ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, February 8, 1996 TAG: 9602080079
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
DATELINE: RICHMOND
SOURCE: DAVID M. POOLE STAFF WRITER
NOTE: Above
During a recent pelvic exam, Betsy Cook felt a wave of discomfort 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 for her insurance plan - refused to refer her.
She faced the choice of seeing him or paying considerably more to be treated by her gynecologist.
"In other words, I had no choice," said Cook, a 26-year-old graduate student at Virginia Commonwealth University.
Providing women 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 obstetric and gynecological care, which most women of childbearing years consider their primary need.
"Call your wives and see what they think," Fairfax County Del. Gladys 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. Advocates couldn't persuade the assembly to pass a law requiring insurers to offer mammogram coverage until the death of a lawmaker's daughter from breast cancer raised awareness, Keating said.
Women's health advocates say they could be poised for a breakthrough this year. Women have increased their ranks to 20 of 140 lawmakers. And the high-stakes managed-care debate has nudged women's unique health needs into the spotlight.
"We're light-years ahead of where we were even three years ago," said Fairfax County Sen. Jane Woods.
Among a dozen managed-care bills are proposals that would:
Require health insurance plans to cover annual Pap smears as well as regular mammograms.
Give obstetricians a greater say in how many days a mother and her newborn can stay in the hospital after delivery.
Provide women unlimited access to their gynecologists.
The Pap test bill - sponsored by Virginia Beach Sen. Kenneth Stolle - cleared the Senate without opposition and was sent to the House.
The maternity initiative seeks to address some insurance plans that require mothers to leave the hospital 24 hours after giving birth. Critics say such short-stay, "drive-through" deliveries compromise care for mothers and newborns.
Dels. Clifton "Chip" Woodrum of Roanoke and Robert Tata of Virginia Beach introduced bills requiring that insurers pay for at least 48 hours after a vaginal delivery and 96 hours after a Caesarean.
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 specifying length of stay by law could encourage some mothers to stay in the hospital longer than necessary and therefore increase the cost of health insurance.
Under a compromise, each insurance company would follow guidelines for "inpatient postpartum" 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 gynecologists.
Keating said her proposal grew out of a legislative study that found that many women were frustrated when insurance plans treat gynecologists as specialists, even though many women consider them their doctor of first resort.
Many insurance plans allow women to visit their gynecologists once a year without a referral from their primary care physician. Keating said each additional visit can require two appointments - one to the primary care physician and the second to the gynecologist.
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 gynecologist. 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 had good intentions, but he didn't know the details of her gynecological history and seemed unfamiliar with the procedure.
Cook said the intimate relationship between women and their gynecologists cries out for an exception from managed-care guidelines.
Opponents say the 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.
If gynecologists get an exemption, opponents warn, the General Assembly will be besieged by other specialists - dermatologists, ophthalmologists and others - seeking direct access to patients.
"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, R-Chesterfield County, offered a compromise in which women could name their obstetrician or gynecologist as their primary care physician.
The various parties were unable to reach an agreement at a meeting that lasted late into the night Tuesday. The two sides were still far apart Wednesday. They will try to reach a consensus when the House panel meets again today.
Keating said she was unsure if she would continue to push for unlimited access.
"I'm trying to decide whether to take a small bite or risk going down," she said.
LENGTH: Long : 118 lines KEYWORDS: GENERAL ASSEMBLY 1996by CNB