Sunday, 1 July 2018

What to Do If a Korean Hospital Refuses to Let You Leave

In order to leave a hospital in Korea, you will have to pay your bill in full either with cash, a debit card, or a credit card. I'm not exactly sure if that's legal since it would seem to me that they're demanding a ransom to let you go home. But just be warned that people have started GoFundMe accounts precisely for this reason.

Let's assume that you can and will pay in full but they still don't want to let you or your child leave. Let's also assume that you or your child don't have any medical issues and they're simply keeping you because of hospital protocol. If you or your child is legitimately sick and need to be in the hospital, don't expect any of the choices below to work. However, you have a few choices if everything is fine.

1. The easiest thing to do is to just stay. Wait until they discharge you and then go home. Some places don't want to discharge people on weekends since the accounting department isn't fully staffed. (It doesn't make sense to me either, they should just be able to plug numbers in). What they might do is tell you they will overcharge you and let you go home on the weekend and then you're supposed to come back on Monday and they will fix your bill.

2. Don't ask for permission to leave, instead, inform them that you're leaving. This is what I would ideally do. I remember asking if I could leave and was told no. The next day, first thing in the morning, I informed them that I was leaving that day. It took four hours, but they finally discharged us.

3. Make threats. I wouldn't resort to this unless absolutely necessary, but if you're fine and can pay and they're still refusing to let you leave, then tell them that you will call your embassy and tell them that they're holding you hostage. Full disclosure, I've never done this nor do I know anyone who has, but hopefully the threat will be enough. I would tell them you're contacting the embassy over the police, because honestly, I highly doubt the police would do anything.

Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

Friday, 1 June 2018

Tricare and Doulas

I talked about Tricare Overseas and home births a few months ago. Unfortunately, Tricare Overseas does not cover home births. Shame on them.

Tricare claims their "primary objectives are to optimize the delivery of health care services in the military's direct care system for all Military Health System (MHS) beneficiaries and attain the highest level of patient satisfaction through the delivery of a world-class health care benefit." How they do that by limiting the choices women to giving birth by not reimbursing women for overseas home births by a midwife is beyond me.

But let's not hold a grudge, let's talk about doulas. According to Tricare, they only cover medically necessary services. They specifically say they will not cover non-medical support during labor and delivery and mention doulas.
Sometimes Tricare Pays for Doulas
Even though Tricare says they don't reimburse for doulas, some women have had doulas covered. Most hospitals and clinics don't break down their bills into super small parts.

For example, while in the hospital, you probably interacted with a few nurses during your stay. However, when you get your bill, it's not likely that you'll be billed for each one. They often get lumped together. Or how about the secretary? You're not likely to see a fee on your bill for talking to her. Another example is your room. You are probably not billed individually for the water, electricity, or sheets that you use. There's probably just a room charge.

Some birthing facilities include doulas in their fees and when they send you their bill, the doula is simply included. Sometimes the doula may be a nurse as well, so it's understandable that Tricare would reimburse families for this fee, especially if they provide medical services during your labor and delivery. Sometimes they're not nurses and Tricare still ends up indirectly covering the cost.

HOW does this happen? Because it's included in the birthing fee.
Some places may even charge the same amount whether or not you use a doula. It's kind of like the room fee. If you take super long showers, you're going to be charged the same amount as someone who doesn't take a shower during their stay.

Bottom Line: Tricare Has Paid for Doulas
Depending on how your birthing facility breaks down their bill, Tricare may end up paying for your doula.

Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

Tuesday, 3 April 2018

How to Get Free Stuff for You, Your Baby, and Your Kids in Korea

Korea is great! You can get free money from the Korean government if you pay into the national health scheme. Here's more info about the GoEun Mom card that gives you 500,000 for free!

I love getting stuff for free! I'm happy to report that I've barely bought any clothes or toys for my kids in the past four years. Nonetheless, their dressers and closets are full of clothes and I'm astounded at how many toys they have. I'm not gifted a lot of things either so don't think that people are buying things for them. I keep telling family to put money into the kids' accounts for holidays and birthdays instead of buying them stuff because we just have so much. Even at my daughters' birthday parties, I ask people not to bring gifts and to bring food to share instead. How do I do this? Through swaps and hand-me-downs. Swaps are especially fun because you never know what you're going to get! There are three main reasons I love going to swaps.
  • I don't buy into consumerism by needing the latest and the greatest.
  • I keep stuff out of landfills.
  • It's free! Can't beat free!
Before my first daughter was born, I made a list of what I wanted and hunted around Craigslist and Facebook groups in order to buy what I needed. Before my second daughter was born, I made a list, but this time asked friends if they had any hand-me-downs and also went to swaps. I try to get things that I can use within the next two years. For example, if my daughter is wearing size 5 now, I'll look for sizes 5-7, this way I can afford to be picky and get good items as well as have clothes on hand in case she goes through a growth spurt.

