Confused about insurance covering Homebirth in VT

[hollytheteacher]

My DH called our insurance company : Blue Cross Blue Shield to inquire about covering homebirths. They said they would cover it as long as it was done by a certified nurse midwife. There do not appear to be any certified nurse midwives in Vermont that DO homebirths though....I'm confused.

And if you are not a certified nurse midwife than what are you? and why isn't it covered?


I'm not pregnant (yet ). We are just looking into our options

TIA

[hollytheteacher]

anyone in VT have experience with BCBS covering their HB???


btw it's in vermont these past few days.

[ajohns1]

Certified Nurse Midwives almost always deliver in hospitals. I think the regulations around that credential make it very difficult for them to practice out of a hospital setting. I used the CNM's at Fletcher Allen for my son's birth a year and a half ago, and they were great (but there were some drawbacks to the hospital birth and the hospital's procedures). I'm currently considering a homebirth for this next baby. And I think all of the homebirth midwives here are Certified Professional Midwives, or Licensed Midwives. It just means they don't necessarily have training/credentials as a nurse.

BCBS covered my hospital birth with the CNM's without any issues at all. I'm with Cigna now, and I haven't looked into what their policies on homebirth are, but I'm not really counting on them covering it.

Still looking for a midwife, though. If anyone can recommend someone who can travel up to northern Franklin County, let me know!

[hollytheteacher]

Originally Posted by ajohns1

Certified Nurse Midwives almost always deliver in hospitals. I think the regulations around that credential make it very difficult for them to practice out of a hospital setting. I used the CNM's at Fletcher Allen for my son's birth a year and a half ago, and they were great (but there were some drawbacks to the hospital birth and the hospital's procedures). I'm currently considering a homebirth for this next baby. And I think all of the homebirth midwives here are Certified Professional Midwives, or Licensed Midwives. It just means they don't necessarily have training/credentials as a nurse.

BCBS covered my hospital birth with the CNM's without any issues at all. I'm with Cigna now, and I haven't looked into what their policies on homebirth are, but I'm not really counting on them covering it.

Still looking for a midwife, though. If anyone can recommend someone who can travel up to northern Franklin County, let me know!

yeah for our first birth we also had a CNM (kristen from Maitri) and she was great but my experience in the hospital=terrible. I really want the HOME birth this time. I guess we'll just have to save up the money and pay out of pocket...at least it will be worth it! Hey I wonder where you are in Franklin county? I used to live in Sheldon and Georgia oh and i went to BFA st. Albans

[Koalamom]

I wish I could help you but my midwife was in NH (even though I am in VT). Medicade covered my homebirth 100% and I thought they would have been the pickiest for natural birth.

[hollytheteacher]

Originally Posted by bluebirdmama1

I wish I could help you but my midwife was in NH (even though I am in VT). Medicade covered my homebirth 100% and I thought they would have been the pickiest for natural birth.

I curious about medicade...what are the stipulations for getting it? I was poking around online trying to figure it out and I know you have to make under a certain amount and be pregnant but I also think I read somethign like you aren't eligible for it if you are currently getting insurane through an employer...
I'm not but I am on my husbands...once I get pregnant and stop working our income will fall below the line I think (for a family of 4 i think it said under 65,000 and with only my dh working we would make under that)...

What is the process like?

[Koalamom]

Originally Posted by hollytheteacher

I curious about medicade...what are the stipulations for getting it? I was poking around online trying to figure it out and I know you have to make under a certain amount and be pregnant but I also think I read somethign like you aren't eligible for it if you are currently getting insurane through an employer...
I'm not but I am on my husbands...once I get pregnant and stop working our income will fall below the line I think (for a family of 4 i think it said under 65,000 and with only my dh working we would make under that)...

What is the process like?

I dont know if I am one to talk to on the requirements, but we do make over $12,000 a year and are fully covered.

As for the process, itis so easy, you can print off an application online, fill it out, and either mail it or bring it in to a local office. They will ask for proof of income, rent, SS#, and then you wil hear back within a month. That simple. It took me a few hours to do, and to get full midwife and any other dr needs covered, so worth it.

[sugarmoon]

My first 2 births were with a CNM who did homebirths, but she is now working for a hospital, only.

However, when I first went to her, my insurance had told me they wouldn't pay -- she wasn't too worried, said, oh let me call them myself, she did and then we were all set.

AND, for my 2nd one with her, I was in the situation you are talking about, where I had insurance through my dh, but let it go and switched to medicaid -- in VT, at least, it is very easy to get medicaid while pregnant, b/c it is under the CHIP (stands for something about children) program. Basically, they are insuring your unborn child, so the income requirements and things are much higher and the coverage is better -- I always got a boatload of dental work done while I had it!!

