MO CPMs and Insurance coverage

[MsBlack]

Are there any CPMs out there--or their clients--who know whether or not CPMs are getting any kind of insurance payment of fees? If you are a CPM or a client of a CPM where fee coverage was granted, I'd be grateful to know what insurance company was involved (or MO medicaid), and how hard it was to make it happen. Even if you didn't get coverage but looked into it, that info would be helpful, too.

thanks!

[Mama Lo]

well, I'm one that looked into it and didn't get coverage. We have Blue Cross Blue Shield and they only cover CNM's.

[MsBlack]

Thanks--all info is good info at this point...even if the good info is bad news

Anyone else? I've heard rumor of success for CPMs obtaining coverage...but 'rumors', well... ya know! Maybe it only originated as a statement of someone's (mw or family, or both) strong wish for insurance coverage, an assumption that being 'legal' in MO is a guarantee of it, or generated from news of CPMs elsewhere getting coverage...so--anyone else try this?

[MsBlack]

bump!

anyone, anyone at all? I know that there has been a legal CPM here for a couple years--and word is that she's pretty busy (not that I know in the least). Seems we have at least one other CPM in the ST L area as well. I don't even know if either of them have sought insurance pmt of their fees. Anyone try to get insurance pmt for CPM services?

[Dmitrizmom]

I applied for medicaid after dd2 was born (and I lost my job), and was told that homebirth midwives were not eligible for reimbursement.

[MsBlack]

Originally Posted by Dmitrizmom

I applied for medicaid after dd2 was born (and I lost my job), and was told that homebirth midwives were not eligible for reimbursement.

Thanks for this

Do you mind telling me when you received this news--approximately, anyway?

[Dmitrizmom]

November 2009.

[MsBlack]

Ah--thanks. It's good to know, since that is when some fams said they were being told that CPMs would be (or might be?) able to take insurance. Could well be that your own investigation and some other fams' as well, proved in the meantime that such is not yet the case. This rumor first came to me last Nov, was repeated by a few since then--but not in some months now. Perhaps the hopeful rumor died a natural death...too bad!

Anyone else try to get insurance coverage of other types for a CPM, since then?

[Blessed_Bess]

I will be trying to get coverage for my CPM services soon, through Blue Cross. My mw says don't hold my breath though. I'll let you know if I get covered.

[MsBlack]

Thanks, Blessed Bess--good luck!

If I don't hear from you in a month or so, I'll try to remember to give you a holler about it

[laughingfox]

I was denied coverage for my CPM, but the reason given on my insurance paperwork is that she was "out of network". I'm fighting them on this on the grounds that there was no in-network midwife within a 100 mile radius.

(The birth was earlier this year, and we already paid the midwife and are just trying to get reimbursement at this point. Paying a midwife's full fees out of pocket was actually cheaper than it would have been to pay our portion of an insurance-covered hospital birth.)

[MsBlack]

Originally Posted by laughingfox

I was denied coverage for my CPM, but the reason given on my insurance paperwork is that she was "out of network". I'm fighting them on this on the grounds that there was no in-network midwife within a 100 mile radius.

(The birth was earlier this year, and we already paid the midwife and are just trying to get reimbursement at this point. Paying a midwife's full fees out of pocket was actually cheaper than it would have been to pay our portion of an insurance-covered hospital birth.)

Thanks for this info. Yeah right "out of network" Since CPMs are legal now, sure seems its on them to expand their network!

I heard this CPM coverage question asked recently at an area meeting of mws and moms. A CPM there said "I'm sure that many insurance companies will do this"...however, she had just been certified and had not yet tried to get reimbursement.

[MommyDOK]

I was told, by Dr Duhart, that medicaid didn't even cover homebirth with a physician. Many moons ago they did (think 70's), but they passed a law that didn't allow it.

There is a traveling mw I know (from online) that says she has been successful in getting payment. I will send info to you.

[Defenestrator]

I bill insurance in MI, where CPMs are not regulated, but things are not as hostile as they are in Illinois. MO, with their current laws, would seem likely to be better than MI.

BCBS fights tooth and nail not to pay me. Sometimes BCBS from other states will pay me (like if there is a large corporation the people here might have BCBS of Florida or New York or Arizona). United Health Care pays and pays well. Aetna sometimes does. Almost all of the little insurance companies pay but they almost always try to negotiate the fee down. I use an insurance biller, but the amount she helps me varies from company to company. Medicaid will not pay me.

The interesting thing is that I have a CNM in my practice now, which I thought would improve things greatly, but they're fighting her too.

[MsBlack]

Hi Stacia--welcome to our little corner of the world

and thanks for that information. Nice to know that you are often getting paid (except by medicaid, so silly) by the insurance companies. Sounds like your billing agency is a big help--something to consider.

[mom2reitmans]

I have United Health Care... and though not able to cover my 2009 homebirth with my most excellent midwife ... I was able to find out that I needed to get a few things in order before the birth.
1) Midwife needed to have some sort of "medical certification" CPM would work.
2) I needed her Social Security # or EIN (employer identification number)
3) a bill; that had a street address, and an outline of services (approximate number of pre-natal visits w/ price per visit, birth costs and approximate number of postpartum visits w/price per visit, I also would include the approximate cost of birth kit (billed under labor/delivery room).)
4) set up an Out of Network Exception with your insurance (This is the most important part, and has to be done well in advance). Keep asking and they should give you the billing code(s) that they will cover. (If anyone has a subscription to findacode.com that would be really helpful for all homebirth families)

now my insurance would only cover 60%... but any help is help.

Katie

[MsBlack]

Great info, Katie! Thanks for lining that out.

[lktate]

I have Health Link insurance thru Health Scope Benefits (Missouri Department of Conservation is the employer). This year we used a CPM for the birth of our second son, and I decided to take a stab at billing my insurance and getting reimbursed. I knew that they listed "birth centers" as a covered benefit, so I figured it might be worth pursuing since there aren't any birth centers in my area.

I went online and spent a lot of time figuring out which CPT and ICD-10 codes applied, and tried to make the bill as detailed as possible. I showed every prenatal & test (although I billed for the medical supplies separately, and that was a mistake, as they refused to cover those), every aspect of the birth & each post-natal/baby check.

They didn't ask questions, but they did take extra long (2-3mos) to make their decision (I suspect they took it to a board meeting). My claim was APPROVED! They covered my CPM's services at the 70% out-of-network rate. I did several happy dances when I got the check this last week! :-)

I will admit that although I was warned here and by an insurance rep (when I called a few months before the birth) that getting prior approval would help, I failed to do so.

Anyhow -- any Missouri state employees (or their spouses) that get coverage thru the Conservation Department should make sure they pursue this if they are planning to use a CPM.

Just wanted to share the good news!