Latest / Pharmacy Podcast Network / Birth Rights, Medical Bills & Legal Advocacy with Andi Orwoll, Esq. | MaternalRx

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Birth Rights, Medical Bills & Legal Advocacy with Andi Orwoll, Esq. | MaternalRx · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession.
0:10
Speaker 2: Welcome to the Pharmacy podcast Network. Welcome to the Maternal
0:26
Speaker 2: RX podcast, where we challenge the status quo in maternal
0:30
Speaker 2: healthcare and explore how education, advocacy, and interdisciplinary collaboration and
0:36
Speaker 2: can improve outcomes from mothers and babies. From pharmacists and
0:40
Speaker 2: healthcare professionals to patient advocates and now legal experts, we
0:45
Speaker 2: spotlight the voices working to reduce preventable maternal morbidity and
0:49
Speaker 2: mortality and empower women to navigate pregnancy and birth with confidence.
0:54
Speaker 2: I'm your host, doctor Danielle Plummer, farm d and Anti
0:58
Speaker 2: Partum Doula, and today's game is Andy orwall A, Nevada licensed,
1:02
Speaker 2: the attorney and founder of Your Legal Doula, a legal
1:05
Speaker 2: practice built specifically for moms navigating the US maternity care system.
1:11
Speaker 2: Your Legal Dula helps US families deal with the unexpected
1:14
Speaker 2: in pregnancy and birth by equipping them with the knowledge, tools,
1:18
Speaker 2: and confidence to assert their rights no matter where or
1:22
Speaker 2: how they're birthing. Andy became a single mother by choice
1:25
Speaker 2: in twenty twenty two, and her own experience with an
1:28
Speaker 2: unplanned C section and the paperwork mountain that followed inspired
1:32
Speaker 2: her to become the pregnancy and birth lawyer she couldn't
1:35
Speaker 2: find when she needed one. You can find her on
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Speaker 2: all social media platforms at your Legal Doula and on
1:42
Speaker 2: her website at your legaldula dot com. Welcome Andy. I
1:46
Speaker 2: am overjoyed to have you here with me today because
1:50
Speaker 2: this conversation is something I've been wanting for a long time,
1:55
Speaker 2: and it's difficult to find a legal expert whose specialized
2:00
Speaker 2: in pregnancy, which, from what I understand, you could not
2:04
Speaker 2: find either through your own experience, and that's why you
2:07
Speaker 2: started this business. So I would like you to add
2:10
Speaker 2: anything I missed and tell us how did you get here?
2:14
Speaker 1: Yeah, well, thank you so much for the introduction, Danielle.
2:17
Speaker 1: I really want to get the word out there about
2:21
Speaker 1: birth rights. That's the whole core, that's my whole mission,
2:24
Speaker 1: and the reason it just all stems back to not
2:27
Speaker 1: only my own birth story, but just my history as
2:31
Speaker 1: a lifelong feminist, as a woman's rights you know, advocate,
2:35
Speaker 1: as someone who is really invested in making life better
2:39
Speaker 1: for women in every way, in every demographic, in every
2:43
Speaker 1: identity of womanhood. And so when I saw that you
2:47
Speaker 1: focus on the medicine part, specifically pharmacy, So thank you.
2:52
Speaker 1: I'm so happy to be here. So when it comes
2:54
Speaker 1: to my story, I started my journey as a single
2:59
Speaker 1: mother by choice. I eventually decided to go to IVF,
3:03
Speaker 1: so that's how my daughter was conceived. I was in
3:06
Speaker 1: the thick of paperwork and intricacies from the very second
3:10
Speaker 1: that my daughter existed, you know, in any form, and
3:14
Speaker 1: navigating that, especially with my insurance and everything, was very difficult.
3:17
Speaker 1: I was already an attorney at that point, and just
3:20
Speaker 1: what you're up against when you are trying to navigate
3:23
Speaker 1: that system is quite a lot. And it made me think, Okay,
3:26
Speaker 1: I'm a lawyer and I can't figure out what the
3:28
Speaker 1: heck is going on here? How is any woman in
3:31
Speaker 1: the United States supposed to navigate this by herself. That
3:34
Speaker 1: kind of continued on into my pregnancy and then my birth.
3:38
Speaker 1: So I had midwives caring for me during my pregnancy.
3:42
Speaker 1: Loved my midwives. We had a home birth, all planned,
3:45
Speaker 1: The tub was all set up, you know, in my
3:47
Speaker 1: living room. It was all ready to go. And what
3:50
Speaker 1: happened in my case was my water broke and then
3:54
Speaker 1: four days later I still hadn't gone into labor at
3:57
Speaker 1: that point. It wasn't safe for me to deliver at home,
4:00
Speaker 1: and that is why we have hospitals, is you know,
4:03
Speaker 1: birth is a physiological process. We don't always need interventions,
4:06
Speaker 1: but thank goodness, they are there when we need them.
4:09
Speaker 1: So in my case, the risk of infection was too
4:11
Speaker 1: high and so I had to go to the hospital
4:13
Speaker 1: and be induced, which was the last thing I wanted
4:17
Speaker 1: because I had researched a lot about the cascade of interventions.
4:21
Speaker 1: If you start with induction, you know where are you
4:23
Speaker 1: going to end up? While I ended up with with
4:25
Speaker 1: an EMERGENCYY section. I mean, it was classic textbook And
4:29
Speaker 1: the thing that keeps it from feeling like trauma to
4:32
Speaker 1: me was that I was able to stand up for
4:35
Speaker 1: myself and hold my ground because I knew what my
4:38
Speaker 1: rights were and as a lawyer, like I am a
4:40
Speaker 1: trained litigator, okay, I used to be a prosecutor. I
4:42
Speaker 1: went to court every day and talk to the judge
4:45
Speaker 1: and I have no fear, I have no shame. I
4:47
Speaker 1: will assert my rights. I will tell you what the
4:49
Speaker 1: law says, you know, and honestly, I want that confidence
4:53
Speaker 1: for everyone because what shocked me was that afterward my
4:57
Speaker 1: doula who went with me to the hospital, thank goodness
5:00
Speaker 1: for her, but she actually told me that she's never
5:03
Speaker 1: seen anyone advocate for themselves in that position. Like I'm
5:06
Speaker 1: standing here in my hospital gown, you know, and they're
5:09
Speaker 1: trying to tell me something, and this is her opinion.
