Me Versus The Insurance Company Doctors, A Saga

1 Feb

I’m slightly ashamed to admit that I was nearly appalled at the idea of pre-baby maternity leave just a few months ago. “Why would I need that?” I wondered belligerently. “I’d much rather have more time off after the baby is born. And I’m perfectly healthy. I can totally work up until the birth.”

And then I suddenly I was in my third trimester, and everything was a little bit different. Even though I’d worked while pregnant with Lucia until about a month before her birth, my schedule and my body were a bit different then. This time around, about 33 weeks along, I was walking out of work on a Thursday, and I told my co-worker, “I’m so exhausted that I think if I went into labor now I’d roll over and beg for a C-section instead.” Even though avoiding surgery is pretty high on my list of things to do, and I’d like to think that I’d get some special energy from the excitement of labor and all, I was not very convinced at that moment. Exhaustion will do that to you- just crumple up your values and throw em in the trash while the real you watches with her mouth hanging open. “Now I see why they give you maternity leave beforehand.” I concluded.

Granted, if they had given me options about how to split up my 3 months of maternity leave, I probably would have opted for more time post-baby and less time pre-baby. Six weeks after having a baby is just not enough time to adapt and go back to work full time. All countries ought to follow the lead of these places giving 6 months to up to two years of paid maternity leave. Seriously. I got to not work with Lucia for almost her whole first year of life, and I needed that time to adapt and recover and bond. Not that you don’t make do if you have to go back to work, but six weeks postpartum I was still reeling from the changes. We moved to Mexico when Lucia was 7 weeks old, and I remember thinking, “well, as hard as this is, at least I’m not going back to a full time job now!”

But now I don’t have a choice. I am lucky to be in Mexico and not the U.S., though. At least I have paid maternity leave, period (Geez, ‘Merica, get with the program). There is no option, though, for how you spend your time off. Where I work, the insurance company pays your leave, based on your due date. They give you 42 days (6 weeks) before your due date and 42 days after the baby is born. Once your baby is born, your second six weeks begins, so there’s no carryover on those other days if your baby is born early. This also probably explains why my doctor informed me that my baby “couldn’t” go past 40 weeks of gestation.

See, the doctor works at/for the insurance company. It’s all just one thing. One option. Take it or leave it. There’s no “you can choose from these doctors” about it. There is a building which serves as the medical facility for the insurance company, and that’s where you go if you have this insurance. There is more than one doctor at the insurance company, but it’s all the same service. You are assigned a general practitioner, and that’s who you see, unless you request a change, for a doctor who might or might not be any better (probably not), and who is still just a medicalized bureaucrat with the insurance company’s best interests in mind.

Of course, I tried to rebel against the system. I looked for loopholes. I planned and plotted and fretted about the situation. I desperately wanted to find a way to have more time after the baby, in exchange for less time before. For one, I hoped that I could finish up the semester that way (which ends in February). I also worried about the implications of basing my leave on a due date, a date which is a very rough estimate that could be anywhere from two weeks before to two weeks after. I assumed that if I went past my due date, I’d be stuck with unpaid time off and a big fight to not get an induction.

I hoped that by potentially manipulating my due date I could advance my cause. Of course, if you’ve been pregnant or been close to pregnant women in the U.S., you probably know they often base your due date on your menstrual cycle. They do that here, too, but for reasons I won’t go into, that wasn’t a precise methodology for me this time around. So they base it instead on an ultrasound. This is a perfectly reasonable and rational thing to do. In the U.S., and in the medical literature in general, it is known that the first trimester ultrasound is likely to be the most accurate, since that’s when there’s the least individual variation in growth. Fetuses follow a pretty strict schedule in that first trimester. So when I got my first trimester ultrasound and the estimated gestation at the time, I assumed that I had an official due date. At that point I still had hope that I could just reason with them, discuss my concerns about having a “late” baby (Lucia was born at 42 weeks, and I was sure of my dates with her), and work with them from there. I was so naive.

