High-Risk Expectant Moms Shouldn’t Have to Worry About Their Insurance, Too


High-Risk Expectant Moms Shouldn’t Have to Worry About Their Insurance, Too


 

By: Erica Heitmann, MD

An expectant mother facing a high-risk pregnancy has a lot on her plate. She understands the importance of monitoring her health and that of her baby. She knows to keep in mind the immediate life changes that will occur once her baby is born. The last thing she needs to deal with is the burden of finding a new doctor because hers has been dropped by her health insurance provider. She has the fundamental right to convenient, high-quality care.

Why would a doctor be dropped by his or her insurance carrier? The reality is today’s health insurance companies can and do add medical practices and drop others without fully understanding their own clinical network needs. And, if you are a patient of one of those physicians when that happens, you may find yourself needing to find another doctor.

The foundation of Obstetrix Medical Group, a national physician group made up of maternal-fetal specialists or perinatologists, is built on the concept of continuity of care for high-risk pregnant women and premature or critically-ill newborns. Continuity of care, also known as continuum care, as defined by the National Institutes of Health is concerned with quality of care over time. It is the process by which the patient and his/her physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost-effective medical care.

So what happens to continuity of care when one of those doctors is no longer part of your insurance plan?

For the past 18 months, Obstetrix Medical Group has been in good-faith negotiations with UnitedHealthcare regarding contract renewals, by agreeing to implement strong quality performance criteria and to forego any rate increases. However, since Obstetrix Medical Group could not agree to a second round of significant payment reductions, UnitedHealthcare has dropped all Arizona physicians and advanced practitioners – approximately 200 providers in total. I am just one of them.

As a result of the drop in coverage, more than 6,000 patients in Arizona may be forced to find alternative high-risk medical providers at a time when they need the very best access to care and the least amount of stress in their lives. For high-risk expectant moms, finding a new physician can lead to fragmented care. In fact, the Obstetrix Medical Group’s Maternal-Fetal Medicine physicians are one of only a few full-service high-risk providers in Arizona that perform high-risk deliveries and cover most of the rural communities within our state.

For the past 20 years, patients at any of the six Obstetrix Medical Group practices throughout Arizona who are insured by UnitedHealthcare, have been able to receive the best possible care no matter where they work or live. Despite this contract termination decision by UnitedHealthcare, Obstetrix Medical Group’s physicians have not turned away any children or adults facing critical health conditions and needing fundamental access to care. This is in spite of the fact that there is no assurance from UnitedHealthcare that the provider will be compensated for this care.

Obstetrix Medical Group patients have been contacted and are being given other options. They can contact United at (800) 985-2356 and a website is available, www.obx-az.com to provide them with other tools and resources they may need.

Obstetrix Medical Group’s goal is always to provide the best medical care to patients. It’s unfortunate that UnitedHealthcare’s demands are creating an inadequate and fractured network of high-risk providers and ultimately putting our patients at risk.

Dr. Erica Heitmann joined Obstetrix Medical Group as a Maternal-Fetal Medicine physician in 2013 after completing her fellowship in Maternal Fetal Medicine at The University of Missouri-Kansas City. Dr. Heitmann is board certified in obstetrics, gynecology, as well as maternal fetal medicine.

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