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Prenatal Tests

Posted Oct 02 2009 10:02pm

I just completed a nightmarish 4 day saga of deciding which prenatal diagnostic tests to have.  I got no real help from my doctors or the support nurses in the Future Moms program I am participating in.  I finally decided to stick with the Nuchal Translucency screening, which was what I did in both of my previous pregnancies.  It involves an ultrasound and a blood test and it looks for markers that indicate a higher likelihood of genetic problems such as Down Syndrome.  It does not test directly for these conditions, but just gives you an indication that you might want to take a definitive test such as an amniocentesis.  There is a pretty high rate of “false positives” – results that indicate higher risk when there is no actual abnormality present.  So you have to be prepared to get a scary result, take another test, and then wait about 10 days for definitive results.  I can live with that.  The NT screening also tests for neural tube defects and congenital heart defects, which CVS and amniocentesis do not, unless they are part of an identified genetic condition.  (I can’t find anything that tells me exactly what is tested for, just these broad outlines.) 

Because the problems with my first baby were detected through ultrasound, I like the idea of this direct “looking” at the fetus.  The 20 week ultrasound will be the most important one, but the NT screen will give me a measure of comfort if the results come back negative.  I also like that the test is more comprehensive, even if less definitive.  My situation does not lend itself to looking for any specific problem since the cause of my first baby’s problems is a total mystery.  I want the most comprehensive testing possible.

All of that was the easy part of the analysis.  The hard part was trying to compare the costs of each procedure.  Health insurance co-pays are supposed to signal costs to the consumer – something that has been lost in our insane collectivized health system. (Of course, the current proposed “reforms” of health care would make this problem worse, but I’m not going to get into that issue on my blog.)  My insurance company, however, makes it impossible to figure out what something will cost me ahead of time.  I spent 4 days making phone calls trying to figure out my portion of the costs of these tests, and ended up knowing nothing at all.  Finally, I gave up.  I’m going to rely on the fact that there is a yearly maximum out-of-pocket expense that I can pay.  I’m going to budget that full amount and be prepared to spend it.  I still have to be careful, though, because if I neglect to get a pre-authorization for a procedure that requires one, I’ll have to pay all the costs and my maximum won’t apply.  How do I know what requires pre-authorization?  I have to guess, and then call the insurance company for every single thing that I suspect might require it.  What clues do I have to go on?  Nothing.  Wish me luck!

The next thing that I decided to do was to get a flu shot.  That took over a week of work.  First, I had to figure out where I could get one under my insurance.  That took a few phone calls and hours in front of their web site.  Once I figured that out, I found that all of the places giving the shots would get a small supply, use it up, and then have nothing for weeks.  I had to keep calling different clinics and pharmacies every day to see if they had any shots and how long the wait was.  One time, I raced out to a CVS in the next town over, only to find that there was a wait of over 2 hours!  I got lucky last night and got my shot at my local supermarket pharmacy.  By just showing up and asking, I think I cut in front of dozens of people on the waiting list (they were waiting for a phone call from the pharmacy), but I could care less.  I’m supposed to have some kind of priority because I’m pregnant anyway, but I don’t know how I was supposed to exercise that priority.  

I’m still debating about whether I’ll get the H1N1 vaccine when it comes out in a month.  It is recommended for pregnant women, but I’m nervous that it is a new vaccine and that it was “rushed.”  I’ll think about that next month.

The bureaucracy of health care is one of the biggest stressors in my life.  Every single time I consider going to a doctor, I become confused, angry, and sometimes I just shut down.  I don’t trust the doctors, who are more concerned with liability and getting ripped off by regulations than in my health, my insurance company is my enemy, and I can’t stand the arbitrary rules, paperwork, and processes.  None of this bothered me at all with my pregnancy with Sammy.  The birth center I used was not part of the medical establishment and I didn’t use insurance, but just paid for it out-of-pocket.  I need to find some way to deal with the medical world this time, or else it’s going to suck all the joy out of this pregnancy.  Honestly, I don’t know how I’m going to do that.

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