Back then, there was only the plan that is referred to as "Samaritan Classic" now. Members had a $500 deductible on each medical issue then the rest of the cost of treatment could be reimbursed up to $250,000. The plan has some exclusions around sexual health in that abortions, problems resultant from an abortion and STD testing were excluded from being funded. At the time, my only concern was for women or men who had a spouse who had an affair and needed to get STD testing because of that; it felt like punishing the innocent spouse. My gut assumption was that people who were attracted to Samaritan would not be seeking abortions for any reason.
Fast forward to last month when I got pulled into the rabbit hole again when researching something about the Maxwell Family businesses pulled up a blog post on how Samaritan Ministries covered the medical bills for Nathan Maxwell's daughters Susannah (who was born with terminal brain damage from unknown causes) and Abigail.
As I was looking at their section on "Maternity and Newborn Care", I saw three sections that scared me from a medical standpoint: ectopic pregnancies, home births and vaginal births after cesarian -sections (VBACs). This post will cover ectopic pregnancies.
Ectopic Pregnancies:
An ectopic pregnancy is a pregnancy that implants anywhere outside of the uterus. The most common site for ectopic pregnancies is the fallopian tube - but rarely it occurs on the ovary, the outside of the uterus, the intestines or the cervix. Fallopian tube ectopic pregnancies will either end when the fetus dies from lack of blood supply or will end when the fallopian tube ruptures causing the fetus to bleed to death when the placenta detaches long before viability is reached. The danger with a tubal rupture is that it can cause massive internal bleeding for the mother and often requires a more complicated surgery to stop the bleeding and mitigate the damage to the mother's reproductive system. Women do die in developed nations from ectopic pregnancies but it is rare because doctors treat ectopic pregnancies by chemical or surgical removal as soon as they are diagnosed. In developing nations, the fatality rate of diagnosed ectopic pregnancies is around 3% - and is probably higher since women who die away from medical facilities would not be reported.
To be clear, NO pregnancies have survived to viability from a fallopian tube ectopic pregnancy. A handful of ectopic pregnancies outside of the fallopian tube have surivied to viability - but the most common outcome is fetal death from lack of blood supply. Delivery of an ectopic pregnancy outside of the fallopian tube is a life-threatening surgery for the mother; the placenta has infiltrated blood vessels of organs that do not have the muscular response to contract when the placenta is removed. This can lead to catastrophic bleeding that has lead to maternal death - and can do so long before viabilty is reached.
Samaritan's Policies:
Expenses Shared—Procedures related to a ruptured fallopian tube (including post-operative recovery of the mother, follow-up care, and treatment of any complications), and, where an ectopic pregnancy is diagnosed before a rupture, all pre-operative tests and consultations and expenses related to keeping the mother under medical care while determining what care should be offered for the mother and child.
Expenses Not Shared—Procedures directly related to the termination of a living, unborn child and/or removal of the living, unborn child from the mother due to an ectopic pregnancy are not shared (e.g. methotrexate, salpingectomy, salpingostomy), unless the removal of the child from its ectopic location was for the primary purpose of saving the life of the child or improving the health of the child.
Issues: Samaritan is mandating that women choose the popular among QF Evangelical route of "Watchful Waiting" where women diagnosed with ectopic pregnancies wait until either the fallopian tube ruptures (or something similar if it is another organ) or the baby dies before removing the pregnancy.Expenses Not Shared—Procedures directly related to the termination of a living, unborn child and/or removal of the living, unborn child from the mother due to an ectopic pregnancy are not shared (e.g. methotrexate, salpingectomy, salpingostomy), unless the removal of the child from its ectopic location was for the primary purpose of saving the life of the child or improving the health of the child.
This is a horrible idea based on flawed premises. The rationale goes that women in the US and Europe have a really low rate of mortality from ectopic pregnancies so it's not dangerous for women to put off treatment of an ectopic pregnancy as long as they are being carefully monitored by their doctors.
