Speaker 1: 0:10

hey guys, welcome back to preview alliance podcast. This is sarah and I got my girl whitney.

Speaker 2: 0:16

We are back and we're gonna be controversial today y'all, we hadn't had a chance to do the podcast in a hot minute, and so we are locked and loaded today we are fired up and something.

Speaker 1: 0:30

So, if you guys are new to the podcast, we've got a lot of new listeners lately and we're super excited about that. But I had postpartum depression. I'm a nurse by training with my oldest, and Whitney is a maternal mental health therapist. She has had her own experience with postpartum anxiety and she sees our Previa moms. This is her niche and so what we have been doing recently with Previa Alliance our Previa Alliance moms know that is a maternal mental health company that is based in the South and predominantly in Alabama. Right now we're working to access other states, but we are fighting for maternal mental health to be recognized as a benefit. It should be a benefit preventative care, to have access of care, all the things. So we're going to give you a little insight of just the landscape of maternal mental health. Why, if it feels like it's hard to get mental health care, it is.

Speaker 1: 1:32

And some of the experiences we have had and things have been told to us by people in government, in payers, in doctor's offices, friends, family, when we're trying to fight for you. So, whitney, let me tell you this. So I learned this recently and I cannot stop sharing this. But so everybody kind of thinks, you know well, mental health should be covered, right, or I would assume that if I did experience depression or anxiety, that I could go to my physician, I could get help and they can navigate it, and that is simply not true.

Speaker 2: 2:18

I was about to say. I hate to say this, but it's a little hit or miss. It depends on your doctor, it depends on your doctor, it depends on your doctor, it depends on your insurance?

Speaker 1: 2:27

Yes, and it literally. For example, you know, I was talking to this one mom recently and she said you know, I told my doctor that I was not feeling like myself, I didn't want to be around the baby. I was just questioning why I was a mom and I was told postpartum depression is not real. And I was like, okay, well, that's false and I'm so sorry. I said, well, what did they say? And they said, you know, probably just the baby blues. You'll get over it. She was four months postpartum Stop. And if you even think about the moms who are brave enough to say anything about how they feel, they're speaking up. It's incredibly uncomfortable to talk about your thoughts and your feelings when society is telling you this is the most perfect time of your life, you're so blessed to be a mom, you should be so happy, right. And then you're met with someone saying what you're feeling is not real, or they classify as the wrong.

Speaker 1: 3:33

Yeah, they classify as the wrong thing. That is not baby blues. For our listeners baby blues go away on their own. They should definitely be gone by four months. We generally say they're gone in a couple of weeks.

Speaker 2: 3:46

Two to three weeks is your guideline.

Speaker 1: 3:49

And so for her to be four months postpartum and saying to us calling us, that is signs of postpartum depression that she's experiencing, for her to be shut down, and she said I walked out and I didn't know what to go from there Because she's like that was my provider. What do I do? Do I find a new provider? She? Said my insurance needs a referral for me to see a therapist, which there is a lot of insurance that require a provider referral.

Speaker 2: 4:18

That's not uncommon for insurance to require a referral for a specialist. However, being a therapist myself, a lot of times people do cash rates. Depending on your insurance deductible, you may be better off doing a cash rate versus paying your deductible before insurance even kicks in.

Speaker 1: 4:38

And that is so true because we have several situations where we have helped premium moms that, honestly, their deductible was so high and they had no idea that they had to pay towards that deductible such a high amount before they could get therapy. A lot of people assume therapy or psychiatric services are fully covered, and they're not for a lot of people, so that's a huge thing, Sometimes, even if you have the same company, same policy with insurance, they can change things year to year.

Speaker 2: 5:14

I have a client that I had been seeing for, I'm going to say, about two years give or take Cancer survivor, mind you. Okay, Went through quite a bit of things. Rolls over from 23 to 24, come to find out Blue Cross changed what they were covering and eliminated any type of what they called behavioral health be covered under their insurance. They could no longer see a psychiatrist. A cancer survivor no longer had access to mental health care because insurance changed what they wanted to cover.

