Tag Archives: doctors

Diagnosis: Female?

16 Aug

Lots of people are talking about the decision on the part of HHS that all forms of contraception be covered for all insured men and women for “free” as basic preventive services under health reform. This decision came not a minute too soon. Recently I found myself having to call in a prior authorization for birth control for one of my patients. At first I figured it was just that the insurance didn’t pay for the birth control patch, Ortho-Evra, but did pay for other methods. However, it turned out to be more complicated. The entire conversation took a half hour and went more or less as follows:

Me: This is Dr. Pro Choice. I’m calling to get a prior authorization for ortho-evra for my patient.

Customer Service Associate: OK, let me look into that for you…(5 minutes of terrible muzak later) I’m showing we don’t cover that medication.

Me: Right, that’s why I’m calling. Can you tell me why you don’t cover that medication?

CSA: Let me look into that for you… (5 minutes of even worse muzak later) We don’t cover any contraceptive methods.

Me: What? Are you sure?

CSA: Yes Ma’am, this plan that your patient signed up for does not cover contraceptive methods.

Me: (after a moment of disbelief) So how can I get this for my patient? She can’t afford it on her own. She has Medicaid.

CSA: You can make an application.

Me: Great, let’s do that.

CSA: What is the diagnosis?

Me: Diagnosis?

CSA: Yes, what is the diagnosis?

Me: (long pause) Female?

CSA: That is not an accepted diagnosis

Me: Human? Able to get pregnant? Sexually active?

CSA: Those are not accepted either.

Me: Umm, OK, menorrhagia [not the real reason but a ‘real’ diagnosis].

[1 minute on hold]

CSA: Your request has been approved.

I wish I could say I made this up, but it happened just a few weeks before this decision came from HHS. There IS no diagnosis code justifying contraception as a way to avoid pregnancy, because diagnosis codes are built around illness. Avoiding pregnancy usually isn’t about already being sick, it’s about preventing something from happening. So birth control clearly belongs in the list of preventive services.

I fear politics will get in the way of the HHS ruling that all contraceptive services be covered free of charge under all insurers starting next year, but if not, women with private or public insurance will not have to pay for their birth control. This is a huge step for all women, and a small step for doctors like me who will no longer have to have conversations such as the one above.

Why YOU Should Be An Abortion Provider

14 Jul

Let’s face it: providing abortions is not the most popular job that a person can choose. Even among the pro-choice medical community, providing abortions is not something that you do; it’s something that you let other people do. I can understand why, too. People don’t generally go to medical school with expectations of being protested, harassed, and threatened when they finish their schooling and get a job. People don’t usually expect to have the simple question of “what is your job?” to sometimes have to be an awkward, nerve wrecking experience. With all of this, some people may wonder why anyone would want to become an abortion provider.

Still, regardless of how many anti-choice laws are passed and how many protests there are, the fact remains that women need abortions. As long as we have pregnancy, we will have abortion. As long as we have abortion, we will need abortion providers in order to keep the abortion process safe. Sadly, the fact is that we don’t have enough abortion providers. In the United States, we have over a million abortions taking place yearly. For all of those patients, we have approximately 1700 abortion providers. Do you see something wrong with this picture? I do.

So how do we solve this problem? Easy! We get more providers! How do we do that? Uh, maybe that’s not so simple. Here’s the truth; it starts with you. To me, one of the basic principles of activism is that, when there’s a problem, you don’t wait for someone else to fix it, or for the problem to fix itself. As activists, we are the repairwomen and the repairmen. We go out and we work our asses off to fix the world’s problems. Providing abortions does not have to be the necessary job that you let other people do. It can be the job that you go out and do yourself.

Obviously, abortion care is not the right career path for all people. However, I believe that one of the main reasons we have so few abortion providers is because so few people ever even consider abortion work as a career path. I don’t blame them. Becoming an abortion provider can seem to be like an “out of the way” kind of thought for most people. My mission today is not to get you to change your major or your career path. My mission today is simply to get people to think about something they may have never considered before: abortion care. A few years ago, every career looked undesireable to me. I had no idea where I was going in life. Then, I considered abortion care, and I found my calling. I decided that I am going to become an abortion provider. Who knows? Maybe this is your calling, too.

Long story short: we don’t just need abortion providers. We need YOU. No one is going to shame you if you decide that providing abortions is not for you; this does not make you a less valuable activist. However, maybe you have it in your heart to become an abortion provider. Maybe it’s simply something you have never considered. If you are one of those people, and particularly if you want to go into medicine, then this might be something to explore. I found my calling; have you found yours?