Frustrated (warning - looong)

This time not because of the usual pregnancy reasons but because of the labyrinth that is the U.S. Healthcare and benefits system. Any of my right-wing friends who want to lecture me about how a central, government run, single-payer system is bound to be inefficient and ineffective are quite literally delusional and have clearly never had first-hand experience with anything beyond a perfunctory doctor's appointment in the U.S. (and obviously have NO experience in the U.K.) Conversely, all my U.K. friends and family who complain about the N.H.S. (National Health Service) and government benefits system should stop. Right now. Stop. You have no idea how lucky you are.

First of all, let's start with pay and disability during maternity leave. You've heard this rant before but, instead of just raging against the only 1st world machine that doesn't provide any guaranteed, paid benefits for new mothers, now I'm frustrated at the number of forms that need to be completed and the complexity of the process to complete them.

Let's start by trying to explain to those of you who have never had to go through this process before, what benefits are available to new mothers (in California at least). This alone should be enough to blow your mind:

• Pregnancy Disability Leave (PDL): Expectant/new moms are entitled to four months of pregnancy disability leave IF, and for as long as, you are "disabled" due to your pregnancy, childbirth, and/or a related medical condition. PDL can be taken all at once during the few weeks before and after delivery, it can be taken at any time throughout and after your pregnancy for morning sickness, prenatal visits, complications, recovery etc... PDL is for any period(s) of actual disability caused by your pregnancy, childbirth, or related medical conditions up to four months (or 88 workdays for a full-time employee) per pregnancy. An employee must be designated as disabled because of pregnancy, childbirth, or related medical condition by her treating physician in order to be eligible for PDL.
  
• Federal Family & Medical Leave Act (FMLA): This act considers pregnancy a "serious health condition" and allows an employee to take up to twelve weeks of family leave for a pregnancy-related disability, without risk of losing their job. FMLA leave runs concurrently with (ie: starts at the same time as) PDL. It's not clear to me what the point of FMLA is exactly, since it runs at the same time as PDL and seems to have similar conditions.
  
• State Disability (SDI): During the period that you are disabled under PDL, you are eligible (after a 1 week waiting period) to claim disability pay under the California State Disability Insurance program. (This is only available if your company has paid into this program - if your company has less than 100 employees, they are not required to do so.) SDI is approximately 60% of your pay and is calculated based upon your earnings from a previous period, dependent on the date when you file your claim. For example, if you file in April, May, or June your base period is the 12 months ending last December 31. You are not eligible to receive SDI if you are also receiving Sick Pay from your employer at any time during your leave. Oh, btw, State Disability is calculated on weeks that run from Sunday through Saturday, just to complicate things further.
  
• California Family Right Act (CFRA): CFRA was established to ensure secure leave rights for, amongst other things, the birth of a child for purposes of bonding. CFRA kicks in after PDL kicks out and provides you with up to 6 weeks of baby bonding time that can be taken at any time in the 1st year after the baby is born. You have to take this time in 2 week increments except in two instances where you can take it in 1 week increments. You can receive vacation pay at the same time.
• Paid Family Leave (PFL): (Not to be confused with PDL.) During this time you are eligible for Paid Family Leave (a California benefit) which is calculated similarly to SDI (I think - all of this still isn't 100% clear in my mind.)

So, that's the benefits and entitlement stuff.

During all of this your employer is only required to keep your job open although many do much more. My employer is"kind" enough to offer the following:

1. You must use up your Sick Pay Benefits at the beginning of your leave. In my company this can be up to 3 weeks, presuming that you did not take a day off sick recently. (You can't accrue more than 3 weeks, however.) What if you (or your baby) get sick after you return to work? Until you accrue enough hours again, you'll have to take the time off unpaid. Fantastic, isn't it?
   
2. You may then (your choice) use your vacation time/pay for a portion of the rest of your leave. In my company this can be up to 3 weeks, presuming you've worked there for at least 5 years and that you haven't had a day off in a while.

After your sick and vacation pay runs out, they are not required to pay you a dime.

In order to make all this happen, there's a myriad of forms you need to complete.

1. A Medical Certificate for your employer, signed by your doctor - Apparently my employer needs this like yesterday but since I don't have a date to go out on leave yet, my doctor won't complete it. My doctor won't consider me as "disabled" until we've got the results of my 37 week ultrasound and have decided whether to go for a c-section or a vaginal birth, so I can't go out on leave until we've had that conversation because I'd have to just use my sick time and wouldn't get disability benefits. Plus, if I go out before the baby is born, this only further reduces the time and benefits I can use once the baby is here. If we decide to move forward with a vaginal birth, since I work from home and plan not to go out on leave until the baby is born, my doctor won't complete this paperwork until I do go out on leave - which probably won't be until the day I give birth because I'm (a) healthy and (b) work from home. But, as I said, my employer needs it now.
2. An EDD (Employment Development Department) Claim for Disability Benefits - This enables you to file for SDI. (Yes, you go to the EDD to file for SDI once you are on PDL!) This document cannot be completed by the doctor until you go out on leave. My doctor will not hold the paperwork and send it off when I go out on leave, although some do. So, this means that the day I give birth or the day I go in for my c-section, someone (namely Hubby) needs to walk these pieces of paper into the office to have them signed and sent-off. Of course, this will be the first thing on his mind on that day. NOT.
3. PFL form - I believe this is automatically sent to you once your PDL ends. Honestly, I'm not sure. I'll cross that bridge when I come to it.

