To the moms who pay for midwife out of pocket: - Page 4

[moonjunio]

I was referred to a really interesting web resource on www.gentlebirth.org, entitled "How to get insurance reimbursement for a homebirth...even if you have an HMO or your plan doesn't cover homebirth or associated charges."


Long-winded title, long winded page :-) It is chock full of ways to badger your insurance into paying in the first place, and ways to get more money out of them.

There are some common exceptions that your insurance provider doesn't want you to know about. For example, if they say your midwife isn't "in network" point out that none of the in network providers will birth at home.

Lots more tips from the trenches of wringing blood from a stone!

Remember, you are proposing to SAVE THEM MONEY by not going to the hospital!

I haven't put this to the test yet since this will be my first homebirth, but I'll definitely be referring to it closely as I submit claims.

[mizznicole]

Self employed people = no maternity insurance. We might have a rider for c-section but I'm afraid to ask because they probably will drop it once they find out I'm pregnant! But even if that occurs, it's 5000 deduct + 20% coins. The midwife is $3500 not including u/s costs and materials. So this is one expensive kiddo.

[dachshundqueen]

Well, we have medical insurance through my FIL's small business.

Walking in the door at a hospy costs me $3500 to pop out a kid, that doesn't include items billable for the child (hearing check and pedi rounds).

We took the risk last time that we might need to transfer and had a successful HB.

We are again taking the same risk, $2800 to HB MW and $40 to OB for shadow care (that's the copay for global prenatal care). Should we end up with a hospy birth and not attended at all by the HBMW then she refunds the LD/PP care portion of her charges. If I end up as a transfer, then I end up fully shouldering the $2800 to the MW and $3500 to the OB.

We'd just rather not have a hospy birth but are taking a decent financial risk at this time to avoid it and we don't really have tons of extra money floating around either. Just coming up with the $2800 has been a real struggle. If we end up at the hospy, that money will be paid on AmEx. It's kind of depressing to be honest.

Liz

[MaerynPearl]

Until the health care reform goes through, I do not suggest badgering your insurance company unless you are ready to find a new one.

[BetsyS]

Our insurance doesn't cover it, either.

I chose to have a hospital birth, but a homebirth would be a heck of a lot cheaper for us. $2800 for a homebirth. Our hospital birth has cost me $6000 so far, and the hospital hasn't billed for the baby's hospital stay yet.

[Dmitrizmom]

We paid cash for our mw/hb because we didn't have insurance. I would do it over again.

[moonjunio]

Originally Posted by MaerynPearl

Until the health care reform goes through, I do not suggest badgering your insurance company unless you are ready to find a new one.

Well that's depressing. Not that the whole thread isn't depressing We are paying these people for coverage (however skimpy), so I think it's worth looking at all the tips to find out what you should ask the insurance reps, how to get pre-approved, how to submit claims effectively, how to appeal, etc.

It takes a lot of energy and gumption to get what you're entitled to, which is what the insurance industry is counting on! Maybe I'm being naive , but I don't think insurance can drop you for making their reps spend too much time on the phone.

[MaerynPearl]

Originally Posted by moonjunio

Well that's depressing. Not that the whole thread isn't depressing We are paying these people for coverage (however skimpy), so I think it's worth looking at all the tips to find out what you should ask the insurance reps, how to get pre-approved, how to submit claims effectively, how to appeal, etc.

It takes a lot of energy and gumption to get what you're entitled to, which is what the insurance industry is counting on! Maybe I'm being naive , but I don't think insurance can drop you for making their reps spend too much time on the phone.

Until some laws pass preventing it, they can and will (Im a former insurance agent, Ive seen it too often)

[Pinoikoi]

At first my insurance said they would pay for midwifery care but not the homebirth... but I argued the point and was transferred to the pregnancy coordinator person (instead of the lady that just states whether you have current coverage or not), and she said they did in fact pay for homebirths in my State.. so I think for some larger insurance companies it is a State by State issue..

Originally Posted by MaerynPearl

Until the health care reform goes through, I do not suggest badgering your insurance company unless you are ready to find a new one.

I am going to lose my very good insurance once health care reform goes through.. I know this because we (our union) just had our contract renewed.. our insurance payment that my employer pays increases EXCEPT those years after 2012.. why? Did my employer somehow figure out a way to keep the insurance rate from increasing? You bet they did.. they plan to switch our entire district to the national plan instead of what we currently have.. they haven't announced it yet, but it is the only thing I can think of that makes sense with their actions... so I guess I am getting a "new insurance company" whether I like it or not.

[moonjunio]

Originally Posted by MaerynPearl

Until some laws pass preventing it, they can and will (Im a former insurance agent, Ive seen it too often)

Alright, thank you for the inside story. That's really a crying shame. I'm in a position to risk it in hopes of getting a few grand back (homebirth with an experienced CNM in my area costs about $4500), but I know a lot of people aren't.

[MaerynPearl]

Originally Posted by moonjunio

Alright, thank you for the inside story. That's really a crying shame. I'm in a position to risk it in hopes of getting a few grand back (homebirth with an experienced CNM in my area costs about $4500), but I know a lot of people aren't.

It is a crying shame. Its also the #1 reason why I am a former insurance agent and not a current one. I do not like being told to purposely screw people over but that is pretty much what you are trained to do.

[Schae]

Our medical aid (in SA it's not insurance ) pays for 12 antenatal visits from the major medical benefit (i.e not from your own savings). Those visits can be with an OB, a GP or a midwife. However, they discriminate against midwives in that they'll only reimburse a tiny portion of the midwife fee, yet will reimburse the full total fee of an OB or GP.

So we pay our midwife in cash as her consult fees are not high, and when we see the OB we submit that to the medical aid. We had to see the OB a lot this pregnancy as it was high risk to begin with - so this has worked out better for us.

Also, we'll just submit the midwife fees as part of our tax return for the 2011 tax year and hopefully get some money back from the govt.

i hope i made sense lol. i think it's kind of different to the US

[TabithaB]

Originally Posted by prancie

We pay with cash because in our state midwifery is illegal. We transferred last time and I had an emergency c-section. Our insurance paid for every penny of the hospital bill. Once you get to a doc your insurance kicks in like normal. I imagine that for those who do not have insurance that they would have a big bill, but that is what they must be prepared to deal with.

I am in Illinois, midwifery outside of the hospital is illegal here and the VBAC rates suck. I don't have any insurance and am not eligible for any so cash it is. I am dreading it if I have to transfer. I will get stuck with the midwife fee, hospital fee and OB/GYN fee for the doc that shows up. Damn global billing.

[ada]

We're paying out of pocket, but we're going to try and be reimbursed afterward. We're not counting on it though, so if it doesn't work out then we won't be broken by it and if we do get anything at all back - found money!

[honeybee]

Our insurance doesn't cover OOH birth, so we pay out of pocket. If we transferred to the hospital, our insurance would cover it (except for deductible, copay, etc.). I would still expect to pay my midwife her full fee if we transferred during birth. That is why she is there, to monitor and get us moved safely in the event there is need. Plus, she would go with us and act as a doula.

Plus, my mw's entire fee is less than just the prenatal costs of going to a doctor (although with insurance we wouldn't pay that all out of pocket ourselves)... definitely well worth the money.