Insurance covered 100% of my home birth and here is my letter (UnitedHeathcare) - Page 2

[gemasita]

I had been working on my letter when the OP posted that letter but hadn't sent it yet.  I was glad that her letter was similar to mine.  I did put a paragraph about costs in there - even with average costs of uncomplicated and c-section births in our area.  And then my midwife's fees and what they include.  (I even included c-section rates to show that if I was at lower risk of a c-section by using my midwife, they chances of them having to pay for a c-section are much lower.)

If something higher-tech is medically necessary, wouldn't a lower-tech option HAVE to also be medically necessary, by definition?  I'm not asking for a MORE expensive service.  Sheesh.

[bcafe]

Originally Posted by frenchkissed 

Tell BCBS that using a hospital is not medically necessary.  Geez! You are saving them so much money!  OK vent over.

You have not already had the homebirth, correct?  (Your sig says due in January)  There is definitely still hope.  If the midwife you are using has the credentials a hospital midwife does (i.e. CNM) and that type of midwife would be covered, you have a good chance of getting your homebirth covered. 

What kind of BCBS plan do you have?  I live in NY where CNMs have to be covered by law, but I was still subject to the in-network/out-of-network stuff which greatly affected what I would have paid. Of course they had in-network midwives in the area, but ("of course," again) none who attend home births.  My insurance is a BCBS of Illinois PPO and I applied for and was awarded a PPO Waiver from BCBS so they covered my homebirth at in-network rate (80% after I met my $1000 deductible). They paid for $2800 of my $4200 homebirth bill. Then my midwife billed BCBS separately for some newborn services and my Rhogam so I actually didn't owe her the full $1400 in the end (I had to prepay 1500 of it so I actually got a little refund).

Good luck!

How did BCBS pay for your newborn?  They are telling me that I need to reach the full out of network deductible on my newborn before they will pay anything for her.  It seems to me that my midwife billing for the newborn was a waste of time. 
 

[mama de dos]

gemasita, just fyi and hopefully peace of mind,  I have a friend here who had a birth w/your midwife 15 mos ago.  She is also covered by BCBS state employees and she got reimbursed.  I don't *think* she applied before hand, just had N send in the stuff afterwards.  I don't think she had any problems.  She also had a

birth w/N 6 yrs ago w/the same insurance and didn't have problems w/reimbursement.  I've had 2 births w/N and the 1st was w/BCBS, though not the state empl. plan.  They reimbursed a good portion of N's fees w/no problems.

Maybe you'll be lucky w/filing afterwards.  Good luck!

P

[AlexisT]

One small point: Every BCBS plan is independently owned and operated. What happens with CareFirst in MD won't necessarily apply to Highmark in PA or Empire in NYS.

(Although Anthem/WellPoint owns a lot of BCBS plans now so their policies might have been standardized.)

[gemasita]

Thanks mamadedos.  I'm 35 weeks so I assume even if I send in my second appeal now, I might still be working on this after the baby's born.  So maybe that will be to my benefit.  Maybe they will approve it or a good portion of it once we send everything in.  Glad to hear someone else from the State Health Plan got covered.  I hope I can use that as an argument!  If you find out any more details from your friend, please let me know!!!!

[raelize]

I had bcbs here in md. Evelyn is my mw and though she is innetwork and they originally told me they covered hb, after the birth they said it was denied. Then after manymany phone calls, they finally told me I needed a refferal from my pcp. My pcp gaveme one three months afterthe birth and just dated it earlier. I know that now your not supposed to need a refferal, but if you started care before the new laws kickdd in I would get one anyway. I would also call bcbs and ask them specifically what you need to do to get it covered. I've always had the customer service reps be very helpful if you are totally up front about what you want.

[mama de dos]

hey again,

Just let me know if you want more details about my friend who had 2 births reimbursed w/state bcbs.  i'm happy to hook you up w/her for info.  She's highly organized and persistent, so she's a good one to know for stuff like this!!

PM me if you'd like and we can talk....  :)

[qadirqutiesmom]

Thank you so much for posting this. I am currently 22 weeks and just trying to start finding a midwife and for a homebirth, after much reading and considering. I was afraid to do this because I too have United Healthcare and they clearly state they only cover CNM in network at 100%, but I don't think any in my area perform homebirths. This is just the inspiration I needed to get the ball rolling for a homebirth. I kept praying for signs and advice to ease my way toward the homebirth without any extra expenses and this may just be what I needed. Thanks again!!!!

[reyasunshine]

Thank you so much for posting this! We do have a high deductible, so we have to pay a bunch out of pocket anyway, but if they don't consider what I'm paying to be part of the deductible, I will need to write a letter. Thanks again! :-D