Originally Posted by AlexisT
If you have an HMO (not POS or PPO, but old style straight HMO), your HMO will not pay for any provider that is not in-network. They are NOT required to pay for "any" OB/MW or provide out of network benefits. On Medicaid, if you can prove that there is no one suitable on your plan's list they can grant an exception.
They are required to cover midwives, in general--i.e. not exclude them from the plan. There is no requirement to cover anyone specific.
in NY insurance is required to cover homebirth midwives. if your insurance does not have one in network, they are legally obligated to cover the out of network midwife at the in network rate. also check with your midwife. my was out, but covered in despite the fact that there was a homebirth midwife in network. the in network provider reported she was booked for my due date. therefore, the other midwife was covered.
i would document in writing, but the insurance doesn't need to grant you an exception. it is your right in NY. there are templates available online if they try to deny you coverage. just follow the rules about getting your referral, etc.