Insurance issues and homebirth in NYS

[bicycle1]

hello!

we're planing homebirth this fall.

I talked to my insurance about covering 'out of hospital birth', and they referred me to their list of 'participating' CNMs.

Of course all the participating providers work only in hospital settings ('all' is 2 offices within 20 miles, we live in a small place..)

My insurance is EPO, which means no coverage whatsoever for out of network. When I mentioned I checked , and there are 3 midwives in my area who do homebirths, they said I can only choose from the list of providers, and they cover midwives, but the 'cannot tell the midwives where to deliver' .

Has anyone experienced this ? Is this true that if there are participating midwives in their network the insurance does not have to cover a home midwife? <man, I hate this #$*&^%#@ insurance industry!!!>

thanks!

[loveneverfails]

Hi there!

I don't know where in NYS you are, but I had my most recent HB in the Albany area with Michelle Doyle at Local Care Midwifery, and the billing was absolutely not an issue at all.  The billing service worked with my insurance and I had approved coverage settled within a matter of just a few weeks from my first prenatal appt.  It was really really easy, although I would guess that things can vary depending on the home birth practice, what billing service they use, etc.  That particular practice is just one of the most well run, professional ones I've come across.  

Sometimes insurance companies are finnicky but it's less of an issue if the billing service knows the magic words to get claims taken care of appropriately .  I'd just skip right to the fun part and call one of the midwives in your area, and go from there!  NYS law requires insurance companies to cover home birth services, so check out what midwives are in your area and I'm sure they'll be able to help!  Congratulations on your pregnancy, and good luck with your home birth!

[bicycle1]

so I spoke with a local midwife, and it doesn't look too promising.

She says with only in-network insurance the insurance company has to cover homebirth, because it's the NYS law, but they make it

irrelevant by demanding the midwife should have malpractice insurance, and no insurance company offers such coverage.

I'm also waiting for an answer from the insurance company, but my guess is they won't cover it ..

[bicycle1]

I have an update from the insurance..

first they said 'no', then they said again 'no out of network benefits'

then when I appealed, and noted the contract says the plan covers home birth, but I didn't find any provider, they said 'we'll look into this'..

now they are calling every in-network midwife to ask if they do homebirth... 

So I'm waiting for them to finish calling.. there are many midwives ( working in OBs office) in the area, so I guess it will take them a few full working days to do this :-D

[janetta13]

Hi, im in the same exact boat. I have blue shield EPO and was told no out of network providers. So they are searching for me now, i dont think they will find one in the area that is in network. Did you find any information on the state law and EPO's, my company told me that with an epo they can opt out of state laws?

[akapril]

I'm in the Syracuse area and am having a home birth with a "out of network" CNM provider. I've been lucky to not fight with my insurance company (Empire Plan through my husband's work) but I have placed a number of phone calls with them to verify (and record who I talk with) their coverage of my services. As a result I am responsible for 20% of the costs and they cover 80% which I'm more than happy with.

Insurance law in NYS does require companies to cover homebirth services (you could google homebirth + insurance law and find the exact information) however they don't have to cover them in full. You also might want to look into setting up a Health Savings Account or a Flex Spending Account through your (or your partner's) employer. It probably won't pay for all of the homebirth charges but we were able to put just over a $1,000 towards the homebirth under the catagory of our "co-pay" (the 20%).

Another option that might or might not work for you is that it's my understanding that Medicaid covers all homebirth expenses (much cheaper than a hospital birth). I know that some people apply and have coverage simply for the purpose of homebirth and then drop the Medicaid coverage.

Good Luck! Insurance companies can be such a hassle!

[mrsrayray]

I had a homebirth in rochester NY with blue cross blue shield (anthem?) EPO... They told me over and over they wouldn't cover the birth, we even went down to the offices and talked to them, sent them letters about how the NYS insurance commissioner requires HMOs to cover homebirth. BUT as an EPO they didn't have to pay for it. :p Interestingly enough, my midwife billed them and they payed out $1600ish (out of the $3700ish bill) to her. They said that it was for "surgery". Either way, at least they paid something! :) 

[kjwinckler]

I can't seem to find a list for the Rochester NY area that has home birthing midwives can people please share the names and or numbers of practices please.