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Originally Posted by JSMa  I already know my homebirth MW isn't licensed because the "wonderful" state of PA  will not license CPM's or DE midwives, only CNM's can get licensed. |
So, there are no CNM's who will attend a homebirth in your area?
I live in NY and will have a homebirth in a few weeks with a CNM. Insurance has been a pain in the butt, but I finally have paperwork proving their commitment to cover it at in-nework rates. I have a BCBS of IL PPO through my husband's employer, but I actually got a new job while pregnant and had my choice of two other health plans-- an Anthem PPO and an Independent Health HMO/POS/EPO combination-- so I did my research with all three companies.
BCBS was a pain in the butt; way back in September/October I made a series of phone calls trying to figure out at what rate my homebirth would be covered. In NY, insurance must cover CNM services, but the in-network vs. out-of-network rules still apply, and my CNM is not in-network with *any* provider (I don't blame her, who wants to sell their soul to an insurance company? *shudder*) BCBS gave me three answers from three different representatives all in one day-- after my $1000 deductible they would cover my CNM's services at the rate of 0%, 50% or 80%- LOL. I used their inconsistency against them in my next call by requesting that someone higher up do their research and give me a letter stating exactly what their and my financial obligations would be, and they sent a letter within three days stating that if I used an in-network CNM it didn't matter where the birth occured, it would be covered at 80%, but if I used an out-of-network CNM, it would be covered at 50%. Also my out-of-pocket maximum for using an out-of-network provider was more than double. But at least I had something in writing.
Then I heard from people here on MDC about applying for an "out of network exception," "gap exception," or "out of network referral." This is also around the time I got the benefit info from my new job. I learned that every insurance company has their own terminology. For a PPO, you need to ask to apply for a "PPO Waiver." BCBS of IL gave me a special phone number to call for that process. I just had to provide my name, insurance number and address, answer a few questions about the procedure I needed (an in-home delivery with a CNM), and give my provider's address. BCBS then made sure that they did not have any in-network providers for that service within 30 miles from my home. They said I would have an answer in 14 business days. On the 14th business day I called them to say I had not yet heard the outcome of my application, and the lady on the phone said she did not see that they had finalized anything. I told her this was unacceptable, that I had a fast-approaching deadline to make important benefit elections and thus decisions about my healthcare, and she said they would call me the next day. They did, and I was approved. Then I received a letter stating so in five more business days.
Anthem PPO had a similar process with the same 30-mile radius rule and their representatives were extremely helpful on the phone, but since I got my approval from BCBS I decided not to switch health insurance (I hope to quit my job after the birth anyway). Independent Health said they knew of my CNM and had reimbursed her services in the past, but my employer's particular plan did not allow for any out-of-network providers to be reimbursed unless my Primary Care Practitioner wrote a letter of referral for the service. Since I haven't yet established a relationship in this area with a PCP (just having moved here last summer), I thought my chances of getting that accomplished were slim.
Anyway, all that to say, if CNMs are generally reimbursed in your state, it is likely you can get insurance to cover your homebirth if you can find a CNM you like to attend it! Best of luck!
~K.