By my second trimester, I’d had enough visits to realize that my doctor was not going to work with me on anything, or even try to understand any of my concerns. But I got much more nervous when she looked at my second trimester ultrasound and announced that I was 19 weeks and 3 days when, according to my calculations, I was barely 18 weeks along. She was basing gestational age on the most recent ultrasound instead of the original. Granted, I had read that 2nd trimester ultrasounds are still pretty accurate, but only to be used if there was no 1st trimester ultrasound. And then it came out that she would base my “real” due date on an ultrasound sometime in the third trimester. “When they’re bigger you can measure them better,” she explained as I carefully refrained from letting my mouth drop open (“the flies will fly in” my mom used to tell me) and tried to tame my other eyebrow back to its normal place. “In the early days there’s barely anything to measure so it’s not very accurate.” I swear she really said something like this.

I was in a panic. I was scared that a third trimester ultrasound would give them an even earlier due date, since I was betting my second baby would be big like my first. Then I could imagine that they’d be trying to induce me at what I calculated to be 38ish weeks, I’d be in trouble at work for having all this excessive maternity leave pre-baby, maybe even end up having to go back early after the baby. I imagined a whole unstoppable cascade of bad outcomes.

I decided I would go and talk to the director, the head honcho of the insurance company, himself a doctor. Surely he would see the insanity in my doctor’s plan and be able to correct the situation. Perhaps I could even reason with him and sell him on my plan of less time before the due date, more time afterwards. In this scenario, I would reasonable explain that my best interests also happened to be their bests interests, so he should accept my win-win situation. And anyway, this is the land of la mordida (the nickname for a bribe- literally a bite). Surely we could come to some kind of understanding. I lost sleep practicing exactly how I would propose this, trying to forcefully imagine my desired outcome.

The director was very polite and pleasant with Conan and me. He did not, however, get up in arms about my doctor’s plan to base my maternity leave and due date on a third trimester ultrasound. He listened patiently to all of my story. He nodded and observed the handy little chart that I’d made detailing all the possible dates- ultrasound date, estimated due date based on that ultrasound, and maternity leave date based on the due date. He said that yes, it was possible that my first trimester ultrasound due date could perhaps be my final due date, but that it was really up to the doctor to use whatever measurements she needed in order to calculate my due date. He tried to reassure me that we could meet with my doctor in his office to discuss the matter closer to my due date. He refused to resolve the matter for me then and there. He tried to tell me that this set up for maternity leave was the best and only way to do it. I forgot to bring any money for a bribe, so that was that.

I was already planning on finding an alternative to the insurance company for giving birth, but this total approval of the lack of science and information on ultrasounds really sealed the deal. My boss was also not particularly pleased with the situation. Their refusal to give me a set due date meant that we couldn’t predict exactly when I would be on leave. (I’d already asked the secretary if I could work a little beyond the start of my maternity leave, and she said no. Thank goodness!) And when you have to teach classes and give final exams and give out grades, it’s really rather important to know when the end of your semester will be, somewhat in advance. You can’t really give a final exam as a pop quiz. It’s not really reasonable to give them very short notice, either: “Well, guys, I guess we’ll have the final tomorrow!” And you certainly can’t get all your grades and paperwork done the same day. So at the end of the day we used the information that I did have- my three possible due dates thus far- to make an educated guess. That dated me to give a final exam just before Christmas break (it can hardly be called “winter break” when it’s still 90 degrees, and anyway, it’s a very Christian country). We’d have to see if I ended up having to do my grades while already on maternity leave or not.

By the time we got to a date close enough to finding out my insurance-approved “due date,” I finally quit stressing about it. I was still grumpy about it, mind you, but I’d weighed out worst-case-scenarios and decided I’d deal with it. There are not going to forcefully, needlessly induce me, because I just won’t go for that, so I took that off my worry list. It would (will?) indeed be difficult and frustrating to have unpaid time off because of the baby coming later than they want it to, but we would probably not starve to death. And if I had to do all my grades while officially on maternity leave, at least I could work on a more flexible schedule. So I kept breathing and waiting.

