getting the MW covered in-network??

[momto4kids]

Hi ladies ~

My ins company will cover my HB, but at an out of network rate. This was okay with us, UNTIL our co-payments changed. Instead of having to pay $500 out of pocket we now have a $1000 payment. This is almost the entire cost of our MW .

Any tips or suggestions on how to get them to give me an in-network exemption? There is no in-network coverage for a HB MW.......

TIA ~

Dana

[My*Scorpio]

Do they have any MWs in network? I would start by calling and asking for a referral. If they can't give you one, it should be much easier.

[Mrsboyko]

That exactly. My MW got covered becasue there is a specific line in our contract taht states they cover CNM's, but there were none in network at all. It did take a long time (9 weeks?) but they eventually said they would cover it at in-network as a "gap extention" (that is a key phrase BTW).

I didn't focus on home birth at all, just the CNM thing.

[momto4kids]

None of the CPM's are covered in-network from my understanding (I had to call them in the beginning to verify all my coverage for her). So I need to talk to them about getting a gap extention.....I knew there was a phrase for what I needed to ask for! Thanks!!

Dana

[sarahloughmiller]

My mw was a cnm but was not in-network but my insurance paid for her as in-network because there was not another mw within 50 miles. There may be something like that where they will pay if the option they normally pay for is not available. FWIW, I was told with both of pregnancies that they would not pay my mw but they did end up paying it. There were a couple things they declined and I had to call on (mostly with my twins, they did not seem to get that there were two of them) but overall they paid when I had been told over and over they did not pay for hb.

[flipsforfun]

You are awesome!

Thanks for the "gap extension" info!! I have BCBS of MN (don't know why, since I'm in SoCal) and while there are CNMs listed in network, they are all in LA which is an hour away.

I'm gonna try your suggestion - the difference for me would be huge. Out of network coverage is a deductible of $1800 and then they only cover 55%. In network, my deductible is only $800 and then they cover 75%.

[naturallyspeaking]

Is that a Gap Exception or Gap Extention? I'm going thru this process right now and got denied since my mw is out of network. The cs rep said we need to pay oop with out of network provider. I wonder then why do we need my doctor's referral for Gap Exception? (this is the term my mw used)...
Am I totally out of luck?? I'm with BCBS FL.

[My*Scorpio]

flipsforfun -

[deymm]

Originally Posted by Mrsboyko

That exactly. My MW got covered becasue there is a specific line in our contract taht states they cover CNM's, but there were none in network at all. It did take a long time (9 weeks?) but they eventually said they would cover it at in-network as a "gap extention" (that is a key phrase BTW).

I didn't focus on home birth at all, just the CNM thing.

Originally Posted by sarahloughmiller

My mw was a cnm but was not in-network but my insurance paid for her as in-network because there was not another mw within 50 miles. There may be something like that where they will pay if the option they normally pay for is not available.

First I called and asked if homebirth was covered. Yes.
Then I looked up providers (CNMs here in IL) and there are none within 30 miles of my house. So when I called the Care Coordination Dept of my insurance company, I told them I was calling for an in-network exception because there were no homebirth providers within 30 miles of my house (which I learned is the boundary for my insurance co). The rep said I could apply for a "geographical gap exception." It sounded like I will go through, but I won't know until I get the official letter in the mail.