5:11
Speaker 1: She's like, they know you're not planning. And that's the
5:14
Speaker 1: energy I wish every woman could walk into her birth with.
5:17
Speaker 1: We are not playing. We are here to have the
5:19
Speaker 1: birth experience that we want, and of course things don't
5:22
Speaker 1: always go to plan, but even when they don't go
5:25
Speaker 1: to plan, we will be respected, we will be listened to,
5:28
Speaker 1: we will not be condescended to. And that's actually your
5:30
Speaker 1: human right receiving medical care is not to be discriminated against,
5:34
Speaker 1: not to be belittled and talks down to. If I
5:38
Speaker 1: get a little spicy, it's because I just feel very
5:40
Speaker 1: passionate about this because the actual statistic from the CDC
5:45
Speaker 1: shows that one in five women is experiencing mistreatment during childbirth,
5:49
Speaker 1: twenty percent of us. It's a complete like my mind
5:54
Speaker 1: just boggles every time I think about it. And luckily
5:57
Speaker 1: for me, I could hold my ground and I don't
5:59
Speaker 1: feel I was mistreated. Now there were things I didn't know,
6:03
Speaker 1: and you don't know what you don't know, and now
6:05
Speaker 1: I've learned a lot more after having gone through the
6:08
Speaker 1: hospital systems. I guess my unique take is that I've
6:10
Speaker 1: been through the more holistic midwiffre remodel as well as
6:14
Speaker 1: the medical model and kind of seeing how they both
6:17
Speaker 1: intersect and when there's time and place for both, but
6:20
Speaker 1: also navigating it all, especially if your single mom like me,
6:24
Speaker 1: it's very hard. The business that I started, as you mentioned,
6:28
Speaker 1: is because I couldn't find I couldn't find the resource
6:31
Speaker 1: that I needed when it was my time, and I thought, well,
6:34
Speaker 1: no more, I will become the resource.
6:36
Speaker 2: You just shared so much information that I have to
6:39
Speaker 2: back up here. You were went through this journey to
6:43
Speaker 2: become pregnant by choice. It was not an easy road
6:47
Speaker 2: to begin with. And if you listen to one of
6:49
Speaker 2: my previous Maternal RX podcast interviews, it was with one
6:52
Speaker 2: of my previous mentors and boss who went through IVF
6:56
Speaker 2: and ended up fostering and then adopting and the lead
7:00
Speaker 2: goal mounting paperwork. I can't even fathom that interview was
7:04
Speaker 2: from a medication perspective, and a pharmacist perspective to get
7:08
Speaker 2: it from a lawyer's perspective. Having the training that you
7:11
Speaker 2: had quite powerful. Like you said, we're not playing around,
7:14
Speaker 2: and that's my goal for every woman, every family heading
7:17
Speaker 2: into that hospital. A few things. So I'm just blown
7:22
Speaker 2: away because your water broke four day.
7:25
Speaker 1: Four four days.
7:27
Speaker 2: Normally, I think it's what twenty four hours, four days
7:31
Speaker 2: you waited for that natural birth to happen. Yeah, what
7:35
Speaker 2: was going through your mind during that time?
7:38
Speaker 1: I was trying, first and foremost not to panic, so
7:41
Speaker 1: I didn't want to fill my mind with worry. And
7:44
Speaker 1: my midwives were really good. They checked in on me
7:46
Speaker 1: every day. I went in and we did a stress
7:48
Speaker 1: test and they were just trying to keep my blood
7:50
Speaker 1: pressure down.
7:50
Speaker 2: You know.
7:51
Speaker 1: As you said, I worked very hard to get pregnant
7:53
Speaker 1: my baby and my experience having this baby bringing her
7:56
Speaker 1: into the world. I could have freaked out sometimes, I think,
8:00
Speaker 1: and I wonder how did I not freak out more?
8:03
Speaker 1: But I think it's because I was. I was doing
8:05
Speaker 1: my birth mantras. I was you see me out there
8:08
Speaker 1: in my neighborhood, kerb walking, you know, two hours a day,
8:11
Speaker 1: nothing excessive because to be RESTful and to be of
8:14
Speaker 1: a good mindset. And but yeah, I think what was
8:18
Speaker 1: going through my mind that I didn't want to be
8:20
Speaker 1: going through my mind was well, what if I end
8:22
Speaker 1: up in the hospital system and then I don't know
8:24
Speaker 1: what to do because I planned for a home birth.
8:27
Speaker 1: My insurance paid for a home birth, so my my
8:30
Speaker 1: lawyer brain automatically kind of goes into the red tape
8:33
Speaker 1: of it all. I can't help it. That was unfortunate,
8:37
Speaker 1: But I think I kept as calm a mind as
8:39
Speaker 1: I could at that time.
8:40
Speaker 2: Okay, let me applause you. That's not unfortunates, That's perfect
8:45
Speaker 2: and wonderful because if you didn't have your lawyer brain,
8:48
Speaker 2: who knows what those outcomes would have been.
8:51
Speaker 1: That's true. That is true.
8:53
Speaker 2: So what's interesting is I did my duelist certification because
8:56
Speaker 2: I wanted to help women in the first trimester. That's
8:59
Speaker 2: how I became this antipodum dulah because the disease or
9:02
Speaker 2: I specialize hyperemesis graviderum, the sooner you get care, you
9:07
Speaker 2: can prevent it from escalating and ending up in these
9:10
Speaker 2: horrible situations later throughout the entire pregnancy. But that first
9:14
Speaker 2: trimester in traditional maternal health care has missed. I also
9:18
Speaker 2: want to circle back Midwiffrey in the state of Nevada
9:22
Speaker 2: is young and new, at least in a legal and
9:24
Speaker 2: open madness for you to choose that route. I'm just
9:28
Speaker 2: grateful not to put down our obstetricians, because I am
9:32
Speaker 2: just so forever grateful to that profession and what we have.
9:36
Speaker 2: But women have a choice now, and we've learned decades later.