So, long story short, call some homebirth midwifes, ask them if they've been able to get bc/bs to cover. They'll be the ones who know if there is a way to tweak the wording for the ins. company.

And here is a website with the income levels for Dr. Dynasaur:

http://www.catamounthealth.org/vermo...id.html#income

Also, there is a ND Katrina, or Katina or something who does homebirths. Look up the VT midwifes alliance and see if you can find her. Maybe BC/BS covers ND care?

Good luck! You'll find a way!

[box_of_rain]

I had friends for whom getting BCBS to cover their homebirth was tricky. Maybe try getting on the VT State insurance (Medicaid/Dr.Dynasaur). They paid for half of my homebirth bill. The other half I had to pay out of pocket, but many homeborth midwives will gladly set up a payment plan for you.

And I can personally recommend Adrienne Trahnstrom - she is fabulous if you're in central VT. Katina (someone mentioned her above) is great, too - she attended me with Adrienne and is my kids pediatrician.

[lizvt]

I had BCBS With my first pregnancy and couldn't get them to cover our homebirth, so ended up paying out of pocket (although they did cover basic blood work, an ultrasound and would have covered other testing) Like you mentioned, they would only cover a CNM and I couldn't find anyone in the area that does homebirths (we are outside of Montpelier) Since the birth of my son I've stayed home with him and haven't had insurance. I'm pregnant with our 2nd and getting medicaid was a really simple process. Best of all they cover licensed midwives and homebirths! There is still a small out of pocket fee for us, but really minimal comparatively. (It is also nice that they cover vision and dental too, since I never had that with BCBS)
Good luck! I feel weird saying medicaid is better than insurance through your employer (or your dh's), but they really cover so much more!

[Catherine12]

When looking at the income limits for Dr. Dynasaur, remember that the baby counts as a family member (even while in utero).

I had my first homebirth on Dr. Dynasaur and it covered most of the cost. My second homebirth we submitted to insurance, not expecting them to pay (they had said they only covered births attended by CNMs) but they paid anyway.

One thing to bear in mind about the cost of homebirth is that if you have a high deductible, you might not "save" much by going with a hospital birth - you will have to pay the deductible out of pocket anyway, and many plans have deductibles that are nearly as high as the cost of a typical homebirth.

[lauren]

Originally Posted by hollytheteacher

And if you are not a certified nurse midwife than what are you? and why isn't it covered?



TIA

Many midwives in VT are direct entry midwives that apprentice with another midwife and then get licensed.

One of my homebirths was denied because "home medical services were not medically necessary." I thought that was such a bogus reason! (they were comparing home birth to visiting nurses after a hospitalization)

[lauren]

This might be helpful:

http://vermontmidwives.net/

[hollytheteacher]

Originally Posted by Catherine12

When looking at the income limits for Dr. Dynasaur, remember that the baby counts as a family member (even while in utero).

I had my first homebirth on Dr. Dynasaur and it covered most of the cost. My second homebirth we submitted to insurance, not expecting them to pay (they had said they only covered births attended by CNMs) but they paid anyway.

One thing to bear in mind about the cost of homebirth is that if you have a high deductible, you might not "save" much by going with a hospital birth - you will have to pay the deductible out of pocket anyway, and many plans have deductibles that are nearly as high as the cost of a typical homebirth.

Thanks for the replies everyone! As for the above we are in no way worried about hitting our deductible...in fact we are def going to hit it every.single.year due to DS's heart condition...each cardiologist apt racks up several thousand and our deductible is 5 grand...unfortuantely we are gonna be paying it every year...this is why I wonder about dr. dynasaur...like I wonder if you have a special health needs child it helps you be more eligible??

[aricha]

Originally Posted by hollytheteacher

this is why I wonder about dr. dynasaur...like I wonder if you have a special health needs child it helps you be more eligible??

High out-of-pocket costs for medical costs DO help you qualify because it allows you to "spend down" your income to meet the income cut-off. So if you earn $5000/yr over the income limit, but spend $6000/yr in medical-related costs, they will consider you to be within the income limits.

You can still get medicaid in some form (and your kids can get Dr. Dynasaur) even if you have medical insurance available through an employer. It may be only if you contribute to the insurance premium for your employer's insurance and/or if you have a deductible or co-pay. Just because your employer offers insurance doesn't mean they offer insurance that their employees can all afford. Another possibility is that Medicaid might pay all or part of your employer's premium.... they send forms to your employer to determine which is more cost-effective.

Medicaid is MUCH better insurance coverage than what my company offers, and there is no way we could afford to cover the whole family through my employer.