Speaker 1: 5:55

I believe it. I believe it and even if, in this area, what we're seeing in the therapy world and our pre-valence therapists don't fall in this, you know, for a reason, who we choose to partner with. There is reasons we partner with certain groups and therapists. But we're seeing where to say, you did find a therapist and you're like, cool, they take my insurance, my deductible. It's not. You know, I just have this copay, which copays can be a lot of money for therapy Very quickly. And there is this part that you know I've I've had therapy in different insurance coverage and when you are paying for it, there is something in the back of your mind that, like you were just like, do I really need this? Even though you know you need it, you question like, am I taking money away from like my kids? Or like, is that shame, guilt, weirdness, that happens right.

Speaker 2: 6:53

We speculate if we should spend that on ourselves because it doesn't feel like a necessity sometimes and the economy is not great right now and people are struggling to put food on the table. So I can see where someone would feel guilty and view therapy as a luxury, as something like I don't have to have that to survive, I need to put that on the back burner, and I get that. I mean, you have to make ends meet, you have to feed your babies. I thousand percent get that. You have. You have to make ends meet, you have to feed your babies. I thousand percent get that. You have to pay the power bill. But therapy can also be a way to help you survive.

Speaker 1: 7:31

A hundred percent and it is what we're saying in this conversation is, you know, they're not making it easy for you to get your mental health taken care of and it's almost set up for you not to, and even, to the extent of you know, so, therapists who get your claims paid by an insurance company. So therapists have to bill, write your notes and everything has to be tidied up with the claim charges. Well, it's very difficult and it's at times payers look for anything not to pay. So to the point, and it's hard for a therapist to get credentialed. It's hard for any provider really to be credentialed into insurance. I mean, there is companies out there that their whole job is to get you credentialed with the insurance. Right, it is a process. It's a process. So for you to utilize a benefit, you're probably going to pay for it. Your therapist is it's work to get that payment from the payer and then. So then you have a lot of therapists going I don't want to take insurance anymore, for whatever reasons, the hassle, and so they're going to cash pay.

Speaker 1: 8:37

Well, not everybody can do straight cash pay Right. Cash rates can get expensive. They can, and I'm not saying people shouldn't. Like you know, their time should be valued and paid for their worth. But it does set the system up where those who can pay, and always have been able to pay, will continue to get service and those of us beneath and in the middle do not get that. So it's not as simple as I'm having. I'm struggling with my mental health, I'm going to use my insurance, find a therapist, and all this happened in a short amount of time.

Speaker 1: 9:14

Wait list can be six to nine months for a therapist or a psychiatrist, and the caveat we've learned with some of our previous moms is inside the insurance policies they may dictate that it's in person and not allow for virtual.

Speaker 2: 9:32

Which boggles my brain. Because did we not learn anything from COVID? That virtual is something that we are capable of doing and still really getting about 95% of the same benefit, if not 100%? Really getting about 95% of the same benefit, if not 100%?

Speaker 1: 9:45

Well, the fact that if you think you're a mom, you're busy, you have a newborn, whatever, you have multiple kids, you're working, you could do therapy during your lunch break, if it's virtual right, you could go to your car, go sit on a bench, hop out your phone, click your Zoom link. The effort it takes to physically go to a therapist's office, the money, the time, the childcare I mean it's a commitment, it's more than just your therapy session. So we're fighting actively for payers to allow for virtual therapy. And there's these codes for called postpartum depression prevention Intervention Codes. They were mandated from the Affordable Care Act.

Speaker 1: 10:28

Now I challenge everybody who's listening to this to go to your insurance benefits and look to see if that is offered by your insurance company. Now there's a caveat with everything when it comes to insurance, it has to be done in person in certain states. So something that is free to you, you don't have to pay a copay. It is mandated to be covered federally. Now they're putting restrictions on you, saying you got to go in person, which that generally falls on the OB, and we love our OB partners, we love them, but it's not their wheelhouse to truly give maternal mental health. So what happens? You have a preventative free benefit you cannot access because the system is not set up for you to get that. So you literally have a benefit right there, but it's like dangling the carrot you can't get it Right.

