When I discovered I was pregnant in late June of 2010, I was surprised; when I lost my job four days later, I was devastated. My employer-provided health insurance was up at the end of the month and I needed prenatal care for the next nine; not to mention post-delivery care for the baby. The stress of finding myself pregnant without insurance coupled with the loss of my job sent me into depression.
Recognizing I needed help and having few options, I contacted VA; I had signed up for the five years of healthcare from VA following my return from deployment in 2008. I had been once before because the shrapnel I had in my arm from an IED strike in Iraq had been causing me lingering pain. After the doctor looked at me during my evaluation, cocked her head to one side and said “I didn’t know women were on the front lines.” I hadn’t been back.
But I was desperate, and I knew there was a new law that said VA would pay for care of newborns. I thought I could get someone to talk to and care for an unborn child in the same place. I called the appointment line; the next opening was over a month away. Not having anything better to do, I went to the VA hospital and sat in the waiting room until the doctor had time to see me. When I finally got into the exam room I broke down.
This visit was the opposite of my previous attempt to access care. The doctor was patient and respectful. The depression care manager she sent me to was a wonderful women who sat and listened to me pour my heart out. She helped me get in touch with the Women’s Care Coordinator to find out about receiving prenatal care through VA. Things were looking up. I was getting the help with my depression and gaining access to much needed medical care.
There was a catch.
VA doesn’t currently house any services for female Veterans to receive obstetric care. I would have to use a civilian provider that contracts with VA. Unfortunately there were only two options and both were too far from where I lived to be viable options. I began to take the contract paperwork to various OBGYN practices closer to my home to see if I could convince one to accept reimbursement from VA. After many calls to billing departments attempting to explain what the reimbursement process was, and many rejections, I found a doctor willing to take me on as a patient.
Then something bad happened.
August 2010, 16 weeks into my pregnancy, I was involved in a car accident. Needing to make sure everything was still okay with the baby, I went to the Emergency Room of the VA medical center. I was told that all the ultrasound technicians had gone home for the day and that was the extent of the care they could give me. I would have to be transferred to another hospital for a full examination. During the transfer process I was assured all the paperwork was taken care of and the secondary hospital knew I was a VA patient and all the bills would be to the VA hospital.
A week after getting a clean bill of health for myself and the baby I got a bill for $1,999.94 from the hospital I was transferred to. It took several calls, being on hold, and a conference call with myself, VA’s Fee Basis Department and the hospital billing department to get everything straightened out.
As I approached 36 weeks of pregnancy I began to email VA about the process for having my labor and delivery covered. What paperwork did I need to bring to the hospital? How should I explain the contracting process to the hospital? Which VA offices should I be talking to? The initial response was that a process had not yet been put in place but that I should have a “Happy Holiday.” The stress of not knowing whether I would be able cover the cost of medical expenses made that “Happy Holiday” difficult to have. As my due date drew closer, the answers to my questions did not get any clearer. “I don’t know” changed to “Have the hospital call us and we’ll explain everything.” I entered the last trimester of my pregnancy with trepidation and not the expectant joy of most would-be-mothers.
My fears where confirmed when I arrived at the hospital the evening before my delivery. My arrival at the admittance desk coincided with the usual quitting times of civil servants, leaving no one at VA to answer the hospital’s calls per my instructions. The hospital had no way of imputing me into the system since VA isn’t an insurance company. The process took over an hour and involved me calling the Women’s Care Coordinator to let her know what was happening. I was eventually admitted with the promise that it would all be worked out after the delivery. At the end I was mentally exhausted and completely drained of the strength that I would need for the 12-hour labor ahead of me.
Through my entire pregnancy I encountered every stumbling block female Veterans face when accessing VA: my service in the Armed Forces was poorly understood, there were long wait times for appointments, I received fractured care and was forced to cut through miles of red tape. My successes in using VA for care have come from me spending hours of phone calls on hold, sending countless emails and being my own advocate. Many Veterans may not have the luxury of the time I’ve been able to put in.
But not all of the challenges I’ve faced are solely the fault of VA. I understand the medical billing is a vast bureaucracy in itself. Therefore, it’s up to VA to help build a streamlined process for the female Veterans coming after me. Putting into place a simple paperwork system and materials can help the Veteran explain to obstetricians and contract care providers what the VA covers.
I am now the proud mother of a beautiful baby girl but as I care for her, I keep a wary eye on my mailbox; I’m waiting for the hospital bills from the delivery to come in and join the growing pile. I wonder how long it will take to get VA to cover them.
Staff Sergeant Jennifer Hunt has served 10 years as a Civil Affairs Specialist in the Army Reserve during which time she has deployed to both Afghanistan and Iraq. Since returning from her latest deployment, Jennifer has worked to raise awareness about the issues facing female Veterans returning from war and reintegrating into the civilian world. She currently resides in Maryland with her husband and newborn daughter.