OHP Open Card to start seeing a Midwife

[mroyelle]

I am currently 17 weeks pregnant and I watched the doc called "The Business of Being Born" and it completely changed my outlook on midwifery.  I am already on OHP and have called and left messages on how I can get an Open Card so they will cover a midwife and birthing center for me.  Am I the only one having trouble with this?  Is it true I have to have a primary insurance provider or be a Native American to get one? Some feedback would be greatly appreciated, since I can't seem to get anyone to call me back and help me out. Someone told me to get my OBGYN to prescribe me a midwife and maybe get one that way. I am lost at this point.  There has to be a way to do this.  Afterall it is much cheaper for the state to cover this for me.   Thank you

[Oregonicmama]

Unfortunately the only way to get an open card is to not apply for OHP until you are in your 3rd trimester (outside of what you mentioned).  Since you are so far along and they already know (i'm assuming) you're pregnant it is very unlikely you will be able to get an open card.  If you were already an OHP client and you let your insurance lapse in order to apply for the open card, you must have been off OHP for at least 4 months to be considered.  And even after 4 months and in your 3rd trimester they sometimes deny women.  I have done it before and will be doing it again next month... really hoping they don't deny me.  You'd think since midwifery care is so much cheaper for them than a hospital birth they would be more accepting of it, but for whatever reason they're really inflexible.  Maybe you can find some way, the prescription from your Dr. sounds like it might work, but I think you would still have to have an open card.  Have you thought about working with midwives at a birth center?

[mroyelle]

Oh ya, the place I am wanting to go through is called Motherwise.  They are very nice and give a discount for having OHP.  I think to get the rest of my prenatal care, the birth and postnatal care and baby care is $3000.  I still want to do it, but I was hoping in some way that the State of Oregon would pay for it, since they are willing to pay thousands of dollars for a hospital birth.  It makes no sense to me, even as a taxpayer if you want to get that into it.  I will just go with paying payments with my midwife, I would rather pay $3000 out of my pocket than go to a hospital at this point.  I like the thought of the personal experience I will be receiving with these wonderful ladies.

[Italiamom]

I will agree with Oregonic mama here to say that even if you've let your OHP lapse, it's still unlikely that you would end up with an open card.

That said, there are parts of Oregon that are automatically open card areas, because no providers will agree to sign on with OHP as a primary care provider.  You mentioned Motherwise, which I am pretty sure is in Bend, yes?  When I was pregnant, Deschutes county (where Bend is) was an open card county only, because no providers there would agree to take OHP patients (in a managed care plan).  I thought about just using my in-laws' address and signing up earlier on in my pregnancy (they are in Bend), so that I could have coverage throughout, rather than just from 28 weeks on.  But the problem there is that if I had signed up early on, and then a provider in Deschutes county had decided to do managed care for OHP, I would automatically be bumped from open card to managed card status.  So I chose to wait.  BUT, if you are already on OHP, I would ask about whether Deschutes county is still an open card county.  If it is, then yes, your care would be covered, regardless of your enrollment date, as long as Deschutes county stays an open card county until your child's birth.

The thing to understand about the open vs. managed care billing, is that it is in fact more expensive for the state to reimburse at the open rate (even with a midwife) than it is with a managed care rate.  It's the reason that SO many providers will not accept OHP patients, or are unwilling to participate in managed care.  Managed care providers are reimbursed at a significantly lower rate that what they would normally bill.  Open card providers are reimbursed at a higher rate than managed care providers, but even then they most often receive less reimbursement than a normal insurance company would provide.

I would call OHP and confirm whether your county happens to be an open card county though.  It's very possible that it is, in which case, your care through a midwife would be covered.  But that will happen only with an open card (sadly).

[mroyelle]

Thanks for the reply.  I have decided to just stay on OHP and pay for the midwife out of pocket.  OHP will still pay for the blood work, the ultra sounds and things like that.  Motherwise has a great payment plan that I can get on.  So it's going to work out for me, it's just gonna cost me a bit more than if I were to have the baby in the hospital. 

[Italiamom]

Originally Posted by mroyelle 

Thanks for the reply.  I have decided to just stay on OHP and pay for the midwife out of pocket.  OHP will still pay for the blood work, the ultra sounds and things like that.  Motherwise has a great payment plan that I can get on.  So it's going to work out for me, it's just gonna cost me a bit more than if I were to have the baby in the hospital. 

Again, residing in Deschutes county might mean that you automatically have an open card.  It's well worth checking with OHP just to verify whether you've got an open or enrolled status card before you start making payment arrangements...