Speaker 2: 11:26

Which is angering, because why are we trying to circumvent this? Yeah, why are we trying to limit people and I mean I'm going to get my little like get more of a benefit or profit to be reactionary to an issue versus preventative, because there's a lot of data out there that actually talks about how people can benefit more from therapy versus a medication. That being said, I'm all for medication. If you need a medication and it works for you, you take that medicine. You take that medicine. However, who benefits from that? Yeah, insurance companies get some type of a kickback, pharmaceutical companies get a kickback from it. So that's why it's like no, no, we're not going to let you have this therapy. We're not going to let you do it virtually. We're going to do all of this stuff. Oh, you need a medicine? Sure, we can get you a medicine after you have been struggling for six to nine months screaming for help.

Speaker 1: 12:33

And no one will help you. And on the fact of medication. So I learned this recently. So you know, I thought, and again, we love our psychiatry friends, but I assumed if I needed mental health medication my mind as a nurse goes okay, a psychiatrist would probably be the most appropriate person for this. Now, when you talk about maternal mental health, so we're talking about mom's mental health from, say, you know, infertility to postpartum, you know, infertility to postpartum and postpartum is not just six weeks, like we're talking like one or two years, Some people say even four years after childbirth.

Speaker 1: 13:11

You assume a psychiatrist would have exposure and education on how to prescribe the proper medications. Well, so ACGME, which is the accrediting institution for like, physicians, right, and they do the boards and certifications, all that jazz, and they kind of dictate to the residencies and fellowships what they have to teach, right. So maternal mental health is not a requirement to be taught or have on staff. So we're talking there is and I've been told this by psychiatrists. They have went through residencies, they've went through fellowship and they have had minimum exposure and education on how to treat a mom who is suffering with her mental health. What's safe to prescribe for breastfeeding, what's safe for the baby? What would you know the proper medications? Do you start or stop her on a medicine as she comes into pregnancy? It's simply not taught. So, if you think about it, an OB may go well, that's not my wheelhouse. A primary care physician may go like that's not my wheelhouse. They go go see psychiatry. Psychiatry is like, ooh, I really didn't get a lot of training on this. And then what does the mom do? She's left and she's going. So who knows what's right? Who can help me? So, to the point, this is such an issue.

Speaker 1: 14:41

One of our advisors from MUSC, dr Smith. She has been great in helping me navigate this because to reach the level of moms we want to reach, we need to partner with providers who know what to prescribe, not to stop a med, you know all these things. And so there was a task force made and there was a curriculum called the National Reproductive Psychiatry Curriculum that reproductive psychiatrists have created. They came together and they said listen, we're in a crisis. Psychiatrists, obs, pediatricians, primary care nurse practitioners, pas they are not getting exposure and proper training. We're going to make a training and let them access that. So one thing that we are doing on a greater scale is trying to get residency programs, medical school programs for these physicians to take this curriculum and learn about it. Because what good is it doing for anybody if you're going to these providers and they don't know how to treat?

Speaker 2: 15:51

you Right, and they feel like, oh, that's not mine, let me, you know, punt it to someone else. And there the mom is suffering the whole time, doing what she is told to do and getting nowhere.

Speaker 1: 16:05

Nowhere. So I assumed I was like well, this is the most common complication of pregnancy, aren't they being taught about this? Are physicians being educated? They're not, and so if you feel like you met a provider along the way, you've been dismissed, gave false information, maybe they stopped a med when they shouldn't have, kind of situation. There's a little backstory to they probably have very limited exposure.

Speaker 2: 16:33

Right. And it's not a requirement and you don't want to own up to I haven't been given exposure to this versus saying, oh, that's not my specialty. Exactly.

Speaker 1: 16:45

I mean I don't blame them right, Like you can't control, like a nurse in school. You were in, you know, when you were in grad school. We could not dictate what was taught to us in our curriculum.

Speaker 1: 16:57

Right. It is a failure at a higher level that we're failing providers and moms and our babies, that we're not making this a requirement for education. So, if you think about it, they're not being mandated to know about this. Reproductive psychiatrists who are dedicated psychiatrists to moms trying to get pregnant all the way postpartum they're rare. We don't have one in the state of Alabama. There's many states that do not have one. So if you're like, oh my gosh.

