The following comes from an August 22 email sent by Life Legal Defense Foundation.
The recent experience of a pregnancy resource center in northern California illustrates the courage and tenacity required to effectively stand for life in the midst of a health care system that can prove to be surprisingly hostile at times.
Marin Pregnancy Clinic is a nonprofit community clinic in Novato, CA, with the mission of providing medical care, counseling, and practical solutions to women facing unexpected pregnancies….
In 2008, the clinic obtained status as a presumptive Medi-Cal provider making them eligible for reimbursement of costs for qualified patients. Participating in the Medi-Cal program has meant extra work, but it has enabled Marin Pregnancy Clinic to make its services available on a level unlike ever before.
Within the last couple of years, changes in the structure of Medi-Cal at the state and county level began to have an impact on Marin Pregnancy Clinic’s ability to reach women in need. The County of Marin hired a new company to provide managed care, Partnership Health Plan. Under the program, new enrollees in Medi-Cal generally have their care managed through the plan, which provides a list of “approved” providers for their members to choose from in obtaining care. Participation in this directory is an essential aspect of reaching new clients as it is the main way for patients to find out about their care options.
When the approved provider directory came out, Marin Pregnancy Clinic was not included. Planned Parenthood was listed, but not the clinic that would provide alternatives to abortion. Marin Pregnancy Clinic’s director, Robin Strom, realized that not being on the list would mean that new clients had limited opportunity to find the clinic and get the help they needed. She started making calls to ask about the process of becoming a “preferred” provider through the plan. She was told that since Marin Pregnancy Clinic does not provide prenatal care through all nine months of pregnancy and does not provide birth and delivery care, it would not be eligible to become preferred provider. In describing the services provided, Mrs. Strom explained that Marin Pregnancy Clinic has developed a great working relationship with a local OBGYN who is a volunteer at the clinic. He is able to take referrals for maternity care and delivery for patients past the seventh month. Thus the clinic sees that each of its patients has care at each stage of pregnancy. This explanation, however, seemed to fall on deaf ears. Staff at the Partnership Health Plan refused to consider Marin Pregnancy Clinic as a potential provider. When Mrs. Strom asked to speak with management, she was told the same thing.
The reason for excluding Marin Pregnancy Clinic based on a lack of “full-term care” failed to ring true since Planned Parenthood is an approved provider—and as is well known, Planned Parenthood does not provide prenatal and delivery services. The plan refused to provide an explanation as to why some less-than-full-service providers were approved while Marin Pregnancy Clinic was not.
Faced with this unequal treatment—and stonewalled for answer—Mrs. Strom refused to give up. For approximately a year she did everything in her power to find a way to join the plan’s network—always receiving the same unsatisfactory answers. “I knew I couldn’t give up.” Mrs. Strom explains. “We had come so far to achieve presumptive status with Medi-Cal, we couldn’t back away when we were right.”
Unsure what her next step should be, Mrs. Strom shared her concerns with Anne O’Connor, general counsel of the National Institute of Family and Life Advocates. As a former Life Legal Defense Foundation board member, who has worked with Life Legal Defense Foundation on California matters in the past, Anne referred the question to Life Legal. Working together, Mrs. Strom and Life Legal lawyers drafted a letter to the plan setting out the problem, and asking for clarification of policies: what would Marin Pregnancy Clinic need to do to qualify for “preferred” status? Mrs. Strom sent the letter, and everyone prayed for a good response. The next week she received a call from Mary Kerlin, the director of provider relations at the Partnership Health Plan. Ms. Kerlin assured Mrs. Strom that there would be no problem with contracting with Marin Pregnancy Clinic, and that once the contract was finalized, they would have full participation in their directories and programs….
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