I was supposed to find out by the end of December, just before coming back from vacation. This seemed ridiculously late to be finding out, since my leave could start as early as Jan. 5, but welcome to Oaxaca. I went for my telltale ultrasound before Christmas. After waiting for a while I was finally informed that the ultrasound doctor was out sick and I’d have to reschedule. New Year’s Eve was the soonest they could get me in. So I rescheduled my doctor’s appointment as well, pleased to hear that my regular doctor would still be on vacation then. I figured I had a better chance of reasoning if it weren’t my regular stone-cold bureaucrat.     

When I finally did get my ultrasound, he gave me a gestational age that was just days later than the original ultrasound calculation. Since I’d recently had an ultrasound at a private doctor that dated my baby almost 2 weeks ahead of that (although the doctor said, of course, that it wasn’t an accurate estimate of age, more an estimate on size), I seriously wondered how in the world this doctor measures on these things. Did he just note down the due date I’d told him and tack on a few days? Is that the general policy? Whatever the case, I was relieved that it was just a few days different from what I now considered “my dates,” and was actually giving me a later due date. I figured that meant I was less likely to be pressured about an induction, less likely to have unpaid time off (I still don’t know if this is what will happen- I don’t even want to know yet!), etc. I went in to my Dr.’s appointment, with a younger, hopefully more open doctor, full of optimism.

I should have known, though, that young though she was, this doctor still worked for the insurance company. She made a little chart of her own (like mine but less organized) with all the ultrasound dates and information, and studied over them briefly. Then she passed the buck. “Well, you can come back in a week and meet with your doctor and the director and see then,” she announced.  I sat dumbstruck for a minute. I couldn’t believe it was December 31st and I still didn’t know when my maternity leave would begin, even though it might begin the next week.

“At least I’ll have a solid three days to do my grades,” I told Conan, once I’d recovered from my incredulity. “I’ll either be off after next Wednesday or I’ll work another week after that at the most. I’ve already given final exams, so the most important part is taken care of. I guess it doesn’t really matter that I don’t know when yet, even though it’s crazy.” Maybe I’m getting better at living in this country, getting better at living with many variables. Whatever the case, I got through the waiting and not knowing.

My next appointment came and my beloved stone cold bureaucrat informed me that we’d be using this latest ultrasound to give me my maternity leave date. She told me I still had another couple of weeks to work anyway. A couple more weeks was not in my calculations, however. That was definitely beyond my estimated latest last day, which would be Thursday January 15. After all my worrying about getting off work too early, there I was getting ready to fight to get off work sooner. Because if I can’t carry over my days off to the post-baby phase then I sure as hell want a good chunk of them beforehand.

“What do you mean a couple more weeks?” I asked, determined to stay calm in the face of insanity, I got out my phone calendar and my handy little chart. “Well, on December 31,” she began, “you were 31.6 weeks along, which is about 31 and a half weeks.” Thirty one and a half? “But the other doctor told me that 31.6 weeks means 31 weeks and 6 days,” I protested. It also states that this is the case on the actual ultrasound pictures, which have abbreviations in English- 31w 6d in this case. I knew I was right and was appalled by the fact that she either didn’t know that herself or knew that and was purposely trying to give me less time off. Either way I was not pleased. So I showed her all my information and managed to convince her. “Okay,” she said, “Come back in a week or so. Say Thursday or Friday.” I breathed. “So that’s when I can actually start my maternity leave, right? Next Thursday.” I wanted assurance. “Yes,” she agreed. “We’ll do the paperwork then.”

Is this feeling like a never-ending saga to you, yet, dear reader? Because it sure was feeling like that to me. And it’s not over yet! And guess what- it wasn’t over the next Thursday, either. Oh, Oaxaca. Oh how I both love and hate thee.

I went to my appointment the next Thursday afternoon, pretty sure that it was my last day at work, although at that point I only told people I hoped it was my last day. I’d renounced any real sense of security on the matter. Long story short (haha, you wish), there was some “problem with the system” and my maternity leave “wasn’t coming out” or something to that effect. At which point I might have become a bit disbelieving and belligerent. “I just called the director,” she told me, after I came back from getting my blood pressure checked by the nurse outside (and surprisingly, my blood pressure was still low), “and he won’t let me do it manually, either. You’ll have to come back in a week or so.” I couldn’t believe it. “Another week?” I asked. “Seriously?” She looked at me earnestly and nodded. “It’s the system, there’s some problem.” I refrained from telling her about all the problems with their stupid system and stormed out to go talk to the director.

