UHC Insurance

[hennaLisa]

I have heard of people getting United Health Care to reimburse for home births, even at in network rates. I will have the option to switch to UHC this year with my company, so I'm wondering which types of plans and basically any other information anyone has. What plans are best? What papers/letters/processes do you use to convince them to cover home birth? I'm excited about the possibility of getting coverage because our last home birth was all out of pocket.

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[Turquesa]

It's going to depend on your state and its laws. In my state, insurance companies are required to cover out-of-network services at an in-network rate IF that type of service provider is not available within a 30-mile radius of where you live.

With the help of my MW, I applied for a "clinical gap in coverage," meaning that I petitioned for in-network coverage because there were no MWs doing home births in my area.

I first tried to apply because there were no in-network CPMs, but that was denied because in-hospital CNMs "counted."

Work with your MW. She'll be used to this routine. If you need to, call multiple times and listen to multiple excuses, but insist on being transferred to a "specialist" because the front-line customer-service reps don't always know what they're talking about.

We have a PPO plan through UHC, by the way. You may PM me if you'd like more info.

[deymm]

I have UHC PPO and so far they have denied my requests for gap exceptions, saying that homebirth is a choice. They have an in-network CNM, but she doesn't do HBs.

So for now we're planning on out of network and we'll see what happens.....

[sept04mama]

Haven't had luck and I have UHC. I haven't tried super hard though because our deductible is more than the HB will cost, so it's not like they'll pay anyway, it would just count towards the deductible.

[Belle]

We had no problem at all getting UHC to cover our homebirth. We paid our midwives full fee up front and they were able to bill for the birth after it happened. Also, they were able to bill for things like home visits and newborn exams. On paper UHC said that they would pay the midwives 60% of their fees because they were out of network. It ended up being more like 92% when all was said and done.

We have an insanely high deductable of $3000. We expected our midwives fee of $2800 wouldn't bring us up to that, but dh had an emergency room visit that met our deductable so our midwives could bill ins.

[GISDiva]

Originally Posted by deymm

I have UHC PPO and so far they have denied my requests for gap exceptions, saying that homebirth is a choice. They have an in-network CNM, but she doesn't do HBs.

So for now we're planning on out of network and we'll see what happens.....

This is what happened to us too, because there were "midwives" in-network (who were hospital only), they didn't consider my homebirth midwife a gap in coverage, just a choice I made. However, our particular plan paid pretty decent even for out-of-network coverage, and they did pay that. All in all it could have been worse.

[hennaLisa]

In Network

A friend of ours (also in Atlanta) is currently pregnant and she just announced that she convinced UHC to pay in network rates for her upcoming home birth. I don't know if it will work out that way in the end, but I'm hopeful. I haven't heard any details from her about how it worked out.

I currently have an HRA plan, which is like a high deductible plan, but it comes with an account of cash that can be used towards the deductible. Whatever you don't use in the account gets accrued over the years, so we will have plenty to cover the home birth by the time it happens (if they will cover it).

I don't know whether an HRA plan works the same as a PPO. This is all pretty new to me because we just moved here and changed jobs one year ago. Any thoughts?

[ShwarmaQueen]

: We have UHC and have verified we have out-of-network HBMW coverage at 70/30%. For out-of-network providers, I have a $375 ind. deductible and a $1500 ind. out-of-pocket max, so for the $3400 that I have already paid the MW, I expect to be reimbursed at least $2000 when it's all said and done.

[Champ]

I would like to try and help you.  UHC is a huge company with many types of plans.   What is the entire name of your plan (usually on the bottom of the card)  Original Medicare has it's stipulations that they must follow, but...all of this varies from state to state, etc.   I would need a zip code and a plan name to research this.   However, tonight their Secure Horizona and aarpmedicareplans.com sites are down.   I truly would love to assist you, but I don't want to just give general info that might not be correct for your service area, etc.  This is my area of expertise, but I need more info.   Thanks!  :)

[Champ]

Originally Posted by ShwarmaQueen 

: We have UHC and have verified we have out-of-network HBMW coverage at 70/30%. For out-of-network providers, I have a $375 ind. deductible and a $1500 ind. out-of-pocket max, so for the $3400 that I have already paid the MW, I expect to be reimbursed at least $2000 when it's all said and done.

[Jynuine]

I delivered at OHSU Aug of '09 and Im looking at having a homebirth, also. My midwife from OHSU also does a private practice for homebirths at Vivante but they said UHC is out of network. Im trying to figure out if I can find a way through the loophole, also.

The big thing to remember when dealing with homebirths and getting insurance to pay for them is to exclude the word 'Homebirth'. Really what they are paying for is not WHERE you are but WHO you use and their credentials. So you would ask if they would cover such and such midwife (usually a CNM) and if you could find one that does homebirths then UCH should cover them. I wonder if there are Homebirthing CNM's they cover that are NOT only affiliated through a hospital???

So far I cant find ANYTHING on midwives period on their website. :/