United Healthcare and Homebirth

[soontobemommyof3]

I am sorry if this has been asked before.
I am 4 wks pregnant with my 3rd and we want to go the homebirth route.
I was wondering if any one has had any experience filing with United Healthcare. We have United Healthcare Choice Plus. I am meeting with 3 midwives during the course of next week too so I will be sure to ask them as well. Just wondering if any one has any pointers.

[HeatherB]

Search for UHC or United Healthcare in this forum and you'll find several threads about our experiences.

Congrats!

[Ellenems]

I have United Healthcare Choice Plus as well, and my policy specifically states that it will cover homebirth with a "Licensed Midwife Nurse." It would be considered an out-of-network provider and covered at 80% after meeting my deductible. I called UHC and explained to them that there is no such classification as a "Licensed Midwife Nurse" here and perhaps they were referring to a LM or a CNM. Their in-network providers are CNMs (in hospitals), so I don't know where they came up with that specific term. So I clarified and asked whether the midwife needed to be a CNM, or if a LM or CPM would be covered as well, or if they needed any type of certification at all (as in a traditional midwife). First they told me the midwife would need to be either licensed or certified, but then after 30 minutes or so of waiting they came back and told me I could choose any midwife I wanted.

I interviewed 6 different midwives and ended up choosing a team of 1 CNM and 1 CPM. They use a local billing company which charges 7% of the total amount reimbursed. My birth won't be until February, so I don't know how everything will turn out, but I'm expecting to get about 50% back of my $4000 birth, depending on how it's itemized. It's kind of disappointing since my last homebirth was completely reimbursed by BCBS even though our coverage was only 80%. My midwife did her own billing and was very generous with the itemization. But really, I'd have a homebirth even if insurance didn't give us a penny.

Good luck!

[soontobemommyof3]

Originally Posted by HeatherB

Search for UHC or United Healthcare in this forum and you'll find several threads about our experiences.

Congrats!

Thank you I had searched the archive and did not find anything, it wasn't till after I posted that I realized you could search the forum... silly I know. I am new here.

[soontobemommyof3]

Originally Posted by Ellenems

I have United Healthcare Choice Plus as well, and my policy specifically states that it will cover homebirth with a "Licensed Midwife Nurse." It would be considered an out-of-network provider and covered at 80% after meeting my deductible. I called UHC and explained to them that there is no such classification as a "Licensed Midwife Nurse" here and perhaps they were referring to a LM or a CNM. Their in-network providers are CNMs (in hospitals), so I don't know where they came up with that specific term. So I clarified and asked whether the midwife needed to be a CNM, or if a LM or CPM would be covered as well, or if they needed any type of certification at all (as in a traditional midwife). First they told me the midwife would need to be either licensed or certified, but then after 30 minutes or so of waiting they came back and told me I could choose any midwife I wanted.

I interviewed 6 different midwives and ended up choosing a team of 1 CNM and 1 CPM. They use a local billing company which charges 7% of the total amount reimbursed. My birth won't be until February, so I don't know how everything will turn out, but I'm expecting to get about 50% back of my $4000 birth, depending on how it's itemized. It's kind of disappointing since my last homebirth was completely reimbursed by BCBS even though our coverage was only 80%. My midwife did her own billing and was very generous with the itemization. But really, I'd have a homebirth even if insurance didn't give us a penny.

Good luck!

Thanks a ton for this. I am hoping the midwife I choose will have info on how to do this too.. I am not even going to call until I speak with her about it. I agree though we are having a home birth regardless of whether the insurance will cover it.

[HeatherB]

Originally Posted by soontobemommyof3

Thank you I had searched the archive and did not find anything, it wasn't till after I posted that I realized you could search the forum... silly I know. I am new here.

No worries! Had it not been rather late I'd have dug some up for you. I hope you found some other good info, though! I have and will file with UHC again. I have a friend with the same MW due within 2 weeks of me who will file with a "gap exception." I'm not doing the gap exception, and we'll compare their coverage. They *should* be exactly the same so one of us will file an appeal based on the other, and both get the best reimbursement we can.

IME, they have paid somewhere around the 50% that a PP mentioned.

[WingonWing]

I am excited to hear this. I planned on paying for my HB in full and won't have a problem with it if it ends up that way, but if it was actually covered by United I'd be psyched!

My midwife is a CPM, and my policy specifically uses the word "licensed" (we don't have licensed DEMs in Maine) so we'll see what happens....maybe the person who processes my claim will confuse the words certified and licensed...

[qadirqutiesmom]

Any updates from anyone regarding how things have gone with United and your home birth? I have many CNM in my area but only one that does home births and she is more than 40 miles from me and there are no birth centers in my area that are in network for UHC. I know others have posted that having a home birth is a choice, so they don't have to consider and cover as in-network but many people have also said there can be a gap extension filed if they don't provide the services you want. I'm currently 22 wks and am just starting my search for a MW because I really want to have a home birth this time. I've been seeing an OB, but don't really think I need to go through the hospital birth experience again. Any help will be appreciated. 

[msmiranda]

I had a homebirth in 2009 and was insured with United.  Our policy covered 80% of allowable charges for out of network providers.  I didn't switch to my midwife until 28 weeks and continued shadow care until 32 weeks, so she couldn't bill for all the prenatal care, just the last few visits and then the birth and postpartum care.  In the end, we paid $3500 to the midwife and received $1200 back (would have been a bit more but the billing company she used took a percentage as well).  I was prepared to pay the whole thing out of pocket if I had to but it was nice to get some reimbursement.  I did not try to get it covered at the in-network rate ... that just seemed too daunting at the time.  I didn't have the energy to pursue it, but I have heard of some people having luck going that route.

[Jaimee]

Ours was covered at 80% and it didn't matter what type of mw it was b/c all the hb mw's were out of network anyway.  We had an issue with pre-authorization.  They considered the hb "home health" which would have required pre-auth, which we did not get.  But we appealed saying we assumed a BIRTH would be considered "maternity."  A third party ruled on our case (the state of Maryland) and mandated UHC cover it at 80%!  So my advice is to specifically ask what it is covered under, if you need pre-auth, and keep notes with dates, times, and customer service reps' names.  Call back at different times so you get different reps to confirm the answer. 

[Jynuine]

I wanted a homebirth BADLY but United would only cover a CNM out of network for me, too. They make it VERY unceonvenient to have a homebirth as far as I see it.

First of all- dont mention it's a homebirth or ask if they cover homebirths. It doesn't matter WHERE you birth rather who attends you.

In portland the miwdwivery cost is mainly attributed to the birth, however the total cost covers all your visits minus Ultrasounds and labs, etc.

I have to have monthly labs and Ultrasounds now and then do to a blood issue I have where I have an antibody to a gene trait my husband carries. So that already brings the cost up for me. On TOP of that I was already seeing midwives at the hospital here so I was in the pot with them as it was. Most the midwives required full payment by 39 weeks.

So- my advice is this: Find a midwife who takes United who is flexible in receiving payments after delivery and start using her ASAP.  Sometimes billing them is a pain in the butt for them- so it's great if they already are plugged in.