Speaker 1: 17:29

And then, if you think about this, so insurance companies, and there's no federal regulation that says that a mom has to be screened for her mental health during pregnancy and postpartum. There is nothing that mandates that. It's recommended by several organizations, but there is nothing holding people to the fire saying you have to be screened, like, say, there's mandates about, you know, heart screenings and diabetes and colonoscopies Right, but mental health for moms, there's nothing making your OB provider, your pediatrician, your primary care doctor, your hospital, your hospital, screen you for the most common complication, and then, on top of that, they're very poor reimbursement. So, unfortunately, this system it is what it is more times than not is so they don't traditionally bill every single month for, like, say, you went in for an x-ray, your doctor bills and you know pays for that Right and then you go in the next month that you see them. They bill for that. So that's right. Single visit charges. How OB is paid is a maternity global code.

Speaker 2: 18:44

Yeah.

Speaker 1: 18:45

So you get. They send one code when you deliver and get one bulk payment and in that, right now, in a majority, there's nothing for your mental health. There is nothing that's required them to do anything about your mental health and get paid for it. So I have been told it's don't ask, don't tell Sarah I'm not getting paid for it. So I have been told it's don't ask, don't tell Sarah I'm not getting paid for this. I discharged the mom at six weeks and I'm done with her. I don't want to follow her through postpartum. It's too complicated. It's too complicated. So you're literally dropping a mom in her most vulnerable time and there's nothing making them or paying them.

Speaker 2: 19:33

Legally there's nothing wrong Ethically I would argue but legally, liability wise, there's nothing that can be done against the doctor for doing that. There's nothing that can be done against the doctor for doing that and honestly, they may view it as a higher liability to continue care post six weeks.

Speaker 1: 19:55

You know. So Medicaid moms, let's talk about a Medicaid moms. I learned this. I learned this very.

Speaker 1: 20:02

We have been searching and seeking and advocating how to reach Medicaid moms. So the current codes that PREVIA uses to provide education, screening, navigation, support, where you have a personal navigator assigned to you. They're a counselor or social worker who gets to know you, and then you have your therapist and then your OB has access to our psychiatric team for medication, consults, education. Now the codes we use for that do not exist in Medicaid currently and I've went to Medicaid and I've asked, and on top of that, the reimbursement for Medicaid so what Medicaid will pay for therapy is drastically lower than what, say, blue Cross, blue Shield will pay, and so there's issues and difficulties getting to be credentialed with Medicaid.

Speaker 1: 20:52

So we struggle to find therapists to see Medicaid moms. We struggle to find OBs to care for Medicaid moms and certainly we struggle for OBs to have a Medicaid mom past six weeks postpartum if they do take her. And then to the point I've seen on OB websites that say I will only accept a Medicaid mom from pregnancy to six weeks postpartum, I will not follow during postpartum, and so these moms are 50% of births in our state. They're the ones with all the risk factors. They're the ones that are struggling, that need us, and so what we have been doing at Previa is we have been beating down the doors of legislation, of government, of nonprofits anybody that will listen to say how do we reach these moms?

Speaker 2: 21:49

Right, I have so many thoughts and not a lot of them are positive. I'm just going to be honest because in you know my history and for listeners, for nine years of my career, my job was to coordinate prenatal care for Medicaid moms and I loved it. I loved doing that. So Medicaid mamas really hold a very special place in my heart. More often than not, these moms are already struggling. There are financial disadvantages, there are housing, there are social support disadvantages going on. So it is a more vulnerable population for the most part, and to shortchange them on their care from an OB perspective makes them more vulnerable and higher risk for so many other complications. Higher risk for so many other complications.

Speaker 2: 22:47

Because what I would want to ask? That OB is okay. What if that mom is six weeks in one day postpartum and all of a sudden she starts having complications with excessive bleeding or her C-section incision? Are you going to say nope, it's six weeks in one day, can't see her now? No chances are. You're going to go in and evaluate what's wrong. What's happening right now? What causes? Is there retained placenta? Do we need to do an emergency DNC?

