ROANOKE TIMES
Copyright (c) 1995, Roanoke Times
DATE: Monday, December 18, 1995 TAG: 9512180098
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: LAURAN NEERGAARD ASSOCIATED PRESS
SOME MOMS AND NEWBORNS are falling through cracks in the new rules designed to prevent ``drive-through deliveries.''
Kathleen Van Hollen was exhausted and bleeding after the emergency delivery of her baby to save his life.
But instead of resting, she was arguing on the telephone - trying to get her insurance company to follow a new Maryland law allowing two days of hospital healing after childbirth.
She failed, joining thousands of women in three states who fell through the cracks of new laws designed to stop so-called ``drive-through childbirth.''
``It's not that the insurers are doing anything illegal - they're just simply ... trying to fatten their wallets,'' said Christopher Van Hollen, a Maryland state senator who pledged to strengthen that law after his wife's experience.
Argued New Jersey Assemblywoman Barbara Buono in a letter to Congress, ``The best way to plug up the loopholes ... is to enact federal legislation that is more encompassing.''
Today, many insurers pay for one day in the hospital after a normal birth or two days after an uncomplicated Caesarean delivery, saying there's seldom a medical need for longer stays.
Insurers insist they listen if doctors recommend a longer stay.
``I hear lots of people say they feel pressured,'' acknowledged Don White of the Group Health Association of America. ``But I have yet to come across an HMO that says, `Regardless of what the attending health professional thinks, you need to go home.' That's just silly.''
But many doctors and the American Academy of Pediatricians say it takes at least 48 hours for the mother to recover and to ensure the baby is healthy. Some conditions, such as jaundice, cannot be diagnosed during the first 24 hours of life.
Three states - Maryland, New Jersey and North Carolina - this year began mandating a 48-hour stay. But some new mothers who thought they were covered are getting a surprise:
State laws do not cover the self-funded insurance plans offered by more than half of employers, because a 1978 federal law exempts such plans from state regulation.
New Jersey law doesn't cover any companies based out of state.
In Maryland, doctors who helped write the law say they intended that women stay 48 hours unless they choose to leave early and get a home visit from a nurse the next day. But the law's language lets the insurance company automatically choose the home visit.
Legislation pending in Congress could settle the issue by covering all insurers, although it is not expected to clear committee before spring.
But Massachusetts state Sen. Lois Pines is telling some of the 17 other states considering 48-hour stays how to close such loopholes themselves without waiting.
Effective Feb. 19, Massachusetts will force every insurer doing business there to cover a minimum 48-hour stay - by prohibiting hospitals from releasing a new mother earlier unless they meet strict safety requirements.
``This law gives birth to a minimum standard of care,'' she said.
Keeping healthy moms in the hospital costs $1,000 a day, a staggering sum considering there are 4 million births a year, insurers counter.
Amid the battle, some hospitals are offering a free second day.
``The cost ... pales in comparison to the cost of re-hospitalization of an infant,'' said Dr. Keith Ghezzi of George Washington University Hospital in Washington, which started the program this month.
LENGTH: Medium: 76 lines ILLUSTRATION: PHOTO: AP. Kathleen Van Hollen couldn't get two days ofby CNBhospital healing from her insurance company after Alexander's
emergency birth. color.