As kids get older, it's harder to find stuff because they wear clothes longer and are harder on them so they wear out. Baby clothes brought to the swap might not be nice either since babies pee, poop, and puke all over themselves for the few first months. On the other hand, since babies grow out of things so quickly, you can also get some nice things that have never been used.

So what can you find at swaps? There are always clothes at swaps and usually more women's than men's clothing. I've also found warm winter coats, baby carriers, strollers, car seats, high chairs, vases, accessories, hats, gloves, scarves, small appliances, blankets, household items, food, toys, shoes, cosmetics, toiletries, wrapping paper, medicine, you name it, you can find it. If you're looking for something specific, try posting in the event and asking people if they have it or try posting in one of the Facebook groups dedicated to freecycling. Don't expect every swap to have everything. Each swap is different.

If I see something I like but am on the fence about it, I take it. I figure if I don't like it, I can always give it to someone else or bring it to the next swap. I have never regretted taking something but I have regretted not taking something.

In fall 2010, I started the Seoul swap and since then it has grown! There are a few other swaps you can go to in Korea as well. There are a few rules for swaps, so make sure you know them before you go. Every swap I've been to has had a no re-selling rule. It should go without saying that if you get something for free, you shouldn't sell it. If you know of any others swaps or groups, please let me know in the comments below so I can add them!

Face-to-Face Swaps
Organised by Dani Phillips and Katie Mae Klemsen Yee, this swap takes place a few times a year. Here's an example of one of their swaps.

Organised by a handful of people, this swap takes place at SIBC in HBA near Itaewon. Here's an example of one of their swaps as well as the Facebook group.

Organised by Angela Gayle Russell, this swap last took place in 2016 at The Big Chill. Hopefully it'll start again soon! Here's their Facebook group.

Wink in Seoul
Organised by Vivan Doan this swap takes place at Wink Kitchen and Taphouse a few times a year. Here's an example of one of their swaps.

Freecyle and Bartering Groups on Facebook
Bartering Korea 
This used to be super active but things have definitely died down. You post what you have and/or what you want and then ship the things.

Camp Humphreys FREEcycle 
This is a pretty active group. You can only post requests once a week. You'll have to arrange pick up. Items aren't usually mailed.

Gwangju Freecycle
There's a decent expat community in Gwangju and people are happy to pass on items they don't need.

Reuse Korea- Freeycle in the ROK
This is Korea wide. Depending on where you're located you'll have to arrange pick up or mail things.

Songtan and Osan Freecycle 
I started this group and while it's not that active, you can still find some good things! You'll have to arrange pick up. Items aren't usually mailed.

Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

Thursday, 1 March 2018

6 Natural Birthing Centers in the Seoul Area, Korea

Natural Birthing Centers in the Seoul Area
There are a handful of foreign-friendly natural birthing clinics in Seoul. Agitanseun (aka Rosa), GM Cheil, Lee Myung Hwa, Mamas' Birth Center, Medi Flower, and Yeon and Nature. They are also very supportive of you having a doula or birth photographer. Check out the list of breastfeeding counselors, childbirth educators, and doulas and here are birth photographers. Some of the birthing centers may offer free or discounted photos with Korean studios. Medi Flower, for example, works with King Kong in Love.

Prices vary, but if you have Korean national health insurance, they should be 1.5-3 mil for the birth itself and include between 6 hours-3 days of recovery time. If you have interventions, need a C-section, or need special care you may be charged extra. Be sure to ask about prices ahead of time. Remember you can use whatever is left on your GoEun Mom card for the birth.

Home Births
Home births are completely legal in Korea. Here's a list of English speaking doctors and midwives who will do home births. If you speak Korean, you will have more options (and usually pay less than what English speaking doctors and midwives charge). The Korean Midwives Association has a handful of midwives who do home births.

