CIGNA ins and home birth coverage?

[mamakaryn08]

My midwife told me that she can and has billed CIGNA for home births and had all her fees covered. Does anyone else have CIGNA and are they covering your birth? We currently have Kaiser insurance which doesn't pay a penny for out of hospital birth but it is open enrollment and DH can now switch to CIGNA.

[billikengirl]

I have cigna PPO and they told me and the midwife's billing service that they'll cover it. Of course, that's at the out of network rate, after the large out of network deductible.... so we'll be out of pocket a decent amount, but we knew that and socked away enough in the FSA.

[OTMomma]

I had cigna for 2 home births- one was covered better than the other. One was covered as out of network- so had to pay that deductible and rate, the other we got an out of network exemption- you need to call practically as soon as you find out you're pregnant to get the best deal on that- but they covered more that way.

[mamakaryn08]

Looks like we can get it covered 100%, even though our new insurance will be the cigna HMO. All I had to do was find an in-network provider, and there are a few CNMs in the area who are listed as providers and have a home birth practice. REJOICE!!!

[mamakaryn08]

Originally Posted by OTMomma

I had cigna for 2 home births- one was covered better than the other. One was covered as out of network- so had to pay that deductible and rate, the other we got an out of network exemption- you need to call practically as soon as you find out you're pregnant to get the best deal on that- but they covered more that way.

How do you get an out of network exception and what exactly is it/how does it work?

[Mama2Kayla]

I had a homebirth with Cigna. My midwife was considered out of network, but they still covered the majority of the costs(like 3/4). I just called as soon as I found out I was pregnant and talked to them. My midwife charged a certain amount and I paid her monthly. At the end of the pregnancy we submitted the claim for care and they covered a like 60% and whatever left over we paid.

I had no problems and it was way easier than the crap I had to deal with in the hospital for my first birth.

Good luck!

[AlexisT]

mamakaryn: you need to be able to demonstrate that there are no providers in-network, within a reasonable distance, who provide the (covered) benefit. Then they may agree to pay an out of network provider at the in network rate (so, 100% versus 70% or in the case of an HMO with no out of network benefits, 0%). The catch is that these percentages are of the "usual, customary, and reasonable charge", which may be less than your midwife's fee. Network providers are required to accept UCR as payment in full but non network providers are not, so you could still be left with a balance.

if there are midwives in network who do home birth, they probably won't make an exception for another provider.

[mamakaryn08]

Originally Posted by AlexisT

mamakaryn: you need to be able to demonstrate that there are no providers in-network, within a reasonable distance, who provide the (covered) benefit. Then they may agree to pay an out of network provider at the in network rate (so, 100% versus 70% or in the case of an HMO with no out of network benefits, 0%). The catch is that these percentages are of the "usual, customary, and reasonable charge", which may be less than your midwife's fee. Network providers are required to accept UCR as payment in full but non network providers are not, so you could still be left with a balance.

if there are midwives in network who do home birth, they probably won't make an exception for another provider.

I spoke with the receptionist at the midwifery practice that has 2 midwives in network. She told me that everything EXCEPT the birth will be covered, because the midwives are only covered at births they do at the hospital (OHSU). She said cigna is not a fan of home births. Still, that's better than not covering anything at all. Unfortunately, though, we do have the HMO so these ladies are my only (covered) option, so I hope I feel comfortable with them. The only other thing I can do is call every single listed CNM in the local network and ask them if they would consider attending my home birth.

So, since there are at least 2 covered midwives, I wouldn't be able to get an out of network exception. Darn. I hope I like these women!

[mamakaryn08]

I interviewed two midwives who are listed as covered providers... one is a CNM and the other is an ND/CPM. The CNM I did not like AT ALL, got a really negative "medwife" vibe from her (she delivers in hospital, too), and the other one... I thought she was nice enough but definitely didn't click with her.

Looks like we will be using the midwife I originally wanted to go with. She charges $2000 total. She said she has billed Cigna many times and they have ALWAYS paid her... I'm still thinking they won't for me because I have the HMO with no out-of-network benefits, but it would be a pleasant surprise if they do. She will bill them and see what happens.

The funny thing is, the CNM who is covered told me that Cigna always pays her for everything BUT the birth, leaving the out of pocket cost somewhere around $1800-$2000.... so, no thanks!