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Insurance battles for homebirth

post #1 of 21
Thread Starter 
So I am growing to truly hate, hate, hate my insurance company (with a red hot passion sort of hate).

I have dreamed of having a home birth for years, and I chose this insurance plan in part because it claimed to cover home birth. But when I first got pregnant I didn't immediately look into home birth because I wanted to make sure that I was healthy and a good candidate. I went to an OB for several prenatal appointments, got a sequential screening done, and was told that even though I am 40, I have the chromosomal risks of a 16 year old. Yay. Then I interviewed midwives and they all said my age was not a problem. We chose a midwife, and in the mean time I placed a couple of calls to my insurance company to verify that they covered home birth. They did.

But then it turned out that none of their preferred providers in my area attend home births. Well, no problem, the insurance rep. said that I would just have to have my midwife call for prior authorization. She did, and they denied the authorization because they said that midwives in this state cannot be contracted with the health plan because they don't carry malpractice insurance.

I appealed, and they denied my appeal. I asked for a level two appeal, which we have next week. We (my husband and I) will meet them in person, and I've already submitted a bunch of documentation about why midwives don't carry malpractice insurance (they can't as the premiums exceed their annual income), why home birth is safe, and why this option saves them a lot of money and they should just write the check and shut up. (of course, I was more diplomatic than that, but you get the idea).

Then today I got the appeals packet from them -- all the info that has been reviewed so far in the process, and I see that among other things they are trying to say that they denied my claim because my age puts me at "relatively high risk." They never mentioned this before, or I would have addressed it in one of my appeal letters, and given the fact that I am in good health and have never been told that I am at high risk, this just makes me want to scream.

Why are insurance companies so evil?

Thanks -- I just needed to vent.

If anyone has any advice on dealing with evil insurance companies, please let me know.

Best,

Donna
post #2 of 21
I don't have any advice, I just wanted to say that really sucks (especially them not telling you about the age/risk crap) and I can understand why you're feeling that way toward them! Good luck with your appeal, I hope they cover it for you!
post #3 of 21
Quote:
Originally Posted by Mariposa40 View Post
Why are insurance companies so evil?
Because ins companies are in the business of making money..... they try to find every way not to pay a claim that is dubious (meaning there is not a stated contract that can be legally upheld). Keep pushing, even though you may get weary and frustrated. That's what they are betting on... that the journey and fight will be too much and you'll give up. Don't! :-)
post #4 of 21
http://www.gentlebirth.org/archives/preApproval.html

This is all I can offer. Mine doesn't cover HB, but it's still cheaper to pay out of pocket with HB MW than it is to pay what the insurance doesn't cover through the hospital., cheaper by like $3K! So that is what we are doing. you can also with you next year tax return file it as "unreimbursed medical expenses" if you choose to itemize your tax return.

Insurance companies are crap. To give you an idea, we pay over $330 a pay check (every 2 weeks) and have $30 copays at all visits except for specialists (45-60) and the don't cover any MW stuff. We are switching to a private insurance company soon. Atleast we'll pay less for crappy benefits! LOL!
post #5 of 21
Just wanted to sympathize with you. I didn't have the guts or motivation to bother with all the claim/appeal crap I knew I would have to go through, and decided on a UC. I have to give you props for getting this far....you're almost there!
post #6 of 21
Thread Starter 
Thanks for all the support. It makes me feel a little better, even though I'm still seething at the insurance company. (When I first got the news of the denial I asked my husband, 'who would be so cold as to deny a claim from a pregnant woman?' the word's weren't even out of my mouth before I realized I was talking about insurance companies -- the people who deny claims from dying people without blinking an eye -- so I guess I should have been prepared).

I'm still gearing up for my fight, so cross your fingers for me, please.

Gabeyho -- what is a UC?

Donna
post #7 of 21
The things I would focus on would be
1- it is not the place of your insurance company to dictate your risk- that is the job of your medical provider.

2- If homebirth is not illegal, then you have a right to it, and if they cover it, then they need to pay.
post #8 of 21
[QUOTE=Mariposa40;14971323] the word's weren't even out of my mouth before I realized I was talking about insurance companies -- the people who deny claims from dying people without blinking an eye -- [QUOTE]

Yup... Our old insurance company refused to pay DS's medical bills from the Pediatric ICU when he almost died from misdiagnosis (another hospital COMPLETELY missed his type 1 diabetes and almost killed him). I'm STILL fighting for it, and that was a year ago in October. The last thing I ever expected was for them to deny every claim from the hospital... I mean, he has diabetes... It's not MY fault the first hospital missed it... Had they done their job right and not blown it off, he wouldn't have needed breathing machines, medicine to maintain his BP, meds for seizure prevention, etc.

Sorry, my own personal rant... LOL. I'm not expecting my insurance to pay for my HB. It might be cheaper to pay OOP since my MW is out of network and I have a higher deductible/lower insurance coverage.