C-sections and Transfers
Simply by giving birth at a birthing center, you will lower your risk for a C-section. Of the natural birthing centers listed below, 3 of them can perform C-sections: GM Cheil, Medi Flower, and Yeon and Nature. Even if you want to avoid a C-section, you should still ask the birthing center what hospital they do transfers to and go there and see what it's like. None of the birthing centers have a NICU. So if your baby needs one, they are going to have to transfer you. Here's an article about NICUs (Neonatal Intensive Care Units) in Korea.

6 Natural Birthing Centers in the Seoul Area
Agitanseun Natural Birth Center (김옥진조산원) Kim Ok Jin (Rosa)
Kim Okjin, Midwife aka "Rosa"
401-1, 3F Saeyang Chungmaru Sang-ga Naeson 2-dong, Uiwang, Gyeonggi-do 
경기도 의왕시 내손2동 401-1 세청마루상가 3F
Telephone: (031) 410-8597
Cell: 010-2447-8231 and 019-447-8231
Near Indeogwon station

GM Cheil Women's Clinic
896 Gwangmyeong-ro, Gwangmyeong, Gyeonggi-do
Telephone (02) 890-2555
  • A new natural birthing center that opened in early 2016. There's an English speaking midwife named Julia who used to work at Yeon and Nature. GM Cheil is located on three floors. The 7th floor is where check-ups are done. The 8th floor is where the delivery rooms are. The 9th floor is where the recovery rooms and education room is. They offer epidurals and can do C-sections.
  • Prices are about half what Medi Flower and Yeon and Nature charge. Expect to pay about 1.5 mil if you have national health insurance.
  • You can read more about them at this post.  
Lee Myung Hwa (행복한이명화조산원) they used to be Happy Birth
Seonbu-dong 1070-12 Gwangwon Building Office 208, Danwon-Gu, Ansan, Gyeonggi-do
경기도 안산시 단원 선부동 1070-12관원빌딩 208호
Telephone: (031) 410-3573 and 010-2803-3573
  • Lee Myung Hwa is the midwife.
  • They attend home births.
Mamas' Birth Center 
A-301 Richensia bldg, Wonhyoro 1-ga, Yongsan-gu, Seoul
서울시 용산구 원효로 1가 리첸시아 A동 301호
Telephone: (02) 797-3573
Danica: 010-7170-1099.
  • Mamas' Birth Center is a natural birthing center. They have experience working with foreigners. They have 5 rooms. Each rooms has a tub. The rooms have great lighting, birthing balls, and birthing stools. They also work with Jinny, a doula who speaks English and Korean. They have birthing education classes. They have double beds (Korean style, so a bit hard).
  • There is no doctor, just midwives. They are not able to perform C-sections, and all pre-natal tests and transfers are done at SCH. 
  • They do home births in Seoul only. 
  • Birth plus 6 hour recovery period: 1 mil. Daily room rate: 250,000. Home births are 1.2 mil and are only done in Seoul. All prices are with Korean National Insurance.  If you don't have KNI, it will be more expensive. People have said a birth plus a 6 hour recovery period is about 3 mil. After that it's 250,000 per day in the room and 10,000 for meals.
Medi Flower
Dr. Hwanwook Chung
2nd Floor of Lotte Castle Medici, 1656-4 Seocho-dong, Seocho-gu, Seoul
Telephone: (02) 548-9400 (Press 9 for English)
Near Kyodae subway station
  • They attend home births.
  • A popular natural birthing center. 
  • About 2.5 mil for a vaginal birth though prices vary depending on insurance.
  • Dr. Chung is the most amazing "labor whisperer". 
  • They are able to perform C-sections. 
Yeon and Nature 
521 Hakdong-ro (Cheongdam-dong 72-1) Gangnam-gu, Seoul
서울특별시 강남구 학동로521 (청담동72-1)
Telephone: 02-518-1300 or 010-4009-1151
  • Dr. Park's place: opened in late 2014. A natural birthing center that also has epidurals and C-sections available. There are no extra fees to use the birthing pool, every birthing room has pool. Total cost will be around 3-4 mil. This includes the labor and delivery, a 2-night stay, newborn screening, and meals.
  • They have English speaking midwives and doulas. 
  • They do placenta encapsulation and placenta prints for about 300,000 won. 

Tender Embrace Birthing offers childbirth, breastfeeding, and newborn care classes and support.

