Western wolfParticipantStatus: PhysicianPosts: 18Joined: 03/08/2016
Curious what the WCI community thinks about this – or even better if anyone has done something similar in the past., advice from OB’s or Pediatricians would be especially appreciated:
My wife is 37 weeks pregnant (G3P2). We have a high deductible insurance plan to take advantage of the Stealth IRA. Our first two deliveries went without complication and resulted in beautiful, healthy babies. Both deliveries were met with very high medical bills – essentially we maxed out our “high deductible” twice with each birth – once for Mom and once for Baby. In both situations absolutely nothing was done for either mom or baby that necessitated an inpatient admission. The bills were extremely expensive as our deductible is 3,500 for mom and child so we are talking 7,000 dollars.
I am an ER doctor and my father is a family doc with pretty extensive OB and pediatric experience. I am not quite comfortable with the risks of doing a home delivery but I am considering signing out AMA from the hospital after our childbirth if everything goes smoothly during delivery and our baby is looking and acting normally. I would obviously watch the baby very carefully and return to a hospital if there were any sign of distress, any failure to pass meconium, or difficulty feeding. I would also have a prompt outpatient appointment with our pediatrician and my wife’s midwife.
I know this sounds crazy but to save $3,500 (babies deductible) and probably avoid maxing out my wife’s deductible (since her hospital stay would be much shorter) I kind of want to do it. It seems to me like the biggest legal risk would be if our midwife or the pediatricians call CPS on us for leaving AMA with a child – even in this scenario I find it incredibly unlikely that CPS would think our home was unsafe for a newborn child. In terms of medical risk I can’t think of any large advantage to being inpatient vs being home given that I’m a physician and would be able to closely watch our newborn and return to the hospital immediately if needed (usually it’s nurses that are checking on the baby anyway other than the brief exam that the pediatric resident does the next morning). I would also make sure to check bilirubin levels either at the pediatricians office or I could order the test myself and have it checked at the local lab.
Very curious what everyone thinks, THANKS!January 1, 2019 at 3:43 pm MST #177654jacoavluModeratorStatus: PhysicianPosts: 1425Joined: 03/01/2018
I think you’re crazy
What does your wife think
The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVAWestern wolfParticipantStatus: PhysicianPosts: 18Joined: 03/08/2016
If it were up to her we would be doing a home delivery. Care to elaborate why you think I’m crazy?January 1, 2019 at 3:59 pm MST #177659SValleyMDParticipantStatus: PhysicianPosts: 340Joined: 05/12/2016January 1, 2019 at 4:07 pm MST #177664hatton1ParticipantStatus: PhysicianPosts: 2733Joined: 01/11/2016
I would check to see if the entire bill will be denied if you leave AMA. I am under this impression but I have never verified it. When I was a resident we discharged some patients 2-3 hours after delivery if they did not have an epidural and wanted to go. If all goes well I think this is ok. Staying 2 days is mainly for education on childcare or breastfeeding help. Do not get fixated on this because you never know. It could be a section for something unanticipated right now.
I blog at http://doctoroffinancemd.com/White.Beard.DocParticipantStatus: PhysicianPosts: 579Joined: 02/06/2016
Your thought process sounds reasonable. Go to the hospital in case something unexpected comes up. Once you know the likelihood of something unexpected happening is highly unlikely, take mom and baby home. As long as mom feels up to getting in the car to go home, it sounds like an ok plan. And I doubt the hospital would report you to CPS since you have the capacity to provide safe and reasonable care to the baby and to mom based on your education and training.
However, would you be saving any money on your share of the bill? Wouldn’t the charge be over the deductible just for 24 hours in L and D?
You might be better off speaking to the hospital finance folks in advance, let them know you are going to be paying cash, and ask them for a self pay, pre-negotiated rate for up front, cash on the barrel. In my area, many hospitals are willing to make a deal with advance planning. Like special rates for cash paying cosmetic patients, etc.hatton1ParticipantStatus: PhysicianPosts: 2733Joined: 01/11/2016
I think most deliveries are a global fee so calling is a good idea. You may hit your deductible no matter what you do. Of course you may not like hotel hospital for 48 hours if the delivery is easy.
I blog at http://doctoroffinancemd.com/jacoavluModeratorStatus: PhysicianPosts: 1425Joined: 03/01/2018
Yeah are you sure AMA after delivery saves you over a one night stay? You should ask. And isn’t most of baby’s initial care under mom’s deductible?