Speaker 3: 23:16

Yeah.

Speaker 2: 23:16

So why on earth do we think we can stop any type of mental health care at six weeks in one day, when chances are you wouldn't actually stop any type of OB care at six weeks in one day?

Speaker 1: 23:29

No. And two, we are big fans of collaborative care codes. They're not active in our state, they're not active in several states, but to that point, for Medicaid moms that is certainly not active, but if it is in some states, if we're even talking about disadvantages of moms, is there's cost share? Would those cost share payments? 50, $40 a month?

Speaker 1: 23:54

Yeah, so even if you were to establish something with your you know, say, if Preview was like okay, here, you know, we can support, and that would encourage them to continue the care past, you know, six weeks postpartum, if they knew they kind of were in it with somebody else to manage their mental health. Because I think the core of it is is there just like well, I don't really am comfortable, I don't know what to. You know how to treat her. I can't find a therapist for her. I can't find a psychiatrist, what do I do? I'm not getting paid for any of this. I mean, that's just kind of like what the providers think. So say, if you had a collaborative care approach where we work with them, you're still asking a mom to pay a lot of money for her mental health monthly and that can't happen. Well, they don't have it. No, no, they're saying, they're like, oh, it's just 40 bucks.

Speaker 2: 24:47

I'm sorry, but $40 can be a can of formula for somebody, that can be groceries, and again we're already looking at a population that maybe doesn't have a whole lot of disposable income. They may not have $40 a month or they have to sacrifice something else to make that happen.

Speaker 1: 25:06

And that's where there is actually a bill that was just released. I don't think it's going to get passed. It was from I believe it's a New Hampshire senator and I forget the other one, but they were trying to mandate that maternal mental health, from pregnancy to postpartum, had no cost sharing on the ball. Now I do not believe it'll be passed. I'm very hopeful, but that's the kind of things that need to happen.

Speaker 1: 25:31

And so if you're hearing this and you're like, what can I do? Well, what you can do is you can learn about maternal mental health. You can go back into our podcast. We have so many great what is? Series that we did. Learn about risk factors, learn about the signs and depression, anxiety, ptsd, ocd, psychosis. Educate yourself, be aware of the statistics and go to your provider and say I want this, they can. Then you can write your legislator, you can call your insurance company. I mean, let me tell you, my insurance company knows me very well and because I'm saying well, why can I not access this benefit? Why are you putting this restriction? And until we all join in the conversation, because no one's not gonna, you know, I I tell people all the I'm like I don't see how moms don't have maternal mental health issues because the system is set up for us to fail.

Speaker 2: 26:32

Correct, they do not care. Again, we like to be very reactive and not proactive.

Speaker 1: 26:38

I mean, it takes a headline, a death, for them to say it's a crisis. Well, it's been a crisis and it's going to be a crisis if you do not start ground zero.

Speaker 2: 26:52

Honestly, though, how many headlines have we seen without any traction?

Speaker 1: 26:57

Well, because now it's like something happens to a mom, right, and it's like you're numb to it, right, like you're. Just like the media is like they'll make one little sentence about postpartum depression or psychosis, or they move on.

Speaker 2: 27:14

Well, I can remember, and this has been several several years ago there was a mom who put like a cinder block or a brick or something on the gas pedal. Her kids were in the car and they were varying ages, I want to say like infancy, to like early elementary school ages two or three children in the car and drove it into a lake and they drowned and everyone was calling her a monster and how horrible, and don't go wrong. That is terrible and that is tragic and it it is heartbreaking. But having the knowledge I have now, part of me is thinking did she have postpartum psychosis? Did she have postpartum depression? What else was actually taking place? Because she was made out to be a monster? When I'm going to give her the benefit of the doubt, she didn't do it just for funsies.

Speaker 1: 28:00

No, that's something that drove that behavior. I mean, that is not a natural response as a mom to do that or a human. And we know about psychoses and psychoses for listeners who've never heard that term before. It's a medical emergency.

Speaker 2: 28:19

Absolutely it is. That is ER level. It's a medical emergency. Absolutely, it is that is ER level.

