holy Cross's Clinic, but they only will take women who are less than 6 months pregnant.

Her doctor in Florida would be happy to call any doctor in Maryland to coordinate care, but so far, all the doctors she's called (Over 30) basically have shut her down. They either do not take Medicaid, or will not take on a woman who is 8 months pregnant.

I am sure her emotional state is compounding her frustration. What I am wondering is - is there any resource, group or doctor in Maryland that I could steer her to? She really just wants assurance that she's okay.

I don't know anything about state Medicaid. She's in the Annapolis area, but willing to travel to Bethesda, Silver Spring, and surrounding areas for a doctor. Her husband works in Downtown DC so they are hoping to find a doctor that can deliver at Holy Cross. But again, they are flexible in where she delivers - she just wants care!

Any help is appreciated!
posted by carmenghia to Health & Fitness (13 answers total) 1 user marked this as a favorite
Planned Parenthood is usually a good place to start with a question like this. Is there a location near enough?
posted by BlahLaLa at 11:54 AM on May 24, 2014 [2 favorites]

Has she popped her ZIP into this Medicaid provider finder? Here are all of the OB/GYN results for Maryland.
posted by DarlingBri at 11:56 AM on May 24, 2014 [2 favorites]

Sometimes if you ask to speak to a nurse -- not the scheduler -- when you call, you get better results. Schedulers can be inflexible crazy people. (I had an ob/gyn office refuse to see me because I hadn't already had a pap smear and the scheduler insisted that it was "too big an insurance risk" to see a woman who hadn't already had a pap smear. And I was like, "So, let me get this straight -- because I am calling to schedule a pap smear, that rules me out of receiving one? You can't be serious." She was. I had my GP call back and they scheduled me for that week, no problem.)

If you can find a GP who will take her on, have the GP's office call around. Or ask her Florida ob's office if their scheduler/insurance person/whomever would be willing to make calls. In general, doctors' offices are a lot more willing to schedule a lot more quickly and with less hassle when other doctors' offices call them.

If I were you, I would start calling the offices and when the scheduler says "sorry, only women less than six months pregnant," go nuts on them and be all, "So you're telling me that because my sister moved, she's going to have to deliver on the side of the road? That can't possibly be the standard of care. Women who, in this economy, have to move for work so they can feed themselves and their children aren't entitled to appropriate prenatal care? You think a better solution is to let them go without care until they turn up in the ER in labor? No. No. I want you to tell me how I'm getting her care, and I want to figure this out TODAY." It will probably eventually work if you keep making calls, and in the meantime it'd make ME feel a lot better to complain bitterly about how stupid their policies are.
posted by Eyebrows McGee at 12:03 PM on May 24, 2014 [8 favorites]

Mary's Center in DC is a nonprofit that does prenatal care:

I think all the GW OBs probably take Medicaid:

This is a birth center in DC that says it takes Maryland medicaid:

And this is a birth center in MD that takes MD medicaid:

There are also two megapractices in the area that might be able to squeeze her in if she is persistent enough. Reiter & Hill and Capitol Womens Health.
posted by yarly at 12:53 PM on May 24, 2014 [2 favorites]

Is there a possibility of her going back to Florida for care?
posted by Mistress at 1:30 PM on May 24, 2014

The medicaid doesn't cover ER visits has got to be a miscommunication. There are some policies in states that won't cover more than a particular number of non emergency ER visits or that won't cover something like a sore throat but seriously she's pregnant and it's most likely covered.

She may have better luck going in person to a clinic and talking. It is much much harder to ignore a very pregnant and emotional women in person than it is to hang up the phone.

