We’ve had many pregnant patients leave our practice lately. Not because they are unhappy with their care, but because the hospital where we provide obstetric care and a major insurance carrier cannot agree on a contract.

Until the issue is resolved, patients insured through that carrier will have to pay more money out of pocket to have their baby at our affiliate hospital. Obviously this is unacceptable, so many of them are reluctantly transferring to other practices.

In the meantime, all the providers in our practice are scrambling to get privileges to deliver babies at another local hospital. This is not a quick or easy process. Even when we succeed at this step,  we often don’t have the provider resources to cover labor and delivery at two different hospitals.

I have grown increasingly frustrated at how much insurance companies dictate the  quality of care I provide to my patients. We are the only local practice that offers 24/7 midwifery care for laboring moms. Now because two businesses cannot reach a compromise over finances, many of my patients may not be able to have the type birth they want with providers they know and trust.

Sadly, insurance issues creep into so much of my daily practice. For example, I hate that a patient’s insurance is a factor I have to consider when doing contraceptive counseling.  

Some health insurance providers do not reimburse us for the full cost of the device. We are therefore unable to offer this contraception option due to the revenue loss.

Because of this, long-acting reversible contraceptive methods like intrauterine and implantable devices are not options for many patients who most want or need them.

I have to refer these patients out of practice to a local family planning clinic. In my experience, only the most motivated women follow up at another clinic, so the others choose a less reliable method, or no method at all. They often end up with an unplanned pregnancy.

Logically, it would seem that pregnancy and birth would cost an insurance company more than a contraceptive device, but I’ve found that logic does not figure into the health insurance business very often.  

The growing opinion that the U.S. healthcare system is broken is not wrong. But we cannot begin to fix the system without a major overhaul of heath insurance companies and their power to dictate where, when and how practitioners provide care.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.