Speaker 1: 28:23

It is not spoken about, it's not educated about. And so postpartum psychoses actually, during postpartum a woman is I believe I forget the statistics 20 or 25% more likely to have psychoses during postpartum or pregnancy than she is in any time of her life. And psychosis is when you are delusional, having hallucinations, you are not auditory like you believe it, and it's like you're not in your own reality and you need someone else to help you. You cannot ask for help right and no one's talking about it right until after that.

Speaker 1: 29:12

So yes this has been probably more of our sassier, heavy, heavy-handed but, but we are out here fighting for moms and we won't stop fighting. And some of the more ridiculous things that's ever been told to me is we've went to try to get partnerships in different OB offices and I've been told well, the office manager thinks it's too much work to build so that you can have this service for free. I've been told bill so that you can have this service for free. I've been told. You know, we're really opening up a Pandora's box. If we start educating and screening, we're going to find more depressed moms.

Speaker 2: 29:49

They're still there, whether you screen them or not, and if we screen them, we can equip them.

Speaker 1: 29:55

I've been told there's no need to escalate. There's no need to move this up higher. It will get reviewed when it gets reviewed from a payer. I've been told women don't pay enough for healthcare in general.

Speaker 3: 30:12

They can pay co-pays. I'm sorry what?

Speaker 1: 30:14

The amount of things that I am told on a weekly basis. That sums it up that moms are just not worth it to a lot of people. You know, when you say there's no mandate in maternity leave and they're like, why would she need more than six weeks? All these comments that when I share with people, they're like someone actually said that to you and I'm like, yes, people have said that to me who have a position to be able to change things.

Speaker 2: 30:49

Yes.

Speaker 1: 30:50

So all this to say is your voices matter and the more we join together and say enough and you rattle some cages.

Speaker 2: 31:00

Right.

Speaker 1: 31:01

Call, write, post, share. Yeah, say enough, and you rattle some cages. Right, call, right post share. Yeah, you know, that is what we're asking and to know, like this is not, this is not. One in three moms will experience a perinatal mood anxiety disorder. Post-covid the number shot up, it used to be more traditionally one of five, one in three, and it can range right mild, right Mild to severe, all that. But it's happening, rather if they want to recognize it or not.

Speaker 2: 31:26

Exactly, and it's a discerning that's not just to the mom but to the baby and to the part in the family Like everybody.

Speaker 1: 31:36

Yeah, employers are wondering why new moms are not coming back to their job. Hello, we can't do it all.

Speaker 2: 31:42

We can't do it all.

Speaker 1: 31:43

We can't do it all and the mental health is health and it should not be something that we are fighting for. It should be part of our care and it should be expected. So just know, if this resonates and fires you guys up, like it fires me and Whitney up Right, do something about it.

Speaker 2: 32:02

Share this Talk, demand more for yourself Right and for the women around you Right and, like you mentioned, going back to these previous episodes that have education on what the signs and symptoms are of all the varying postpartum and mental health diagnoses, you can advocate for yourself with your provider, and that's unfortunate that we do have to be our own advocate, but I think we're in a spot where we don't have a choice to be our own advocate.

Speaker 1: 32:33

So education is. We always make this podcast accessible and free and that is because we believe every woman, not depending upon her race or education, her zip code, her situation, should be provided education about her mental health for her to be able to have a like. If you know about it and you are aware that's half the battle and equip yourself. Go back to some of the Toolbox Tips episodes, go back to some of our guests even we've brought on and they'll give you, they tell you kind of ways they got through it, how they mentioned and so and if you're like I'm being met with this resistance or someone said this awful thing to me about it, you're not alone in that and I wish that didn't happen to you. But no, that's not an isolated event and that just you gotta keep moving Right, absolutely. Challenge for everyone who's hearing this listen, learn, advocate and share for us and we'll keep doing the same for you. That's right. All right, guys, till next time we will be back. All right, see ya.

Speaker 3: 33:42

Maternal mental health is as important as physical health. The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables, like anxiety, anger and even apathy. Hosted by CEO founder Sarah Parkhurst and licensed clinical social worker Whitney Gay, each episode focused on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges, as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey. We're here to help.