9:40
Speaker 2: That's why I started this podcast. We have the highest
9:42
Speaker 2: maternal morbiditing mortality rates of any developed country. Why and
9:47
Speaker 2: it's so difficult to go to med school now, the
9:50
Speaker 2: years it takes to get not just your medical degree,
9:53
Speaker 2: your residency, your fellowship, your advanced certifications. There's just not
9:57
Speaker 2: enough to support the pregnant women. And there's a perfect
10:01
Speaker 2: place for midwives.
10:02
Speaker 1: Yes, Can I speak a little bit to that, because absolutely,
10:06
Speaker 1: Because I think a lot of people are surprised when oh,
10:09
Speaker 1: you're a lawyer and you wanted to have a homeless
10:11
Speaker 1: are you crazylutely? And to me, that was not an
10:15
Speaker 1: uninformed choice. You do not even know how many books
10:19
Speaker 1: I read, how much research I did, how many interviews
10:23
Speaker 1: I did of different providers, I knew what my options were,
10:26
Speaker 1: and so I knew, as my health history and all
10:30
Speaker 1: of that, as a low risk pregnancy, which I had
10:34
Speaker 1: up until the very end, as a low risk pregnancy,
10:37
Speaker 1: I was more likely to have good outcomes with the
10:40
Speaker 1: Midwiffery model of care. We know in the United States,
10:43
Speaker 1: statistically we see it. This is not a crunchy alternative,
10:47
Speaker 1: like wild kind of thing. I'm a little crunchy, and
10:50
Speaker 1: I don't have any shame in that because the research
10:52
Speaker 1: backs it up. You know, it shows us that we
10:55
Speaker 1: have good outcomes with low risk pregnancies with this model
10:58
Speaker 1: of care. And I had my doula and I had
11:00
Speaker 1: all these pieces of my team. It didn't look like,
11:04
Speaker 1: you know, the a lawyer's birth team necessarily. But I'm
11:06
Speaker 1: really grateful that I knew as much as I did
11:09
Speaker 1: so that I could have the experience that I did.
11:12
Speaker 1: My midwives, Oh, we would sit for forty five minutes
11:14
Speaker 1: in a pre nittle appointment. You maybe see EOB for
11:16
Speaker 1: forty five seconds.
11:17
Speaker 2: It's yeah, that's all they have time for.
11:20
Speaker 1: Yeah, they're way overbooked. And like you said, no shade
11:23
Speaker 1: on our obi's We need them. They care deeply about
11:27
Speaker 1: women's health, and it takes all of them. It takes
11:30
Speaker 1: the whole entire scope you know, of different practices and specialties.
11:34
Speaker 2: Dula's are starting to be covered by insurances and I'm
11:37
Speaker 2: really excited to see dula's become part of the maternal
11:41
Speaker 2: health care team. So for those who do not know
11:43
Speaker 2: what a DULA is, it's a trained professional who provides
11:47
Speaker 2: non medical, non physical support to include emotional support, informational
11:52
Speaker 2: support to a person during pregnancy, child pirth, postpart and recovery,
11:57
Speaker 2: and sometimes unfortunately, pregnancy law. Unlike doctors, midwives, or nurses,
12:03
Speaker 2: dulas do not provide medical care or deliver babies. Instead,
12:07
Speaker 2: they help families by offering education and evidence, bace, information, supporting, communication,
12:12
Speaker 2: and advocacy during labor and delivery. If you're a labor
12:15
Speaker 2: and delivery DULA, which the majority are, providing comfort measures
12:19
Speaker 2: such as breathing techniques, positioning, massage, reassurance, helping partners for
12:25
Speaker 2: those who have partners with them feel more involved and
12:27
Speaker 2: supported and assisted with the postpartum transition in newborn care guidelines.
12:32
Speaker 2: But as I said, there's not just labor and delivery dulas,
12:35
Speaker 2: there's postpartum dulas. There's bereavement dulas in my case an
12:40
Speaker 2: antipartum dula to help you get off to a good
12:43
Speaker 2: and healthy pregnancy, and in your case dula so you
12:47
Speaker 2: help filmis understand your rights, paperwork, consent issues, workplace protections,
12:52
Speaker 2: and advocacy within the maternity care system.
12:55
Speaker 1: Great, And to me, that was the piece that was missing.
12:58
Speaker 1: Is there are so many amazinging maternal care specialists. There's
13:02
Speaker 1: chiropractors and pelvic floor physical therapists and folks like you
13:06
Speaker 1: and our doctors and our midwife. It's so many different specialties.
13:10
Speaker 1: And I'm sitting from my legal vantage point looking at
13:14
Speaker 1: all these ladies. They had to get the law changed
13:16
Speaker 1: in Nevada just to have a birth center. They had
13:18
Speaker 1: to change the law just to exist. And so I'm
13:22
Speaker 1: looking here thinking, okay, but what about the moms who
13:25
Speaker 1: need help in navigating all of this? And so the
13:27
Speaker 1: doula framework, I guess, came about. I'm not trying to
13:30
Speaker 1: you know, I'm not trying to mislead anyone. I'm not
13:32
Speaker 1: a doula. I am not a trained doula, but I
13:35
Speaker 1: am a legal doula. So I want to walk you through.
13:37
Speaker 1: I want to be your support. I want to empower you.
13:40
Speaker 1: One of the things that I offer is a birth
13:43
Speaker 1: rights course. I offer education and it walks you through
13:46
Speaker 1: not only what are your rights, but where do your
13:49
Speaker 1: rights come from? Because sometimes you can be so intimidated
13:52
Speaker 1: by that white coat syndrome. Someone in a hospital is
13:55
Speaker 1: telling you this is policy. Well, you know what, policy
13:57
Speaker 1: never overrides your rights. If you don't know what your
14:01
Speaker 1: rights are, you don't necessarily know maybe where they come from.
14:04
Speaker 1: Is it a federal law, is it a state law
14:06
Speaker 1: that protects you? So the birth rights course goes through
14:09
Speaker 1: all of that, and then it goes through how to
14:11
Speaker 1: as search your rights in a way that's strong. You've
14:14
Speaker 1: got conviction, you've got confidence, and you're not playing like
14:17
Speaker 1: we said before, And then no matter how much we do,
14:20
Speaker 1: we can be our own best self advocate and hopefully
14:23
Speaker 1: that prevents violations of our rights. But occasionally there are
14:27
Speaker 1: going to be times where that doesn't work for one
14:30
Speaker 1: reason or another, and then you have to protect your rights.