The reason that developed nations have low rates of mortality is because doctors interviene in ectopic pregnancies prior to rupture - even if the fetus is still alive. I'm Catholic and the Catholic Church has recognized this basic principle for as long as doctors have been able to diagnose ectopic pregnancies. There is no chance of survivial for the fetus and ~25% chance of a potentially lethal rupture for the mother so the Church allows for the fallopian tube to be removed. Yes, this kills the baby - but the purpose of the surgery is not to kill the baby but to prevent a ruptured tube so it is not immoral. I find the rationale a bit hackneyed - but women have an option to end the pregnancy.
The QF believers will reply "But we don't really know how long a Fallopian pregnancy can survive because doctors won't let nature take its course!"
Here's a sane reply: Ectopic pregnancies have been killing women for centuries. Doctors have been doing autopsies on dead women for 150 years. They've collected plenty of data from dead women with dead babies that shows that ectopic pregnancies in the fallopian tubes will rupture by 16 weeks and that the later the rupture happens the higher chance of maternal mortality or injury.
OB/GYNs like babies. They like delivering healthy babies to healthy mamas. They would love to figure out how to save ectopic pregnancies - but it's not possible until we can build a placenta from scratch and attach it in the right place.
There will be another post on this topic soon. :-)
I've also heard stories of these medical share programs taking so long to pay that the bills actually go to collections and ruin the person's credit. Obviously not as bad as insisting a women should try to carry an ectopic pregnancy but enough that I would never recommend anyone use them.
ReplyDeleteI didn't think of that! Yeah, I don't know what the turn-around time is for Smaritan is - but even if it is fast they do have a caveat that it is possible that the need request for a given month might not be completely covered because there's not enough people paying in.
DeleteThe issue I have is that the first step - not said in the sign-up area but stated in the blog posts from people who had large bills paid by Samaritan - is to inform the hospital billing department that you do not have insurance. Samaritan calls that getting the best discounts - but what they are really doing is having their bills offset by nameless donors. They push trying to get 90% or more discounted by hospitals and over 60% by doctors and independent practioners but encourage people to refuse Medicare or Medicaid if they qualify for it.
To me, it's immoral to expect the people who save your life to be short-changed because of your religious views.
If you have real insurance they usually do that negotiation for you. Especially if you are in network. It sounds like a huge pain to have to do it myself.
DeleteThe kicker is that for complicated things - like a woman who is under medical supervision waiting for an ectopic pregnancy to resolve or rupture - there are multiple providers in play. For the 28 hour period before my son was born, there was my OB/GYN consultations, the general hospital bill which covered the room, normal supplies and nursing care, pharmacy bills for IV medications, each of the blood tests, an anesthesiology consult and a neonatal consult. That's four separate groups to negociate bills with which sounds exhausting to me.
DeleteThis is disgusting because it places more value on an unborn child (whose chance of survival is already nothing) than an adult woman. Unless the surgery is to save the child, no action. I really am starting to believe that most evangelicals and fundamentalists truly hate females. You also are not allowed to join these types of groups unless you believe, no-holds-barred, in biblical inerrancy.
ReplyDeleteThank you for tackling all these issues. Your perspective is so refreshing and intelligent.
Thank you!
DeleteAbout 14 months ago, I spent a rough night facing a 26-week C-section because I had developed HELLP syndrome which would likely kill my son and me within hours to days without treatment which was delivering him very prematurely. I was worried sick about my son - and stayed in denial about what the C-section could mean for me. See, HELLP destroys platelets so I was at high risk for catastrophic bleeding during the CS. My odds of surviving were high because the doctors knew I had developed HELLP and had matched blood on hand in the operating room along with packed platelets and uterine contractile agents to try and stop any bleeding possible - but it was still terrifying for me.
My husband was looking at a potential future where he lost Jack - and a potential future where he lost me and Jack on one horrible day.
I support a woman's choice to do "watchful waiting" as long as she understands that 1) there is 0% chance a fallopian tube ectopic pregnancy will survive to 23-24 weeks, 2) each week she waits increases the risks of a fallopian tube rupture leading to catastrophic bleeding, 3) each day she waits increases the risk of losing her fallopian tube (and potentially her feritlity), and 4) there is no promise that the doctors will be able to save her even if she is in the hospital when the rupture occurs.
Oh - and that Samaritan must cover all of the incurred costs and not get "discounts" by having the person claim they are uninsured. That's cheating.