transfers are emergencies, insurance wise?

[xixstar]

Our insurance is making some changes this year just before baby arrives and one of them includes eliminating all out-of-network benefits. It's also an open access HMO plan, which is slightly less restrictive than a traditional HMO plan, and that has some aspects that worry me a little bit policy wise.

But my once concern is about transfer for a homebirth. This will be my 3rd birth/2nd homebirth and I am confident we'd only transfer for emergency reasons (and not for pain relief/exhaustion) but I would like the reassurance that obstetric emergencies are still considered emergencies insurance wise. When I look at the benefits manual, for all obstetric services it talks about how your care provider will provide all the pre-authorization needed for the hospital (which you need for any non-emergency care) -- my care provider will be doing no such thing. And I know the general assumption is that a laboring woman would be going to the hospital in the first place.

I also worry that since they're dropping the out-of-network benefits (which were crappy anyways, but still!), that we could be caught in a loop where only some of the hospital care providers are in-network but some are not. I guess I've read personal finance stories about where people went to the hospital and their doctor was in-network and fully covered but they got hit with major bills from the anesthesiologist, labs, and other peripheral people that weren't.

I realize this is mostly an insurance based question, but thought someone might be able to just remind me that emergencies are emergencies, regardless of if they're birth related or not. Maybe it's a silly worry to have in the first place.

[starkyld]

You should talk to your insurance company to be sure, but yes, emergencies are emergencies.

My insurance company will cover my homebirth at the in-network cost if and only if I never transfer out. In the case of an emergency transfer, the in-network benefits for my midwife evaporate and services are covered at the in-network rate at the nearest medical facility, regardless of whether it's technically in-network or not. In the case of a non-emergency transfer (e.g., long labor + exhaustion), in-network benefits for my midwife also evaporate, but I have to be transfered to an in-network hospital for services to be covered at the in-network rate.

So insurance coverage may depend somewhat on the reason for your transfer.

[dachshundqueen]

These are the reasons that many women have shadow care and some like myself, declined to inform the provider that they are having a planned homebirth. Everything is preauthorized and a physician relationship is already in place.

Liz

[mntnmom]

I know my insurance (Tricare) would cover it as an emergency. But they work on the assumption that you could be out of your country of residence and get in a car wreck etc., so they are very liberal on how they handle emergency medical care.

[lach]

I'm crashing from New Posts, I hope you don't mind.

I would talk to your insurance company. I had to travel very close to my due date, and my OB specifically told me to check with my insurance company. She said that if I go into labor after 36 weeks, it would be considered not an emergency and if I didn't deliver at an in network hospital from that point on, the insurance company would consider it out of network care and charge me accordingly.

Remember that they're in the business of making money, and thus look for any excuse to deny you. (I have some horror stories about that, but that's off topic.)