14:32
Speaker 1: You have to vindicate your rights. I offer the steps
14:35
Speaker 1: on what to do, and so that's if your rights
14:37
Speaker 1: have been violated in the hospital, in any other kind
14:40
Speaker 1: of care setting, or at work, that's something Danielle, we
14:42
Speaker 1: were talking about this before we got on the recording,
14:45
Speaker 1: is that these workplaces, there's been a really cool EEOC
14:49
Speaker 1: trend the last couple of months where in the state
14:51
Speaker 1: of Florida, of all places, the PWFA that's the Pregnant
14:54
Speaker 1: Worker's Fairness Act. So that is a relatively new piece
14:58
Speaker 1: of litigation. It's only two years old. A lot of
15:00
Speaker 1: these employers don't even really know about it, but they
15:03
Speaker 1: don't know how to be accommodating under that new framework.
15:07
Speaker 1: And so the EEOC, some of these new lawsuits, some
15:09
Speaker 1: of these new complaints that are coming in, they're showing
15:12
Speaker 1: these employers that they can't keep treating pregnant women as
15:15
Speaker 1: if they're the first pregnant woman who has ever had
15:18
Speaker 1: the nerve to work. That's kind of how I felt
15:20
Speaker 1: I was treated. There was no policy about maternity leave.
15:23
Speaker 1: As an attorney, I got ten weeks of unpaid leave.
15:26
Speaker 1: That's it.
15:27
Speaker 2: Wow, And I'm saying wow, because that's more. It used
15:31
Speaker 2: to be six weeks, right.
15:33
Speaker 1: Oh yeah, well, you know, because I had the C section,
15:36
Speaker 1: so eight weeks would have well, I mean, but you
15:39
Speaker 1: said unpaid unpaid Yeah wow, Yeah, So I didn't even
15:43
Speaker 1: have any kind of I could go off, but I won't.
15:47
Speaker 2: You can, It's okay, let it all out.
15:49
Speaker 1: Yeah. Well, I mean that's one of the problems is
15:51
Speaker 1: that I felt so alone. And I was a single mom,
15:55
Speaker 1: and I was the breadwoaterer for my future child. And
15:57
Speaker 1: I'm thinking, I'm an attorney and they're trying to do
16:00
Speaker 1: weird wage and hour stuff with me, and I'm feeling
16:03
Speaker 1: so intimidated that I can't advocate for myself because I'm
16:07
Speaker 1: in this vulnerable periineedal state when you're pregnant. Oh god,
16:11
Speaker 1: I had the worst pregnancy brain. I forgot half the
16:14
Speaker 1: English language. It was horrifying. And as an attorney going
16:16
Speaker 1: to court every day, you know, you can imagine, so
16:18
Speaker 1: let alone when HR would say something and I knew,
16:22
Speaker 1: I knew in my lawyer analysis, I'm like, that's not right,
16:25
Speaker 1: that's not correct. I should take this higher, I should
16:28
Speaker 1: do something. But I was, you know, seven months pregnant.
16:31
Speaker 1: I was. I'm not in a position to advocate for myself.
16:34
Speaker 1: And the same with postpart is, you're very vulnerable. You've
16:37
Speaker 1: got this brand new, squishy, lovely little baby. You know,
16:40
Speaker 1: in your healing. I did not prepare for a C section,
16:43
Speaker 1: So I did not have any idea the amount of
16:47
Speaker 1: time it was going to take and the mental energy
16:49
Speaker 1: and everything rehabilitating my body at the same time as
16:53
Speaker 1: I was breastfeeding this child and coming to terms with
16:56
Speaker 1: my identity as a mom. Matrescence is the word that
17:00
Speaker 1: I keep hearing lately, is you know, it's like a
17:02
Speaker 1: second puberty almost, because you're going through so many hormonal shifts.
17:06
Speaker 1: You're going through all this, okay, so the last thing
17:08
Speaker 1: you need to be doing is paperwork and trying to
17:11
Speaker 1: navigate it a.
17:11
Speaker 2: Whole incredible But you do have a healthy baby today.
17:15
Speaker 1: I do, Yes, I do have a healthy little almost
17:18
Speaker 1: three and a half year old, and she is the
17:21
Speaker 1: absolute light of my life. I recorded a TikTok video
17:25
Speaker 1: probably five months after she was born, because I had
17:27
Speaker 1: done tiktoks for my IVF journey, for my fertility journey,
17:32
Speaker 1: and I wanted to, you know, update people and what
17:33
Speaker 1: was going on. And somebody had posed a question in
17:36
Speaker 1: some group that was, what would you tell your pre
17:38
Speaker 1: pregnancy self, you know you could go back, And of
17:41
Speaker 1: course in the video, I start tearing up and I'm thinking, well,
17:44
Speaker 1: if I could tell her something it would be. It's
17:46
Speaker 1: so much better than you can possibly imagine. All the
17:49
Speaker 1: reasons I wanted to become a single mom by choice,
17:52
Speaker 1: it was the absolute correct decision. Being a lawyer does
17:56
Speaker 1: not get in the way of my motherhood in any sense.
17:59
Speaker 1: And in fact, I think it helps me be a
18:01
Speaker 1: better mother. I think it helps me learn the patients
18:04
Speaker 1: kind of to see different points of view. That includes
18:07
Speaker 1: different schools of parenting. That includes dealing with my toddler,
18:10
Speaker 1: who is a real free mager. And you know, good good,
18:14
Speaker 1: you know, let that girl have for big presence and
18:17
Speaker 1: her I know that she will come to me because
18:19
Speaker 1: we have such a close bond and she doesn't hide
18:21
Speaker 1: things like I'm not making her into a little girl
18:24
Speaker 1: who's going to have to shrink down to be accepted.
18:27
Speaker 1: She should be the exact shape she wants, you know,
18:30
Speaker 1: as big as she wants. I mean, I'm her mom,
18:32
Speaker 1: so I think kind of thing. She doesn't have a
18:33
Speaker 1: choice when it comes to that, one hundred percent.
