Rescheduled level II for 15 weeks

I don't know whether or not to be upset with this. Okay, I'm upset, but wondering if I should not be.

Yesterday we asked our doctor for an u/s right after 14 weeks to see if our Twin-B made it to this big milestone. As many of you know, we were told that the real test for twin-B would be 14 weeks and dh and I have been waiting to really spread the news about the twin until that milestone. While things are looking good so far and the amniotic sac size issue is resolving, our doctor agreed that it would be wise to have a peek at the babies right after 14 weeks.

I just got a call from the perinatology department at the HMO. She offered me an ultrasound for April 18th. This is great! April 18th would be right on 15 weeks. I'm delighted with that appointment. However, she said she was going to cancel our Level II u/s that was scheduled on May 6th. I told her that this u/s was supposed to be an additional u/s and was not meant to replace the level II. She also told me that my u/s on May 6th was only booked as a singleton pregnancy and she wasn't aware it was twins or that there were issues with the twins. I know for a fact that my RE called the head of perinatology and informed him/her of our circumstances. I guess that news didn't get put in the system. Grrr.

I tried to convince her that we needed the one on the 18th, but that we also needed a follow-up level II at the appropriate time, since I thought 15 weeks was too early for a level II. I told her that the main purpose of the u/s my OB just ordered was to see if the babies had resolved the amniotic sac issues, were developing well, and to also confirm that they were dichorionic, which would rule out TTTS once and for all.

She said I could have just one or the other so I chose the one on the 18th. She said that if they couldn't do all the things for the level II and see the gender then I may be able to get another one scheduled. I sure hope so! I'm just concerned that it might get pushed out of the ideal window.

I need to remind myself that my doctor told me she wanted an u/s with perinatology every 4 weeks - I just hope that perinatology follows through with that. Right now I'm livid that they didn't know this was a twin pregnancy and they didn't have it in their system about the issues we have already been facing. Grrrrr.

I should add, however, that I'm having one of those pregnancy emotion days. I seem to have a very short fuse today.

 

I would be upset too. I don't get who she thinks she is telling you that you can only have one or the other. I am sure your OB can get you another Level II. Hang in there, Lisa :hug99:

 

15 weeks is way too early for a proper level II scan. The organs you need to see may not be developed enough to check thoroughly. Your Peri should be dictating U/S timing, not an HMO. Also, most twin pgs have a growth U/S every 4 weeks anyway so you could have one at 15 and one at 19-20 weeks. I would push the Peri to intervene. It's really important and you may be stressed when you don't have to be.

 

Thank you. I told this woman scheduling it that 15 weeks was too early and she said then that she wouldn't give me the one at 15 weeks. Ugh. So, I took the one at 15 weeks but gave her a little lecture about how twin pregnancies are different and shouldn't be followed under the standard "formula" of just one ultrasound. I'm insured by Kaiser Permanente - HMO - and they seem to have a formula for all pregnancies and only deviate when absolutely necessary. Maybe I should give them a little more time and opportunity to show me I'll get adequate care. I've only been in their system under the formula for a couple of weeks. Before that I was being treated at my infertility clinic. My OB told me that infertility patients often have these kinds of problems when they transfer into the regular care but in time it gets worked out.

For now I don't have a peri, just an OB who reports to a peri. A peri has been ordering many of my tests, though, so I know one is assigned to me, I just haven't seen him yet. I was told I would be seeing him about every 4 weeks after 20 weeks.

So as not to confuse the stupid woman in perinatology, I'll wait until the u/s on the 18th and then I'll e-mail my OB (and hopefully the peri supposedly assigned to me) about getting a proper level II scheduled for 19-20 weeks.

I just can't believe that the woman thought I was a singleton pregnancy. Grrr.

 

Good luck! That sounds like a very good plan. Insurance companies are a pain. Ours keeps denying things to us because we have 2 children with the same birthday - um, ever heard of twins?

 

I would be upset too.

I agree with the others that 15 weeks is too early for a level II. Do you have reason to believe you might have TTTS? (I've been recently diagnosed with mild early Stage I TTTS.) And if you do have reason to believe you might be dealing with TTTS or even a mono/di pregnancy, I think the TTTS Foundation webpage suggests that you try to start u/s monitoring by 16 weeks.

Regardless, I don't think they should've cancelled your later u/s appointment just for this 15 week appointment. I'd press my doc about the issue for sure, and perhaps even contact the kind people at the TTTS Foundation for their recommendations if you do think you might have a mono/di pregnancy or issues with TTTS. Early intervention in some cases makes a HUGE difference.

Hang in there and don't give up on what you think is right!

 

We've had some sac size differences from early on that were of concern and they suspected TTTS. I did contact the TTTS Foundation and got some great advice from them. They are wonderful! Thanks to them I started drinking the protein drinks and spending lots of time on my left side, and that seemed to help balance out the sac sizes!

At our NT ultrasound they told us that they are 80% sure that the babies are dichorionic. So that's a big relief, but it's not 100%. I've been pushing for another u/s to try to confirm the chorionicity, which I hope they can do at this one on the 18th.

Thanks for your kind words. I'm glad to know that I'm not upset over nothing. It just looks like I'm going to have to push for these ultrasounds and for the answers we need.

Insurance is a pain in the ***.

 

I'd be annoyed that they didn't know it was a twin pregnancy too. However, I'm glad you took the earlier appointment and had the other one cancelled. Since it was an appt for a singleton pregnancy, they would not have enough time put aside for you to get done everything they needed to and you would be upset all over again. Your doctor will no doubt reschedule your Level II. Our Level II wasn't until 19 weeks so don't worry about it being too late.

:hug99:

 

I absolutely despise the fact that some clerk at the insurance company determines what is appropriate based on some standard "formula" and what they are willing to pay! It is sooooo frustrating!

Get your doctor involved as early as possible. At this point, you're not just being an advocate for your own care, but for your unborn babies. :hug99:

 

Yup.. I would get your dr.s involved with setting up all the u/s's. I would be very upset.

 

Lizzybo, keep us posted! I hope it all works out!

 

Thank you. I will definitely get my doctor to push the ultasounds. At first I was really impressed with the care from my HMO, but that was when I thought I was having one baby. Now that I'm having two babies, I'm really shocked that only my OB has changed the formula accordingly. I think part of it is that the perinatology department was told of the complications with the twin and I think they might have assumed the twin wouldn't make it. I suspect this because my RE called them to get them to increase the time in my level II u/s that was already booked, or at least schedule another u/s previous to it... that obviously didn't happen.

 

My OB had to push, push, push for Level II u/s's (with my insurance). The issue didn't really resolve itself until I just started to see a peri exclusively. He did all the u/s's after that.

I did want to add though, that I had my first level II u/s at 14 weeks. It was my understanding that that was the earliest they could start doing them. BUT, we also did it with the understanding that I would have one every 3-4 weeks after that as well.

 

QUOTE
I'm insured by Kaiser Permanente - HMO - and they seem to have a formula for all pregnancies and only deviate when absolutely necessary


That's what I was going to ask. What a drag. I hope you end up getting both!