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anyone used Susan Dodge as a homebirth midwife?

post #1 of 14
Thread Starter 

I loved her when we interviewed her but my only hesitation is that I would have to pay upfront by 36 weeks and then she would submit to my insurance (Carefirst) after the birth.  I feel that even though I know it would be covered at 80%, that there would still be a chance for them to totally deny it and we'd be out $4,000 for the birth.  I know the other CNM's in MD - Joey and Evelyn don't require full payment before and that they will submit to insurance first.  However, both are really far from me while Susan is close and she also only takes on 4 clients per due month which I liked. 

 

Does anyone have any experience using her?  I have emailed a few clients of her today for references but didn't know if anyone on here could provide any input.  Thanks!

post #2 of 14

My midwife, a CPM, does the same thing. (I have to pay in full by 36W, then she'll bill insurance.)

 

You say you "KNOW" it'll be covered at 80%. Why? Is she an in-network provider for Carefirst? If so, you may be able to get from them, in writing, what their max allowed payment is for the global fee ("global" referring to the prenatal care, L&D, & PP care altogether.)

 

I actually was lucky enough to get an exception! I have a letter stating that they will cover my HB with my CPM at the in-network rate (they max they'd pay for any in-network maternity care provider) because there are no in-network providers available to me who provide HB services.

 

This obviously is fantastic for me to have lined up in advance, but it can be risky. They can easily say, "We don't cover HB" and then you're left with NO coverage at all!!!!!!!!! Whereas other HB mamas have told me they simply had their MW bill as an "out-of-network" provider without telling the insurance co that it was an HB .... and insurance just never realizes that the, normally separate, "facility bill" simply never arrives.

 

So it's a bit of a gamble. But it never hurts to call & ask about coverage options and ask, "Do you cover HB?" and if they say yes, see if you can get the exception for in-network coverage rate of Susan if she's not in-network.

 

Finally, $4K for global fee is high! I thought my CPM was high at $3,700. Unfortunately, even with full-coverage at the in-network rate, I'm still going to have to fork over approx $1,100. That is because insurance companies have max allowed rates. You may have seen on other "explanation of benefits" insurance statements for other services - there is the amount the provider bills, and the amount the insurance company is willing to pay, and the latter is often less!!

BUT... because these providers are "contracted" with the insurance company, they have to accept what insurance is willing to pay. [I think I have all this right - someone jump in if I'm wrong.] Whereas for my CPM, she's not a contracted provider and is free to make ME personally obliged to make up any difference between what insurance pays and what she charges.

 

Therefore... the "80%" you refer to could be 80% of the max allowed fee for an in-network provider. Which I'm told by my insurance company, based in Virginia, is around $2,600. That sounds right to me because Upper Chesapeake told me they charge $2,700. So if I had 80% coverage, I'd owe my CPM my 20% of $2,600, PLUS the extra $1,100.

 

I wouldn't let this stop you if you like her & she is convenient to you. If she's usually covered at 80%, then it is a pretty safe bet you'll get that 80% too. Also, with insurance, being denied doesn't mean you are SOL ;) - you submit a claim again! Sometimes if they submit it differently (i.e. not 'global'), they get more coverage. My MW has a billing service who manages the whole mess, so she can keep trying.

 

Hopefully Susan has someone who does billing for her too. I say just get on the phone with that person & run through all of this, and see what kind of written commitment you can get from insurance about coverage for Susan's services.

 

Best of luck!

post #3 of 14

i used Evelyn for both dds births.  they were both totally covered by insurance - first by Aetna ( i think? it was five years ago) and then by carefirst.  because of the way the plan was written with dh's work, they covered her totally as an in-network provider.  i think, also since she has hospital privileges, they don't necessarily "know" where she attends, you know?

but,i will say, call them first.  they gave me trouble 3 months after the birth cause they wanted a referral from my PCP, so, i would call them first and make sure you know what they are going to do.  surprisingly, i have never had any trouble with carefirst and they were always helpful .

post #4 of 14

I have carefirst, there are like 100 or so different version of Carefirst, depending on what companies offer it to your employer. What I was told over the phone when I called was no, they don't cover homebirths. However Evelyns office called for me and they said YES they do, but it must be with a CNM, then they would cover it 100%. So I would have someone else call on your behalf, because for some reason I think they get better answers then if you call. I have no idea why. They would not cover supplies and I think Evelyns offices said that the assistant is usually not covered. And I was told by Evelyns office that sometimes they will cover post natal and prenatal care but not the actual homebirth.

 

From my understanding, my insurance covers 70 of out of network - I don't know if a CPM is considered out of network or not covered at all. I met with another midwife who was not a CNM, she also wanted to be paid by 36 weeks, however I am 35 weeks, so I don't think that is possible ; ) I know she was willing to look up the information for me and contact insurance my insurance company, but I had to pay her first and then submit.