18:36
Speaker 2: And I did say, I have three adult daughters, and
18:38
Speaker 2: you know, I told them to go conquer the world
18:40
Speaker 2: and they are and I'm just so proud of them.
18:43
Speaker 2: And to watch you at the beginning of this journey.
18:45
Speaker 2: But going back to the hospital experience, which was not
18:49
Speaker 2: anywhere in your plan that you had mapped out with
18:52
Speaker 2: your doula or your midwives. Now you had this c section,
18:56
Speaker 2: you get home, and following this new that you have
19:01
Speaker 2: with you came you said, a mountain of financial paperwork
19:05
Speaker 2: of hospital bills. Yes.
19:07
Speaker 1: Yes. Part of the problem was that so I had
19:10
Speaker 1: a PPO plan with my insurance, and so I had
19:13
Speaker 1: paid out of pocket for my midwifery. You know, upfront
19:17
Speaker 1: it was a certain amount that you had to pay
19:19
Speaker 1: by week thirty seven or something like that. So I
19:21
Speaker 1: had paid it all, and I was told at the
19:23
Speaker 1: beginning of my pregnancy, when I was making all the
19:26
Speaker 1: calls and research and all this by the associate on
19:30
Speaker 1: the phone with my insurance company, that I would be
19:32
Speaker 1: reimbursed at sixty percent. That's what I was told. What
19:35
Speaker 1: I didn't know was that they meant, oh, well, we
19:38
Speaker 1: will reimburse you sixty percent of what we think was
19:41
Speaker 1: medically appropriate, which meant that I went through this absolute
19:45
Speaker 1: battle with my health insurance company, and I wasn't about
19:49
Speaker 1: to lay down and roll over because they make it
19:52
Speaker 1: so difficult, so disheartening, the appeal periods come up so quickly,
19:58
Speaker 1: and like we were talking about, in postpartum state, you're
20:01
Speaker 1: not keeping track of deadlines as all these hospital bills
20:04
Speaker 1: are starting to come in, and I'm thinking, oh my gosh, okay,
20:07
Speaker 1: So now not only I have to pay for not
20:10
Speaker 1: only my unexpected C section and my daughter's unexpected nick ustay,
20:13
Speaker 1: which is tens of thousands of dollars. So now I've
20:16
Speaker 1: got that and the amount I'm not getting reimbursed from
20:19
Speaker 1: my insurance company. And so I had to navigate all
20:21
Speaker 1: those things. And that's just another area where if I
20:25
Speaker 1: had someone to negotiate with my insurer for me, or
20:29
Speaker 1: to help me figure out a plan with the hospital
20:31
Speaker 1: for dealing with those unexpected bills, or any kind of
20:34
Speaker 1: advocacy or guidance at all, it was just me. Like
20:37
Speaker 1: when I say, a mountain of paperwork, That's what it
20:39
Speaker 1: felt like, and that early postpartum just those kind of feelings.
20:44
Speaker 1: You don't need that. Nobody needs that ever, but I mean,
20:47
Speaker 1: especially at that time, you're so vulnerable, and so the
20:50
Speaker 1: paperwork mountain. I you know, some battles I won at
20:54
Speaker 1: that time, Oh my gosh, okay, I remember this random
20:57
Speaker 1: bill that came up from a genetic test that had
21:00
Speaker 1: been done in my first trimester. And I think it
21:02
Speaker 1: was eighteen months later that I was getting this bill
21:05
Speaker 1: and my insurance is saying they're not going to pay
21:07
Speaker 1: it because it's untimely and yes, and I'm like, I
21:10
Speaker 1: just got the bill just now, Like, you can't tell
21:12
Speaker 1: me it's untimely and you're not going to pay it, Like,
21:14
Speaker 1: go complain to the testing company. Don't make it my problem.
21:18
Speaker 1: But they do. If the insurance cannot pay, they will
21:21
Speaker 1: not pay if they can find a reason.
21:24
Speaker 2: Well, I was just wanting to ask because there's a
21:26
Speaker 2: clear double standard here with insurance companies. We have a
21:30
Speaker 2: limited time to appeal a bill. However, the insurance company
21:35
Speaker 2: can come after us at any point in the future.
21:39
Speaker 2: This has happened to me, This has happened to everybody
21:41
Speaker 2: I know. Not to do with pregnancy just as a
21:44
Speaker 2: general rule, and I don't understand how that's legal, but
21:48
Speaker 2: this is the battle that we're fighting. So that was
21:51
Speaker 2: one thing. And the other thing you mentioned is if
21:54
Speaker 2: you had someone to help you navigate this process, does
21:58
Speaker 2: such a person or position exist.
22:02
Speaker 1: Well, that's what I'm trying to create. In fact, so
22:06
Speaker 1: your legal doula is not only birth rights education, you know,
22:09
Speaker 1: pregnancy rights education while you're at work. But my new
22:12
Speaker 1: offering that I am developing is a sort of concierge
22:15
Speaker 1: service for moms, because the most important work that you're
22:20
Speaker 1: doing during your perry datal season is not paperwork. It's
22:24
Speaker 1: everything else that only you can do. And so I'm
22:27
Speaker 1: developing a framework where I can take someone on and
22:30
Speaker 1: help guide them through. You get a piece of paperwork,
22:33
Speaker 1: you send it to me, you don't understand what it is.
22:36
Speaker 1: We walk through it together. We talk through what possible
22:39
Speaker 1: accommodations you may need if that's the question, what kind
22:42
Speaker 1: of appeal you may need to do, if it's an
22:44
Speaker 1: insurance issue, and you're you know, you've gotten all these
22:47
Speaker 1: different things coming in the mail. You don't even know
22:49
Speaker 1: which it's the hospital, But then the doctors over here
22:51
Speaker 1: have a bill in the anesthesiologist has a bill and
22:54
Speaker 1: keeping track of all those. You should see my spreadsheet.
22:56
Speaker 1: It's ridiculous. I have a spreadsheet and so let that
23:00
Speaker 1: I'll show you that this is something I am building
23:02
Speaker 1: out so that it can benefit other moms. I don't
23:05
Speaker 1: know if anyone else who's doing anything like that anywhere
23:08
Speaker 1: in the country. And I want to grow my business
23:11
Speaker 1: and help more and more moms so that I can
23:14
Speaker 1: be that figure.