I hope they pay! If not, check to see if your MW will allow you to extend payments post birth. Mine does (which is a rarity here). It's still cheaper to have a HB and pay OOP than to have a hospital birth! At least here, lol.
post #9 of 21
Wouldn't it be nice if insurance companies just had to fork over what the average cost of a birth in your area was and you could choose anyone you wanted......
post #10 of 21
Sorry about your problems. I know insurances suck, since I work for one My advise is to get a copy of your EOC (evidence of coverage) booklet and check the exclusions section. If it does not specifically exclude homebirth then you still have a shot. Also if you exhaust your second appeal with the insurance company then you can go to the State Insurance Commissioner for an appeal. They are much more reasonable and less bias. Good Luck I hope they cover it for you.
post #11 of 21
Thread Starter 
Well folks, tomorrow I meet with the enemy. My husband and I will attend our appeal hearing. I've gathered all the evidence I can -- the documentation showing that it is a covered benefit, the documentation that I need an out of network provider because there are no network providers within a 70 mile radius of my home (and driving 70 miles, in the snow, over mountain roads, while in labor, or waiting for a midwife to drive that far in those conditions while I am in labor, sounds potentially dangerous), the amount of money this will save them, studies documenting the safety of home birth, and my midwife's letter stating that I *am* a low risk pregnancy and a good candidate for home birth. Tomorrow we will try to make them see reason. If that doesn't work, we'll contact the State Insurance commissioner, and possibly take them to court -- but really, I'm 35 weeks pregnant -- I want this resolved last month.

Please think good thoughts for me tomorrow at 3:30 mountain time.

Donna
post #12 of 21
Anything? I've been thinking good thoughts for you today.
post #13 of 21
hoping things went well.
post #14 of 21
Thread Starter 
Well, I'll hear their official verdict tomorrow, but I'm not feeling terribly hopeful. They have a new story every time I talk to them. First it was that midwives in the state of New Mexico could not be contracted with the health plan because they don't carry malpractice insurance. Then it was that home birth was no longer a covered benefit. Then it was that I was actually a high risk birth. Today their story was that yes, home birth is a covered benefit and yes, they do have midwives as preferred providers, and yes, I am a low risk pregnancy, and yes, since they don't have any preferred providers in my area they would be willing to make an exception and work with an out of network provider, but darnit, it is out of their hands since they are just the middleman and it is really up to the State of New Mexico. They have to abide by the state's regulations, and since the state says that providers have to carry malpractice insurance, well, there just isn't much that the insurance company can do about it. (If they would just stick to one story it would be so much easier to argue with them, which of course is why they are not sticking to one story.)

So, we will wait to hear the verdict tomorrow, and then if it isn't what we want to hear, we will proceed to the next level of the appeal.

Again I find myself wondering, why do I have health insurance? If I just didn't pay the premiums every month I'd have enough to pay the midwife. But of course I don't want to be without insurance if anything catastrophic happens, and they are banking on that fear.

It is days like today that I really want to start looking for a job in another country -- one that has universal health care. Any Canadians out there (just to pull one possible country out of a hat) know of an opening for a Shakespeare professor?

Donna
post #15 of 21
Thread Starter 
P.S., thank you for the supportive thoughts. They meant a lot to me.
post #16 of 21
Please keep us posted! My insurance wasn't too big a battle, but they paid NOWHERE near what my MW deserved....I think she got less then 1,000 from them. It's absolutely ridiculous.
post #17 of 21
Thread Starter 
Well, as I'd feared, they have decided to uphold the original denial. They recommend that I take it up with the State of New Mexico and see if they will agree to credential my midwife if I sign a waiver releasing them from liability. I did point out to them that if I had been told months ago that I needed to contact the state, not Lovelace insurance, then this could all have been resolved, and I suggested that perhaps their "customer care" reps need some education (remedial education, I should have added). She agreed.

So, we will take our appeal to the next level. I am so sick of all this. I am 35 weeks pregnant TODAY. I should be spending my time nesting, making baby clothes, researching about vaccines and interviewing a new doctor for the baby, and generally focusing on the upcoming birth and my new child -- instead I am arguing with idiots who keep changing their story.

As soon as possible I am going to switch insurance providers. Mind you, I don't know that any of my other options are any better, but I refuse to keep giving my money to the people who have lied to me.

Donna
post #18 of 21
I'm sorry it's been such a rough time for you. I hope the state sees the insanity in this so you can start focusing more of your time on the upcoming birth!
post #19 of 21

Mariposa40 - I wish you the best of luck

Mariposa40, I feel your pain. Well, not exactly, but I know insurance companies are terrible to work with. I am an attorney and have worked to defend and to sue insurance companies so I have seen their tricks. I am also from New Mexico and am thinking about a home birth. I also have Lovelace so it looks like I'm going to have an uphill battle if I want them to pay for it. I enjoy reading your posts, and appreciate your candidness. Please keep us posted on your progress. Hopefully I can take your advice and run with it!
post #20 of 21
Thread Starter 
Tatiana42, where in New Mexico do you live, and which Lovelace plan do you have. I am on the State of New Mexico plan. If you have that plan and live somewhere where they have a preferred provider, you might be O.K. (might -- because they really have continually changed their story with me, so who knows if they'll actually honor their contract or not.) The problem with me is that none of their providers who do home birth are in Santa Fe, and none of the providers in Santa Fe do home birth. The midwives in Santa Fe who do attend home births are CPMs and don't carry malpractice insurance. Now ironically, if I were on medicaid I could have a CPM in Santa Fe attend my home birth and get it completely paid for, because in 2006 a new medicaid program was introduced (I believe after a legislative act basically forced the MCOs for medicaid to behave themselves) that allows women to have a home birth, even if the provider doesn't have malpractice, as long as the woman signs a waiver releasing the state from liability. I would be more than happy to do that, but Lovelace says it is out of their hands and I have to appeal to the state. So that is our next step.

But basically, my advice would be to start working on all of this asap. I took my time while "thinking about" a home birth because a. I wanted to make absolutely sure that I was a good candidate for a home birth, health wise and all, and b. because I was sure my insurance would cover it, since they said they would. Silly me. I should never have trusted them. Anyway -- make sure that your insurance covers home birth AND that they have a provider in your area, or if they don't, find out what sort of a provider they might be willing to contract with and what you have to do to get that taken care of.

Good luck.
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