All this is without mentioning the forms I need to get completed by the doctor at the beginning of my leave for AFLAC short term disability benefits (something I pay into every month out of my pay check to avoid financial ruin in the case of major illness or injury.)

Now let's talk Health "Insurance"

I have healthcare through my employer and (right now at least) do not participate in the cost of my insurance because I stick to the basic program (HMO). (I am assured that, due to the rising cost of health insurance, our company will require an as yet tbd employee participation in even the basic insurance in the 2009/2010 benefit year.) If I wanted to "buy up" into a better program of insurance, a PPO, I would need to pay $360 a month or $4,320 a year, to my employer. Umm... no thanks.

1. Each pre-natal doctor visit I have attended costs $25 in co-pays (for the UK peeps out there, this is the portion of the cost for your visit that you, as the patient, are responsible for - yes, even though you have "health insurance".) By the time my pregnancy has ended, I calculate that the total cost of pre-natal doctor visits alone will be: $325.00
2. Looking at my insurance paperwork, I also have a co-pay for my hospital stay. This works out to be $500 per day I am in hospital, up-to 4 days, after which time they pick up 100% of the cost. This means that, if I have a c-section and stay the routine 4 days, my co-pay will be: $2,000.00
3. Once baby is born, the average number of check-ups he/she will need to go through in the first year will be 6, each at $25 per visit. This does not include the cost of any extra visits or tests etc... that might need to be done if the baby is sick. Minimum total co-pays in first 12 months for well-baby visits: $150.
   
4. Within 6 weeks after the baby is born, I have to add him/her to my insurance. Since my company will only pay 100% for me, this will be a monthly cost of: $360 a month or $4,320 a year. Again, this number is likely to increase in December when my benefit year ends and my employer can no longer continue to keep-pace with the rising cost of health insurance.

TOTAL OUT OF POCKET HEALTHCARE COSTS TO
HAVE A BABY IN THE FIRST 12 MONTHS: $6,795.00

Note 1: the above number does not include the cost of any prescription drugs I take after birth/surgery. My co-pay for generic drugs is $15 per prescription.

Note 2: Once my employer stops paying me (after 3 weeks because I'm not going to use up my vacation time) then any out-of-pay-check benefits I currently have, I'll have to write a check to them for!

The other curve-ball we got thrown last night at our last birthing class was that, if we have a boy and want to get him circumcized (another topic altogether in our marriage), some insurance programs only cover circumcision when done at the hospital before you're released but then some pediatricians will only do it at their office. If that's the case, you have to pay 100% for the circumcision; it's not covered by your health insurance. So now we have to go back to my health insurance benefits paperwork, figure out if there are any such conditions, and then establish whether or not our pediatrician will do it in their office or if we can get it done at the hospital.

Adding to this conundrum is the fact that, since my insurance is an HMO, I am restricted to doctors within the Mercy Medical Group. When we were searching for pediatricians, we couldn't find anyone barely in the Folsom area (close to our hospital, Mercy Folsom). The one we found, liked, and ultimately picked is in Carmichael, and closer to Mercy San Juan. She does not have hospital privileges to Mercy Folsom. So, if we need to get our son circumcized at the hospital, we'll need to use the on-call pediatrician. At our Stork Tour last week, we were told that not all the pediatricians there will even perform circumcisions any more.

So, you know, who the **ck knows how we'll do it or who will pay. I'm done trying to figure it out, especially since it's not even me that wants to get it done (as I said, topic of debate in our marriage - English baby boys only get circumcized for medical/religious reasons and are in the vast minority, US babies used to be circumcized routinely but now the numbers drop every year as more parents choose not to. American Pediatric Association says there are benefits to circumcision but not enough to make it medically necessary.) Who knew a foreskin could be the subject of such debate????

The bottom line is that the system(s) out here are ridiculously convuluted and almost impossible to navigate. Even when you're lucky enough to have a job and insurance, you're still landed with high bills, lost income and paperwork. It's easy to see how 1 in every 3 bankruptcies in the U.S. every year are a result of healthcare costs.

Further, for all those small-business-obsessed Republicans, it should also be noted that the cost of providing healthcare to employees can be crippling. For a business with about 100 employees, you're looking at paying about $250 per employee per month for healthcare alone.

And people say it will be "inefficient" if we have the government run it! Yeah, right, because the private sector is doing such a great job right now. NOT.

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On a more personal note, today we had yet another ObGyn visit.

• My belly measures 37cms which, according to a Google Search, puts me right in the normal parameters for 36-38 weeks. Maybe baby is slowing down?
• I only put on 0.6lbs which is just as well considering our last appt was only last Thursday!
• Our next appointment won't be until Monday 3/23 because our ultrasound is next Tuesday, the 17th, there are no appointments available on Thursday, Friday is surgery day, and Wednesday is too early for the ultrasound results to be in from the day before. So, we have to wait almost a week to discuss the results of the ultrasound with our doc. Grrrrr.

We also "graduated" from our birthing class, Great Expectations, last night, which was a wake-up call of sorts. D-day seems so close and yet so far away right now...