23:16
Speaker 2: You know, you'll be reaching out to people like me.
23:18
Speaker 2: I've been an amicus CURII for a case where a
23:21
Speaker 2: mom she took cannabis through her pregnancy and then Social
23:24
Speaker 2: Services took her baby away. Yeah, it was really crazy.
23:29
Speaker 2: She did end up getting her baby back, but she
23:31
Speaker 2: had approved it was for her hyperemesis and it was
23:33
Speaker 2: the only thing that allowed her to eat. It was
23:36
Speaker 2: a wild story. That was with a nonprofit law firm
23:39
Speaker 2: that was taking on that case and got every expert
23:42
Speaker 2: in the country to talk to write in on her behalf.
23:45
Speaker 2: And then yeah, another time I wrote a letter for
23:48
Speaker 2: one of my hyperremecis moms that I'd worked with early
23:50
Speaker 2: in her pregnancy. It was during the pandemic. Her obstetrician said,
23:54
Speaker 2: stay out of the hospital, go to infusion centers for
23:58
Speaker 2: your ivy therapy, to include your vitamins, minerals known as
24:01
Speaker 2: a banana bag, your lactated ringer to get your electrolytes.
24:05
Speaker 2: And she did, and it came out to some crazy
24:07
Speaker 2: seventy or eighty thousand dollars bill. And here she was
24:10
Speaker 2: as a new mom as well, getting the mountain of paperwork,
24:13
Speaker 2: and the insurance company denied that benefit because they said
24:18
Speaker 2: in one place in her medical record it said Zofran
24:22
Speaker 2: was helping decrease vomiting. Because of that one statement at
24:26
Speaker 2: one OBI visits, the insurance company used that to deny
24:30
Speaker 2: all this and it was just a long battle and
24:33
Speaker 2: she did in the end, the insurance company did pay
24:35
Speaker 2: for that, but her family was just it would have
24:39
Speaker 2: destroyed them that financial debt. So I'm grateful Andy, you're
24:43
Speaker 2: stepping into the space, this hole that exists right now
24:47
Speaker 2: that needs to be filled. Can you give us a
24:49
Speaker 2: little bit about did you negotiate with the hospital. There's
24:53
Speaker 2: individual negotiations, it's strictly appealing with the insurance company. How
24:57
Speaker 2: did you even formulate a plan to this?
25:01
Speaker 1: Yeah, so that all depends on what your status is, like,
25:05
Speaker 1: how you were insured, what type of plan it was,
25:08
Speaker 1: things that you paid out of pocket for, because come
25:11
Speaker 1: to find if you're insured and your insurance is covering
25:14
Speaker 1: part of your hospital bill, you can't negotiate the rest
25:18
Speaker 1: the portion that you owe with the hospital. Because what
25:22
Speaker 1: was explained to me in the hospital's financial office was
25:24
Speaker 1: that essentially I owed that money to my insurance company,
25:27
Speaker 1: I'm paying the hospital. But that was the way they
25:29
Speaker 1: described it to me. So my appeal process with trying
25:32
Speaker 1: to get more reimbursement for my midwiffery bills was really
25:37
Speaker 1: where I went in full blast because that was where
25:40
Speaker 1: they were denying what I believed, you know, thousands of
25:43
Speaker 1: dollars that should have been reimbursed that would have helped
25:46
Speaker 1: with those unexpected hospital bills. I mean, how to form
25:50
Speaker 1: a plan like I had to wing it, And I
25:51
Speaker 1: don't want other moms to have to do that because
25:54
Speaker 1: it's just it's so overwhelming. I'll tell you about a
25:57
Speaker 1: case that I dealt with one of my clients where
26:00
Speaker 1: there was certainly some birthrights violations during her birth. There
26:04
Speaker 1: was an unnecessary diagnosis in nick you stay. Essentially there
26:09
Speaker 1: was no catastrophic injury that a medical malpractice attorney would
26:13
Speaker 1: have wanted to take on because there weren't thousands and
26:15
Speaker 1: thousands of dollars in damages, so that attorneys they're not
26:19
Speaker 1: going to get paid really, but she still needs vindication.
26:23
Speaker 1: I worked with her to get her hospital bills forgiven. Actually,
26:28
Speaker 1: that's something that is the type of remedy. I want
26:31
Speaker 1: people to think creatively, how can we put moms in
26:35
Speaker 1: a better position after their berths if there's been issues
26:39
Speaker 1: and they're dealing with the mountain of paperwork. It doesn't
26:41
Speaker 1: always have to be let's jump right to a lawsuit.
26:44
Speaker 1: Let's think creatively about the plan. I could have probably
26:47
Speaker 1: sued my insurance company, and I chose not to because
26:49
Speaker 1: I didn't have the resources. And now the statutementations is
26:52
Speaker 1: over and it's too late. So now that I feel
26:55
Speaker 1: fired up about it, but when it's happening, you want
26:58
Speaker 1: a partner, you want an advocate there to help you
27:00
Speaker 1: create that plan, because it is very overwhelming.
27:03
Speaker 2: It's incredibly overwhelming. And I want to bring back a
27:06
Speaker 2: point you mentioned earlier that insurance companies will pay a
27:09
Speaker 2: percentage based on what they think is fair value. But
27:13
Speaker 2: there's no way to get that fair value at the
27:16
Speaker 2: time you're hiring your medical team. And I actually went
27:20
Speaker 2: through that last summer. I hired a physical therapist just
27:23
Speaker 2: I wanted to build muscle. I knew show's at a network,
27:25
Speaker 2: but they said, we can still submit the bills to
27:28
Speaker 2: the insurance and I thought I was going to meet
27:30
Speaker 2: my deductible just through that and came back exactly what
27:33
Speaker 2: you described where they said, well, she's charging a lot
27:37
Speaker 2: of money, two hundred an hour whatever it was, and
27:39
Speaker 2: then they said, it's just seventy five an hour is
27:41
Speaker 2: what we allow. Then my deductible wasn't not even tapped into.