Thursday, 1 February 2018

Home Births and Tricare Overseas (Examples from South Korea)

Tricare Overseas is not like Tricare stateside. A few women recently had home births in Korea and filed claims with Tricare Standard. After a year of going back and forth, with Tricare asking for more and more documentation and these women being reassured that Tricare would reimburse them, Tricare finally issued their response: they wouldn't cover it. None of it was covered. These women were about $8,000 out of pocket. The home births took place with staff from MediFlower.

What Kind of Labor and Delivery is Covered?
On Tricare's website it states that labor and delivery are covered. On that page, they also say . . .

Usually, your TRICARE plan determines the type of birthing facility you will use (military or civilian, office-based or freestanding, etc.). You also have different options for the type of provider who delivers your baby (obstetrician, Family practice provider and or Certified nurse midwife, etc.). These types of decisions will be made by you and your provider during your prenatal visits. 

However, there is no mention of home births, just certified nurse midwives. All midwives in Korea are CNMs.

What about Home Births?
Tricare Standard actually does mention home births. The December 2015 Tricare Maternity Care Fact Sheet talks about choosing to deliver at home and what the cost shares are. 
Contacting Tricare on Facebook and the Tricare Overseas Hotline
That sounds promising, doesn't it? Don't get your hopes up. I contacted them on Facebook since the Tricare Overseas hotline kept saying home births should be fine when I talked to a representation after pressing 3 (for claims).


Calling Tricare Overseas, Again
About a week later, I called the Tricare Overseas hotline, again. This time instead of calling about claims, I pressed 2 (for referrals and authorizations). I said it looks like home births are covered but women in Korea are repeatedly getting denied. They put me on hold and came back and said home births are considered home health care and home health care is not covered overseas. I couldn't believe it, but sure enough, you can find the information on Tricare's site as well. How in the world they consider home birth to be the same as an illness or injury is beyond me, but that's Tricare for you!

The funny part is that they're wrong. (I know, you're shocked that Tricare is wrong). Home births are not home care. So why aren't home births being covered? It's because of the midwives.

Are Korean Midwives Covered?
The midwives they went through also work at a birthing center in Seoul. Tricare Overseas will cover births at that birthing center (MediFlower), but won't cover home births. Tricare says they cover midwife services if they're state licensed and certified by the American Midwifery Certification Board.

Korean midwife do not fulfill those requirements, so why is Tricare reimbursing patients who give birth at the birthing center but not those who give birth at home? When women give birth at the birthing center, a doctor is put down on the invoice since there is always a doctor on call. The midwife is then put down as a nurse. The same is not true for home births: the midwife is simply put down.


Bottom Line: Tricare is Not Covering Home Births in Korea
It's not fair to women to be told that home births are covered and then to find out they're stuck paying the full bill. Had these women known, they may have gone to birthing centers or chosen a less expensive midwife.

Tricare's Convoluted Stance on Home Birth Overseas
On Tricare's website it states that labor and delivery are covered. However, there is no mention of home births, just certified nurse midwives (CNM). All midwives in Korea are CNMs. Tricare claims that home births overseas fall under home health care and therefore don't cover them. Home birth really isn't home care. If Tricare doesn't want to cover home births overseas, that's up to them, however, they should update their maternity section and specifically list home births.

If You Still Want to Have a Home Birth, Read This:
If you're going to have a home birth in Korea, here's a list of providers. You might also want to consider reading The Essential Homebirth Guide as well as getting some birthing supplies together.

I personally believe that women should allow to choose where they give birth as long as they are able to do so safely. Hopefully Tricare will change. I just wouldn't hold my breath. Since Tricare isn't covering home births overseas, you have three options.
  1. Choose a cheaper midwife. MediFlower is great, don't get me wrong, but they're also more than double what other birthing centers charge for people with Tricare.
  2. Choose to give birth wherever you want and pay out of pocket. Don't bother filing a claim.
  3. Go to the USA and find a CNM who will do home births.  

Tips for Dealing with Tricare or any Medical Insurance Company
This medical hack below has lots of tips to help you out. Many times the people dealing with claims are paid minimum wage and have no medical background. They're simply checking boxes. If a claim is denied, it's usually because certain boxes aren't check. The last thing you want to do is have someone with no medical background making decisions about your health coverage! So follow these tips below if your claims are denied. (This will not work for home births in Korea since they don't fulfill Tricare Overseas requirements).

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