Medicos has struggled with the growth in its responsibilities for women's health care. Adding Cesarean services was not easy, and family planning services are central to the mission. The request for tubal ligation was frequently impossible to fulfill. Reasons were many. Lost sterilization permits. Transportation and language barriers led to missed appointments with the only OB service in town accepting medicaid patients for stand-alone tubal ligation.
Uninsured patients were even more difficult given the need to pay hospital charges for OR, anesthesia, and the full physician's fee. Our only source for referral was the OB-Gyn residency downtown.
These charges usually were more than $2500. The no show rate for referrals sent by Medicos was more than 50%. This created friction in the already tense arena of OB-Gyn care for the underserved. Rodney WM, Martinez C, Chiu WK, et al. Prenatal Patients Who don't Deliver: Unplanned Events, Uncounted Services, Risks. Am J Clin Med 2009 in press.
Essure in the office has been a Godsend, but the materials for each procedure must be paid by the physician up front. The cost is $1415, and Medicos is concerned about providing these services without incurring a loss.
TOPIC DEPOPROVERA--There was little response to the DepoProvera conundrum of medicaid reimbursements set at $55 while one "wholesale" dealer charged $62 for the 150 mg medroxyprogesterone. Women come to the office, go to the drugstore, return to the office, then, and only then, do they receive these family planning services.This is common and not necessary.
The answer--Medicos has located a licensed pharmacist who will compound injectable DepoProvera for less than half this price.
Index--Essure, Family Planning, DepoProvera, surgery in office, charges
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