There’s a difference to me between a plan, and a surprise AMA exit. Have you talked with the doc that’s planning to do the delivery?
you can check mdsave.com some places are now offering bundled prepayment online discounts
The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVAJanuary 1, 2019 at 4:28 pm MST #177673AnneParticipantStatus: PhysicianPosts: 614Joined: 11/07/2017
I have had a couple of friends go home same day after uncomplicated delivery sans epidural of 2nd/3rd baby. Not AMA. Maybe this is more common in certain parts of the country? They still hit their deductible though.ZZZParticipantStatus: SpousePosts: 103Joined: 06/18/2018
You’ll probably max out your deductibles either way.
You’re an ER doctor…why don’t you just work an extra shift or two and not worry about rushing your newborn and post-partum wife home to potentially save a few hundred bucks? Sure, odds are very high that nothing untoward will happen, but in the unlikely event something goes sideways, would you and/or your marriage survive…all so you could fund an HSA?
And, as she’ll deliver in January, odds are both mom and baby will incur additional medical expenses this year, so you’ll end up paying that deductible sooner or later this year. Report back at the end of the year…I bet this doesn’t save you any money, or only a trivial sum.
FWIW, the whole ‘insurance won’t pay if u leave AMA’ is urban legend.PedsParticipantStatus: PhysicianPosts: 2374Joined: 01/08/2016
If it were up to her we would be doing a home delivery.Click to expand…
ok that is crazy.
also vit K and vaccines please.RocketBoosterParticipantStatus: PharmacistPosts: 57Joined: 05/06/2018
Definitely sounds crazy… and kind of laughable to consider those options in the grand scheme of things (the money you’d be saving vs. the money you are earning as a physician vs. the chance that things don’t go as smoothly during birth this time). Risk vs. Benefit? I know what I’d be doing.
And… it’s almost as crazy as having a home birth in 2018 with no vitamin K/vaccines (as the poster above said), but not quite that insane.TimParticipantStatus: AccountantPosts: 809Joined: 09/18/2018
If everything goes as planned, great.
If something goes wrong, you have a plan too.
If your plan doesn’t work, no amount of insurance or talk will clear your mind. Not only the loss, but the fact you wanted to save a few bucks would crush you as Dad and husband I think.
If colleagues wife and child cane into the ER with serious injuries, would you think it better for you or him to take the case?
Your assigned role in creating your family is Dad, plain and simple. Sit back and enjoy it!trebizondParticipantStatus: ResidentPosts: 66Joined: 12/31/2017
My understanding is that insurance will pay despite AMA but readmissions for any or possibly specific reasons may not be covered. Not sure if God forbid mother or baby had any sort of complication that prompted going back to the hospital if this would be covered if it was within the realm of something that could have been (more) efficiently picked up during the 48 hr post-partum window.
My background is in internal medicine and pediatrics. I think for savvy families leaving the hospital the next day after the delivery is not totally unreasonable. I would not advise leaving before 24 hrs or so post-delivery because we do want to do the newborn screen after 24 hrs of life and get the congenital heart screen then as well as chances increase that the ductus is narrowed or closing when the testing is done.
The 48-72 hr observation periods +/- labs are not entirely random. They are benchmarked on sepsis risk which is based on prolonged rupture of membranes and GBS status and whether mom was treated or not, and of course anything else even more alarming like chorio.
I think your best bet rather than leaving AMA is negotiating with ob and peds about a discharge at ~24-30 hrs post-partum. Many people will be reasonable about that. They will respect your medical training but you’ll get further by negotiating rather than up and running.
Added to this, I think it’s paramount that your wife be driving this ship. You don’t want her to feel pressured to get out sooner than she’s comfortable, or feel like her baby could have benefited from an extra day in hospital. Not dismissing your role as the father, but in the peripartum period you should probably be guided by your wife when making decisions to go against obstetric or pediatric recommendations, conservative although they may be.wideopenspacesParticipantStatus: PhysicianPosts: 833Joined: 01/12/2016
I’m guessing the delivery itself will meet the deductible so signing out ama is pointless. I left 24 hours after having my last baby, I don’t think 48 hours is the standard anymore for an uncomplicated vaginal delivery. So do what your doctor recommends.
Please don’t do a home birth. We had a fourth year anesthesia resident and her ED attending husband do a home birth about 7 years ago. Baby died. Mom has PTSD and has been unable to finish residency. I can’t imagine living with the guilt of knowing my choices caused my baby’s death. 7k is well worth a healthy baby and mom.
Congrats and good luck!