 

And yes, just because they deny it, doesn't mean you can't keep writing letters. I had a heck of time with getting feeding therapy for my daughter, they would only pay for 1/2. They just deny and assume people will walk away and leave them be!

post #5 of 14

 

Quote:
Originally Posted by lillymonster View Post

So I would have someone else call on your behalf, because for some reason I think they get better answers then if you call. I have no idea why.

Now, the woman who manages billing for my CPM told me the exact opposite - regarding getting an "Exception" for the CPM (who is an "out-of-network" provider) at the IN network level, she said she has seen better results when the insured mama calls versus her calling herself.


So just goes to show you, keep trying! Keep trying different approaches.

post #6 of 14

My BCBS plan (Fed Employees) only covers CNMs, not CPMs, but they are all different. A friend of mine had a fully-covered homebirth with a CPM under her Carefirst BCBS plan.

 

CNMs can be preferred providers if they want to play the insurance game, but financially it's not worth the hassle for providers with a small patient population.

post #7 of 14
Thread Starter 

Susan told me she would not be considered in network with BCBS but out of network.  So that's why I asked what they covered for out of network providers and they told me 80%.  Of course the first time I called and asked if they covered homebirths, they said no.  I didn't ask this second time around, but I gave the global maternity code and they said they would cover 100% if it's an in-network provider and 80% if it's out of network. 

 

I've asked Susan more info about this and am hoping she can help me figure out exactly what they'd reimburse beforehand.  The most annoying part is that if I used a birth center or hospital, it would be covered 100% and we would not pay a dime out of pocket. 

post #8 of 14
Quote:
Originally Posted by alireb View Post

Susan told me she would not be considered in network with BCBS but out of network.  So that's why I asked what they covered for out of network providers and they told me 80%.  Of course the first time I called and asked if they covered homebirths, they said no.  I didn't ask this second time around, but I gave the global maternity code and they said they would cover 100% if it's an in-network provider and 80% if it's out of network. 

 

I've asked Susan more info about this and am hoping she can help me figure out exactly what they'd reimburse beforehand.  The most annoying part is that if I used a birth center or hospital, it would be covered 100% and we would not pay a dime out of pocket. 

I know, this is the battle I am facing with my husband. If I can pull of switching to a homebirth at this late in the game (I am 36 weeks on Monday) he doesn't want to pay the 30 percent. And he  doesn't want to pay anything up front at all and wait for it to come back because he thinks the insurance will drag their feet.

post #9 of 14
Thread Starter 
Ugh. I'm so torn right now. I called my insurance again and asked what amount my policy approves for the global maternity code and it was $2200. And they would only cover 80% of that and her total fee is $4300 including the birth assistant which means I would have to pay about $2000-$2500 out of pocket.

Of course they pay 100% for a birthing center or a hospital and so I might end up going with a birth center because of the cost. I don't know if I can justify the extra cost which sucks because I really want a home birth. Darn insurance companies!!
post #10 of 14

that is what gets me.  it would be so much cheaper for them to cover HB's then to pay for hospital or birth centers.  but they won't do it. 

post #11 of 14

Yes - Susan attended 2 of my homebirths. She was working with BirthCare in Alexandra at the time. I didn't know she had branched out on her own. How exciting. I loved having her attending my births and wouldn't have had it any other way :)

Tammy

post #12 of 14

My first baby was born January 2011 and we used Susan Dodge CNM from the beginning. I cannot recommend her highly enough and would be happy to discuss it further. She took excellent care of me during the pregnancy--often having 2 hour prenatal visits to answer all of our questions, in our home. And my 24 hour labor went perfectly smoothly, thanks to her expertise and calm demeanor. I can't imagine giving birth anywhere else, any other way and will do it again with Susan some day.

post #13 of 14
Thread Starter 

OP here - I ended up not using Susan because of finances :(  I really wanted to but insurance covered the birth center 100% and we just couldn't swing it.  I had a great experience at Special Beginnings though and would love to have a homebirth if we have a 3rd. 

 

I did recommend Susan to a good friend who is pregnant with her 3rd (and used another CNM as her homebirth mw for her 2nd), and she is super happy with her.  I am actually a little jealous she is able to have Susan and she says her first appointment with her went great and she is very nurturing. 

 

I

post #14 of 14

I have Aetna PPO (Baltimore City Employed DH) and they said multiple times that they wouldnt cover Homebirth to DH.  Then they said they "might" cover some to Evelyn.  I paid 100% upfront at 36 weeks.  And they then paid 100% of my birth afterward!  We were shocked.  We thought we would be out $3600.  But nope!  So happy, because we really couldnt afford it, but it was so important to us to have DS at home, we would have paid twice that much!

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