The director remembered me complaining about dates from before, so that worked to my advantage. He looked at my new and improved handy chart and agreed that yes, I was due my maternity leave now, by any and all calculations. He very politely asked if I could go ahead and work one more day and then just come in straight to the insurance office Monday morning for my maternity leave paperwork. I breathed deeply. I decided I could do one more day (but not one more week!). I had him shake on it and verbally promise me that it would be Monday, rain or shine, hell or high water. I did not make him cross his heart and hope to die, although I thought about it (it’s not a promise that translates well). I left the office only slightly angry and belligerent, and a little relieved that at least I had a promise of only working one more day. “If they don’t give me my paperwork on Monday I’m throwing a tantrum there until they do,” I assured myself and all my coworkers.

I went in Monday ready for a fight, ready for a new turn of events. There was a different doctor in the office, for some reason. Who knew if that would be to my advantage or not. I held on to the memory of the director’s promise, and walked into the office.  “Are you the one with two C-sections?” the doctor asked me. “No!” I assured him. “I’m here for my maternity leave.” Once that was cleared up, he asked to see my ultrasounds. “This is the first one?” he asked, looking over my first trimester ultrasound. When I told him that it was, he said, “This is the good one. The most important one.” He checked the dates and told me I was 35 weeks along, which put me at one week overdue for my maternity leave- certainly entitled by then. (“Where have you been my whole pregnancy?” I wanted to ask him. Instead I asked how I could get transferred over to be his patient, even though I have no idea if he’s a good doctor- at least he’s read something about ultrasounds at some point!)

He put all the information in the computer for my ultrasound, frowned and declared that there was some kind of error in the system. “We’ll just do it by hand,” he said, and I relaxed again. Finally, finally, I had my papers in hand. I still had to turn them in to work that day, and go and get the money out of the bank a week or so later (which turned into its own saga), but I had the paperwork in hand. It was really happening. I was finally on paid maternity leave.

And then I lived happily ever after, ish. I’m resting a bit better. I’m finally getting things prepared for this baby- hospital bag is packed, plans for Lucia are set, baby clothes are washed, etc. I’m spending loads of time with my two year old who’s been wanting my attention. I’m spending time with Conan instead of just going on errands and cooking and falling asleep on him. I’m keeping up my exercise and yoga routines, at a more leisurely pace. I’m drinking less caffeine. I’m writing this at 3 am when I can’t sleep, instead of not sleeping and stressing about having to go to work in a couple hours. I’m still exhausted at the end of the day, but I’m not exhausted all day every day. So pre-baby maternity leave is definitely treating me right. It’s just what the doctor ordered. Not my insurance doctor, mind you, but a good doctor. Like the one that’s gonna deliver my baby- sometime in the not too distant future! So thanks, Mexico, for this paid time off. You didn’t make it easy, but I’ve got it and I’ll take it.

A decent pic of my sweethearts enjoying my time off with me!

A decent pic of my sweethearts enjoying my time off with me! Lucia is taking her work in the sand very seriously. 

One of the perks of pre-baby maternity leave- a weekday at the beach!

One of the perks of pre-baby maternity leave- a weekday at the beach! This is the sad face of Lucia because I caught her at a bad moment. 

3 Responses to “Me Versus The Insurance Company Doctors, A Saga”

  1. juliainman February 1, 2015 at 5:25 pm #

    As my much adored niece would say, “Yikes!” What a saga, I’m so glad you may have found a doctor you have some faith in. Always thinking of you all.


  1. No Medicine is the Best Medicine Sometimes | exile to mexico - February 26, 2016

    […] *I’m sure there are plenty of good doctors around here. I’m not saying other docs are all awful, but we’ve had some unpleasant consultas, and I am saying that the other doctors that we’ve visited are not a good fit for us. And, okay, I am talking bad about the many, many doctors everywhere who don’t want you to ask questions. They are bad doctors if they don’t want the patient involved in his/her own care, in my humble opinion. For more examples of the madness, you can read about my fight with my insurance company doctor during my pregnancy here: […]

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