There are lots of programs for low income mothers and mothers to be. Maybe call around to them and see if they have recommendations. Try groups that may not even necessarily serve your sister but work with people in tough situations who may not get care until late like teenagers.
posted by AlexiaSky at 1:41 PM on May 24, 2014

Here is the PDF of Maryland Medicaid's covered services, including:
Hospital inpatient and outpatient (acute, chronic, psychiatric, rehabilitation, specialty)

I'm not sure where she got the "Medicaid doesn't cover ER visits" thing.
posted by melissasaurus at 2:13 PM on May 24, 2014

yarly put together a good list. I'll add a direct link to Family Health and Birth Center in NE DC. Most of their clients are on Medicaid, they are used to dealing with people in difficult situations, and they have a group model for appointments that might be good for her. They do deliveries at Washington Hospital Center.
posted by Xalf at 4:38 PM on May 24, 2014 [1 favorite]

It's not clear exactly how your sister has been phrasing this in her phone conversations, but is she making it clear that she has been getting consistent prenatal care and wants to transfer her care to a new doctor due to a household move?

Basically, women who haven't been getting any prenatal care are much riskier so OBs are hesitant to take them on. (Which still makes absolutely no sense because then wouldn't it be MORE important for them to see someone? But whatever, that's what I've read / heard.) There's a big difference between, "I'm 8 months pregnant and need a doctor" and "I need to transfer my prenatal care from my doctor in Florida due to a household move. Can I have my Florida doctor call your office to discuss my transfer of care?"

Seconding the previous poster that she may have more luck if she gets through to a nurse rather than a scheduler. In my experience, the nurses in these practices are pretty empathetic and want to help. The nurse is also going to have a direct line to the doctor who is the one who decides who gets taken on as a patient.

Even if that doesn't work with a specific practice, if she manages to get a semi friendly nurse on the phone, I would then ask that nurse what she would recommend... "Look, I understand that you can't do anything about your clinic's policy. But I have been getting consistent prenatal care up until this move required me to move states. I've called over 30 clinics and no one is willing to help me. What would you recommend? Can you do anything to help me? I need to see a doctor, I know how important good prenatal care is."

I also had the thought that it may be more useful to go in person rather than via the phone, but at most OB offices I've used, you aren't getting past the front desk to talk to anyone other than the check in lady unless you are a patient.

It might be worth calling the hospital where she wants to deliver and explaining the situation and then asking them what they would recommend. A lot of hospitals have a patient services department or something similar, if she could get through to them, they may have some ideas as well.
posted by pallas14 at 5:26 PM on May 24, 2014 [3 favorites]

All -

Thank you for the links, and very thoughtful answers. I am forwarding all the links to her. Up until she lost her job, she had insurance through her employer, so this has been very stressful for her. The timing of her pregnancy wasn't the best, but she and her husband had planned to have children - it just happened a little earlier than they had expected.

@pallas14 - I think she's been WAY too emotional and upset on the phone and I think a script such as yours would be very helpful. I am going to suggest she word her introductions like you mention. I tried to explain something similiar over the phone, but she started to cry. I think seeing it written out, and being able to refer to it will go over much better for her. Her doctor in Florida was by all accounts - wonderful, so I would imagine they'd be happy to coordinate care with her new provider in Maryland, and I truly think having the doctor's office advocate for her is the best route.

You all really made me feel like I had something more to offer her - I cannot thank you enough!
posted by carmenghia at 6:26 PM on May 24, 2014

Memail me if she doesn't get in to a prenatal soon. I am connected to a powerful coven of lobbyist mommies in DC and we will figure something out.
posted by yarly at 5:32 PM on May 25, 2014 [1 favorite]

Thanks yarly! She's going to try the places suggested on Tuesday and use the script to explain her situation - it's good to know I've got a coven in my back pocket if she continues to get stonewalled. I'm in NYC so it's been hard to help remotely.
posted by carmenghia at 9:29 PM on May 25, 2014

I just wanted to second for clarity that Medicaid absolutely does cover emergency department visits, otherwise it wouldn't be much good as a safety net for low income people. I'm no expert in Medicaid, but I do work in an emergency department, and I know at least in some of the states I worked in, the staff would get irate that some of the Medicaid patients seemed to abuse their freedom in using the ED for medical care, because ED visits didn't incur any co-pay but primary care visits did. It doesn't sound like your sister needs an emergency department right now, but if she does at some point, I don't want her to be afraid to go.
posted by treehorn+bunny at 9:52 PM on May 25, 2014

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