It can't possibly be that easy.. can it?

[soontobemommyof3]

I called up United Healthcare and asked about midwives and homebirth. The rep. I talked to told me it would be covered same way an OB would.

85% in-network
and
70% out-of-network

I just about fainted with delight.

If its out-of-network she said all I would need to do is call prior to the midwife billing and let them know, if I don't they could reduce their payment by $200. I am thrilled! It seems to good to be true. I am worried I will call back later and they will refuse to cover of something.


Has anyone had it be this easy?

(Now I just hope DH's job waits until June to merge with the other company otherwise it won't matter what the insurance was willing to cover.)

[allisonrose]

I also have UHC. I was told that yup they cover midwives and homebirth. My in network is 80% and out of network is 60%. I put in for a gap exception for my midwife because of deductible: in network is $1,000 and out of network is $2,000. (They allowed it since there aren't any in network midwives near me.) I suspect (and hope) that the gap exception will be worth the trouble in the end.

I ran into another spot of trouble when the midwife's office billed for a "home" visit. They cover those differently than "office" visits. However, it shouldn't be an issues since the midwife is going to send them a global bill once the baby is born rather than billing each visit as we go. I also mentioned the issue of "home" vs "office" visits and she said she had no problem billing as "office" regardless.

Oh and a reminder: get names. When someone confirms coverage for you, get a name in case you call up later and get a different story. (I often forget to do that.)

[ShwarmaQueen]

Yep, maybe UHC finally figured out that they SHOULD prefer HBs over hospital births!

I called early on during my pregnancy and verified that my HB would be covered. It was, at the out-of-network rate after my deductible. I submitted my invoice afterwards with the global billing code and after a few back-and-forths re dates and addresses, etc., they paid. In the end, I paid about the same or maybe even less of what it would have cost for a hospital birth.

[MegBoz]

i think my MW said Aetna is great too.
Although I believe she also said it's hard to know HOW MUCH they will cover & it varies. I'm a little baffled by that one.

Mostly what I've heard around here though is to just verify what coverage you'll get for an out-of-network provider (like if you're using one of our local CPMs, who are illegal here in Maryland & thus quite likely out-of-network.) But do not tell them you're planning HB! They'll just get the 'provider' bill from the MW & then never realize that the "facility" bill just never arrives. That's what I've heard works in my tribal area.

[IdentityCrisisMama]

[QUOTE=soontobemommyof3;15853802

Has anyone had it be this easy?[/QUOTE]

With my DC it was that easy for us but that was Northern CA about 9 years ago. We actually had a hospital transfer and insurance paid for both the hospital portion of the birth AND the homebirth midwife!!

[WingonWing]

Are any of you in states where there is no licensing system? I'm in Maine, and while CNMs are definitely covered, CPMs are certified but not licensed. Last time I read the paperwork my coverage was for licensed midwives.

Anyone have an experience with that?

[kryztuh]

I also have UHC and my CNM homebirth is covered 100% minus a $5 copay for the first visit to confirm pregnancy, no deductible, no copays for visits, no copays for bloodwork or ultrasound. The only thing is my MW charges an assistant fee that won't bill to insurance so it's costing me a few hundred dollars. Yay for UHC!

[soontobemommyof3]

Originally Posted by WingonWing

Are any of you in states where there is no licensing system? I'm in Maine, and while CNMs are definitely covered, CPMs are certified but not licensed. Last time I read the paperwork my coverage was for licensed midwives.

Anyone have an experience with that?

I am in Wisconsin, which just started licensing for midwives in 2007. I am seeing a CPM... when I decide on which one.

[Kimrose]

Oh - I am SO envious - as we suspect nothing will be covered for our homebirth Very happy for all of you that are having it covered easily - hopefully more coverage in the future! Happy homebirths!

[Belle]

Yep UHC was really good at paying our HB. Our out of network was 60% after a $3000 deductable. DH had an emergency room visit earlier in the year that took care of that so they paid the midwives fee. Our midwives also billed them for some newborn exams and home visits and they paid them no questions asked. We were getting refund checks from our midwives for months after the birth because they were still getting paid by UHC. I think we figured our out of pocket when all was said and done was around $300.

[smeep]

Get it in writing!!! Seriously. They may really cover it with no hassle, but I would have them send you something (a letter, fax, whatever) stating exactly what she told you. That way IF they pull something on you then you'll have something in writing stating that it would be covered.

[lovebeingamomma]

Originally Posted by smeep

Get it in writing!!! Seriously. They may really cover it with no hassle, but I would have them send you something (a letter, fax, whatever) stating exactly what she told you. That way IF they pull something on you then you'll have something in writing stating that it would be covered.

I second this.

[newcastlemama]

Originally Posted by smeep

Get it in writing!!! Seriously. They may really cover it with no hassle, but I would have them send you something (a letter, fax, whatever) stating exactly what she told you. That way IF they pull something on you then you'll have something in writing stating that it would be covered.

Yes. I had expensive blue cross insurance with my last birth and they said they cover 90% of ALLOWABLE charges...so guess what? They end up only ALLOWING 50% of them and I end up being billed for the rest. The lady who billed it too was an expert in getting the most out of insurance for the homebirth bill and they would not budge. Or they will say you have the wrong location codes for the birth (because my home has no code like hodpitals do) it just went on and on...

Sorry to be a downer I was so excited at first but when it came time they really stuck it to me.

[CookAMH]

On your DH's job - when is the normal renewal time for your insurance regardless of the merge? If it's for the calendar year, the company is likely to retain the current insurance and start new with the new calendar year with new or different insurance (that is what happened when my company was bought in July a couple years ago. We kept Highmark the rest of that year then we all had to go to Cigna).

And, that is awesome about the coverage!!

[L&K'smommie]

My insurance(a no namer) covered my HB in 09 just as it would've a hospital birth. And BCBS(which was my insurance provider until halfway through my pregnancy) covered the same way.

[Mama2Kayla]

Yes, I have cigna and they covered my CPM as an out of network provider(60%) no questions asked. The women on the phone asked me if I was having a homebirth or going to a birth center. Once I told her she was very nice and said it was not a problem! I was shocked...after reading so many stories of insurance difficulites, I just assumed I would have to fight mine too.

[Mama2Kayla]

Originally Posted by WingonWing

Are any of you in states where there is no licensing system? I'm in Maine, and while CNMs are definitely covered, CPMs are certified but not licensed. Last time I read the paperwork my coverage was for licensed midwives.

Anyone have an experience with that?

My state is one that doesn't license CPMs and my insurance still covered it. If she's a CPM then she's licensed somewhere, maybe that's all that matters?

[msmiranda]

I also had UHC and had my homebirth covered at the out of network rate (80% of allowed charges). Because I switched to my MW halfway through the pregnancy and continued to "shadow" with the OB until 34 weeks, I only ended up getting back about 1/3 of what we paid her ... which was ok, we were prepared to pay the MW fully out of pocket so I was happy to get anything back ... but yes, my MW said that in her experience United is pretty good about paying HB claims.

[Just1More]

I don't know if it applies to anyone, but my understand is that most insurance companies pay better if billed by visit, instead in a lump fee. May or may not apply to you, but thought I would throw it out there in case it helped someone.