THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, February 8, 1996 TAG: 9602080389
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DAVID M. POOLE, STAFF WRITER
DATELINE: RICHMOND LENGTH: Long : 105 lines
During a recent pelvic exam, discomfort washed over Betsy Cook like a wave as her general practitioner kept apologizing for his inexperience in such matters.
Cook had wanted to see her trusted gynecologist. But her primary care doctor - who acts as gatekeeper in her insurance plan - refused to refer her.
She faced a choice of seeing him or paying considerably more to be treated by her gynecologist.
``In other words, I had no choice,'' Cook, a 26-year-old graduate student at Virginia Commonwealth University, told lawmakers this week.
Providing women with greater access to obstetrical and gynecological care has emerged as one of the central issues in a General Assembly debate on managed health care.
Women's health advocates want insurance companies to remove bureaucratic and financial hurdles to ob/gyn care, which many women of childbearing years consider their primary need.
``Call your wives and see what they think,'' Fairfax County Del. Gladys B. Keating advised the seven men appointed to a House of Delegates panel on managed care.
Women's health issues rarely have been at the forefront of the male-dominated General Assembly. Until the death of a lawmaker's daughter from breast cancer raised awareness, Keating said, advocates couldn't convince the Assembly to require that insurers offer mammogram coverage..
Women's health advocates say they could be poised for a breakthrough this year. Twenty of the Assembly's 140 lawmakers are women. And the high-stakes managed-care debate has nudged women's health needs into the spotlight.
``We're light-years ahead of where we were even three years ago,'' Fairfax Sen. Jane H. Woods said.
Among a dozen managed-care bills are proposals that would:
Require health-insurance plans to cover annual Pap tests as well as regular mammograms.
Give ob/gyns a greater say in how many days a mother and her newborn can stay in the hospital following delivery.
Provide women with unlimited access to their gynecologists.
The Pap test bill - sponsored by state Sen. Kenneth W. Stolle, R-Virginia Beach - cleared the Senate without opposition and was sent to the House.
The maternity initiative seeks to address some insurance plans that require new mothers to leave the hospital 24 hours after giving birth. Critics say that such short-stay, ``drive-thru deliveries'' compromise care for mothers and newborns.
Dels. C.A. ``Chip'' Woodrum, D-Roanoke, and Robert Tata, R-Virginia Beach, introduced bills requiring that insurers pay for at least 48 hours of hospital care after a vaginal delivery and 96 hours after a Caesarean section.
The proposal - patterned after a law in Maryland and several other states - was opposed by a powerful coalition led by insurance companies and some of the state's largest industries.
The coalition argued that legislating length of stay could encourage some mothers to stay in the hospital longer than necessary and increase the cost of health insurance.
Under a compromise, each insurance company would follow guidelines for ``in-patient post-partum'' treatment and follow-up home visits established by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.
Woodrum said the compromise would reaffirm the ``control of physicians without busting the budget.''
Woods, sponsor of a similar bill in the Senate, said she expects the measure to win General Assembly approval.
A bitter and emotional fight, however, is expected over a bill that would give women unlimited access to their ob/gyns.
Keating said her proposal grew out of a legislative study that found many women were frustrated when insurance plans treat gynecologists as specialists, even though many women consider their ob/gyn as their doctor of first resort.
Many insurance plans allow women to visit their ob/gyn once a year without a referral from their primary care physician. Keating said that each additional visit can require women to make two appointments - one to their primary-care physician and the second to their ob/gyn.
Other women have been more than inconvenienced.
Cook, the VCU graduate student, was denied a referral and couldn't afford to pay to see her ob/gyn. She told the House panel Tuesday that what could have been a routine examination turned into an uncomfortable and emotionally taxing encounter with her primary-care physician.
She said the doctor was well-intentioned, but he didn't know the details of her gynecological history and seemed unfamiliar with the exam.
Cook said the relationship between women and their ob/gyns cries out for an exception from managed-care guidelines.
Opponents say the ob/gyn bill would defeat the purpose of managed care, which controls costs by coordinating treatment through a specified primary-care physician.
Insurance companies warn that businesses and individuals will face higher premiums if patients are allowed unlimited access to certain specialists.
``To say that anyone can have unlimited access to anything these days is probably an outdated statement,'' said Michelle Whitehurst Cook, a Richmond physician and president-elect of the Virginia Academy of Family Physicians.
Del. John Watkins of Chesterfield County offered a compromise - allowing women to name their ob/gyn as their primary-care physician.
The various parties were unable to reach an agreement at a meeting that lasted late into the night Tuesday. They will try to reach a consensus when the House panel meets again today at 7 a.m.
The two sides were still far apart Wednesday.
KEYWORDS: GENERAL ASSEMBLY by CNB