27:45
Speaker 1: So well right right, because I'm sorry, I'm an attorney
27:49
Speaker 1: and I don't math is not something that I want
27:52
Speaker 1: to be dealing with very much, and so trying to
27:54
Speaker 1: figure out what that Okay, I've paid my copays and
27:56
Speaker 1: then I've got my deductible and then it's my out
27:58
Speaker 1: of pocket maximum, and then I I'm trying to navigate
28:01
Speaker 1: whether or not they were bssing me basically when they're
28:04
Speaker 1: sending me these answers on well your midwives this and
28:06
Speaker 1: this and this and so. For example, in my first appeal,
28:09
Speaker 1: the first level appeal that I did, I tried to say, like,
28:12
Speaker 1: you all reimbursed, you know, basically three dollars a visit.
28:15
Speaker 1: And when I calculated it out because I went through
28:17
Speaker 1: my calendar, you better believe that I counted every single
28:20
Speaker 1: prenatal visit and they were like over twenty and the
28:23
Speaker 1: way they had reimbursed. It was as if they were
28:25
Speaker 1: paying like pennies for every visit. And I went through
28:28
Speaker 1: and I said, here's what they did, here's the time
28:30
Speaker 1: they spent. And it was like they wouldn't they make
28:34
Speaker 1: it hard on purpose, like they get the most obtuse
28:37
Speaker 1: possible person to review the situation. And frankly, it's people
28:41
Speaker 1: who don't understand the midwif free model of care, because
28:44
Speaker 1: insurance especially let's talk about Nevada. You said midwif free,
28:47
Speaker 1: it's very new. My insurance company did not have a
28:49
Speaker 1: single midwife in network that would attend to birth, not one.
28:53
Speaker 1: Even though it was my right to choose my provider.
28:56
Speaker 1: If I was going to choose the provider that I wanted,
28:58
Speaker 1: I had to pay out a pot when it came
29:01
Speaker 1: down to trying to negotiate with them when they don't
29:04
Speaker 1: understand the system, No, you're in a losing position already. Actually,
29:08
Speaker 1: previously we spoke on this point, is that having providers
29:12
Speaker 1: who understand the system is also really important because I
29:19
Speaker 1: kind of feel like I had to tackle that battle
29:21
Speaker 1: all by myself, and if the providers step up and
29:24
Speaker 1: help with those kind of appeals, it's actually much stronger,
29:27
Speaker 1: partly from a legal perspective, because these insurance companies have
29:30
Speaker 1: to do things evidence based, you know, they need to
29:32
Speaker 1: pay for this preventative care. And if your provider is
29:35
Speaker 1: there talking about the evidence and citing a research article,
29:39
Speaker 1: like my fertility doctor, she wrote into my insurance and
29:42
Speaker 1: she helped me get one of those bills down because
29:45
Speaker 1: she is an expert, you know, she's an artist actually
29:49
Speaker 1: in her field. And so her say so about what
29:53
Speaker 1: it was worth and whether it was necessary in this
29:55
Speaker 1: and this and this, that all matters a lot, you know,
29:58
Speaker 1: and as the patient, you're not necessarily in the position
30:01
Speaker 1: to articulate any of that.
30:03
Speaker 2: So Andy, let me ask you. You mentioned your fertility
30:06
Speaker 2: doctor help in this case. How would you know if
30:09
Speaker 2: a doctor would be willing to go for bat When
30:11
Speaker 2: you're newly pregnant, you're looking at midwives or obstetricians and
30:16
Speaker 2: hoping we have this wonderful, glowing pregnancy. Like nobody prepares
30:20
Speaker 2: ahead saying I need to track every visit. I need
30:22
Speaker 2: to track every copey and co insurance and deductible met
30:26
Speaker 2: or not met, and if insurance deny things, I need
30:29
Speaker 2: to have this paperwork prepared. Should we be thinking about
30:32
Speaker 2: that ahead of time.
30:34
Speaker 1: And I hate to say that the answer is yes,
30:38
Speaker 1: but the answer is yes in the system that we
30:40
Speaker 1: live in, in the current model, you know that we
30:43
Speaker 1: operate under, most of us are going to have our
30:45
Speaker 1: works covered by insurance, you know, whether it's through our employer,
30:49
Speaker 1: whether it's medicaid, whatever the source may be. They care
30:53
Speaker 1: about the documentation, they care about those dates, They care about,
30:57
Speaker 1: you know, your receipts. So what I did was I
31:00
Speaker 1: had a planner that was basically calendars, and it had
31:07
Speaker 1: all the stages of my pregnancy, and I would just
31:10
Speaker 1: note my appointment dates in there so that if for
31:13
Speaker 1: some reason I didn't write it down in my phone
31:15
Speaker 1: calendar or something, I had a physical place to look
31:18
Speaker 1: for everything, and I just put all the receipts, everything
31:21
Speaker 1: I printed out and put it in that binder. Now,
31:23
Speaker 1: obviously that probably sounds excessive, but it's the reality that
31:29
Speaker 1: we live in. That's again why I'm trying to do
31:32
Speaker 1: what I You know, that's why I am planning to
31:36
Speaker 1: do what I'm planning to do, is because I know
31:40
Speaker 1: that that is not something that most pregnant moms are
31:44
Speaker 1: thinking about.
31:45
Speaker 2: It's the reality that we live in. You know, I
31:48
Speaker 2: used to think socialized medicine was better. If anyone outside
31:51
Speaker 2: of the US is listening to this conversation, their head
31:54
Speaker 2: must be spinning. Whatever socialized medicine like the UK, Spain,
32:00
Speaker 2: or Canada, there's pros and cons to that as well.
32:03
Speaker 2: And I find depending on the country, certain things aren't covered.
32:07
Speaker 2: You maybe have longer wait times, you might not have
32:11
Speaker 2: There's many other things. But for those of us in
32:14
Speaker 2: the US where it's not a choice, right, this is
32:17
Speaker 2: the world we live in, and it's very, very important.
