Billing Help

[ColwynsMommy]

My homebirth was in May. My midwife billed my insurance once, but it was denied because she hadn't used approved forms. I found out what form was needed, had her email me her itemized bill and then she had to print the billing form from my insurance company's website, fill it out, then mail it to me. I just got the denial in the mail, stating that services were not covered. It turns out she had put the location of my prenatal visits as in my home, and my insurance doesn't cover home visits. The prenatal visits were actually in her home, which I figure is like her office, right?

So I guess I need to have her print out the form, fill it out, and mail it to me again. I'm feeling bad about asking her to do so much so long after the birth. Is it unreasonable to ask her to do this again?

I'm not really expecting the insurance to cover the birth because homebirth is specifically not covered. Homevisits aren't covered either, but I was hoping they would at least cover the prenatal visits. Any other tips on getting these services covered? We have Harvard Pilgrim PPO.

Thanks!

[allisonrose]

I don't have any tips on getting your insurance to cover anything but I don't think it's unreasonable to politely ask your midwife to redo the forms. Explain to her that they won't cover "home" visits but that they should give you some reimbursement for "office" visits and ask her to code them as such. I imagine she's run into all kinds of insurance issues and has had to do similar things for clients before.

[Rose_S]

I had similar issues after my homebirth with midwives billing "incorrectly" for my insurance. I talked with my insurance to find out how to bill correctly and then talked with my midwives. My insurance considered my homebirth to be a "physician office" birth, since they don't have a category for home birth. Insurance ended up paying about 1/3 of the cost of prenatal and birth. All this was done at least 3 months after the birth. It doesn't hurt to try again and specify "physician office" birth and visits.