32:20
Speaker 2: You know. Usually on this podcast, i'll give clinical pearls
32:22
Speaker 2: because we're talking about medication, but in this case, we're
32:25
Speaker 2: giving legal pearls because this is probably one of the
32:28
Speaker 2: most important things any one of us can do. And
32:32
Speaker 2: this is not just through pregnancy. This is any time
32:35
Speaker 2: you're going to get any procedure done, see any type
32:38
Speaker 2: of specialist, Track your appointments, track what you paid, Track
32:43
Speaker 2: what your insurance plan says they'll cover. I've been given
32:46
Speaker 2: a run around, and I feel like, if this is
32:49
Speaker 2: happening to me, and I know more than most about
32:51
Speaker 2: our US healthcare system, how is everyone else navigating this? Andy?
32:55
Speaker 2: This is why you have a position. But what is
32:58
Speaker 2: a deductible? So I was old deductibles for anything that's
33:02
Speaker 2: not an office visit. But that's not true because my
33:05
Speaker 2: current insurance said it deductibles only if you're impatient. But
33:09
Speaker 2: then a previous insurance I had, I had a procedure
33:12
Speaker 2: done in a hospital minor, but they came back to
33:15
Speaker 2: me five months later saying it wasn't part of the
33:17
Speaker 2: copay I thought I was paying. It was part of
33:19
Speaker 2: my deductible, and I tried to appeal it. They denied it.
33:21
Speaker 2: And because it wasn't that much money, you're not talking
33:24
Speaker 2: tens of thousands of dollars, I didn't want to go
33:26
Speaker 2: into collections. They know people like me are just going
33:29
Speaker 2: to pay it, and it was wrong. Now I wish
33:32
Speaker 2: I knew then what I know now and anytime. Unfortunately,
33:34
Speaker 2: this is the world we live in. It's if you're
33:36
Speaker 2: in the US going to see a doctor of any kind,
33:39
Speaker 2: especially something like pregnancy, where you never know what could happen.
33:44
Speaker 2: Track everything, keep your spreadsheets and keep your receipts, and
33:48
Speaker 2: you can do a digital version of receipts as well,
33:50
Speaker 2: but have that information and best case scenario, you can
33:54
Speaker 2: get rid of all of it when you're done, if
33:56
Speaker 2: you don't need it, but it's there if you do right.
34:00
Speaker 1: So much better to have it and not need it
34:03
Speaker 1: than to need it when you don't have it. And
34:06
Speaker 1: that kind of feeling is not good. And so I
34:08
Speaker 1: want to just touch real quick on the legal pearls.
34:11
Speaker 1: This is all great legal information and it's good insight.
34:15
Speaker 1: Of course, none of this is legal advice. It is
34:18
Speaker 1: absolutely from a lawyer's perspective, and as a mom who
34:21
Speaker 1: has been through it, this is my experience as someone
34:25
Speaker 1: who practices law and who tears apart statutes and tries
34:28
Speaker 1: to see, you know, what the nitty gritty is. I
34:31
Speaker 1: feel like the system happened to me as a mom.
34:34
Speaker 1: Every American mom you know, be aware.
34:37
Speaker 2: This is what we need to do. And thank you
34:39
Speaker 2: for throwing the disclaimer in. I normally do all my
34:41
Speaker 2: disclaimers at the beginning, but since I wasn't talking about
34:43
Speaker 2: medications this time, I did not. But I'll add one
34:46
Speaker 2: more to it. Anything we say or do, it's just
34:48
Speaker 2: our own opinion and experiences and for education and not
34:52
Speaker 2: part of a reflection of who we're where we were. Andy,
34:55
Speaker 2: any last thoughts you'd like to share with our listeners today.
34:59
Speaker 1: Yeah, one of the things the statistics I like to
35:03
Speaker 1: share is that the birth of our children is one
35:07
Speaker 1: of the last things we tend to remember. Even women
35:10
Speaker 1: with Alzheimer's are able to remember the births of their children.
35:14
Speaker 1: And birth matters. The way we are treated in our birth,
35:18
Speaker 1: the way we feel during our postpartum all of that
35:21
Speaker 1: is important. And of course, like you said, I've got
35:24
Speaker 1: my healthy three year old, and thank goodness, we're healthy
35:26
Speaker 1: and I'm all in one piece. But that's not the
35:30
Speaker 1: only piece. The experience matters. The way that you feel
35:34
Speaker 1: about it matters because it's this transformational experience. And in
35:38
Speaker 1: our culture where we have very few rights of passage
35:41
Speaker 1: really other than graduation from high school, college, you know,
35:45
Speaker 1: trade school, anything like that, this is something that women
35:48
Speaker 1: and pregnant folks going through. It is a big experience.
35:52
Speaker 1: It is something that matters, and you are allowed to
35:54
Speaker 1: have big feelings about it. And so I just want
35:58
Speaker 1: everyone to know that there is such a community around
36:01
Speaker 1: you of different types of providers, different types of professionals
36:05
Speaker 1: that really want to make the experience better for you.
36:08
Speaker 1: Whether that's taking off stress, it's taking away pain, it's
36:11
Speaker 1: you know, mitigating that nausea. Whatever it may be, there's
36:15
Speaker 1: going to be something that someone can do to help.
36:17
Speaker 1: So don't be afraid to reach out for the help,
36:20
Speaker 1: and don't feel like you have to be alone, because
36:22
Speaker 1: it's not how we're designed. That's not how we're designed
36:24
Speaker 1: at all as human beings, creating more human beings. We
36:28
Speaker 1: need our village and now it looks like maybe different professionals,
36:31
Speaker 1: but we're here and we want to help.
36:33
Speaker 2: Everybody has a support person available reach out. That's one
36:37
Speaker 2: of the reasons I started this podcast and the work
36:40
Speaker 2: I do with hyperremeses moms so that nobody suffers alone.
36:43
Speaker 2: If we can, like you said, mitigate that stress, whether
36:47
Speaker 2: it's financial stress, physical stress, We're here to support you. Andy.
36:51
Speaker 2: Thank you so so much for sharing your story and
36:54
Speaker 2: your knowledge and experience and starting this business that is
36:59
Speaker 2: just going to pay it forward to so many. Please
37:02
Speaker 2: follow her your legal doula on social media. Your Legaldula
37:06
Speaker 2: dot com is her website. You can find me on
37:09
Speaker 2: LinkedIn or at hdpharmacist dot com. Please reach out to
37:13
Speaker 2: us here to support you for all your needs through
37:15
Speaker 2: your pregnancy journey. Thank you so much,