Originally Posted by Ava'sMommy
We are planning a homebirth for our third baby due in September. We have Priority Health (Michigan) and my midwife has already mentioned that she has not had any luck with coverage with them. She usually bills after birth, but I am wondering if it is a better idea to get a head start. My husband's employer has fairly close ties with Priority Health (they each sit on each others Board of Directors) so I think that if I start early and coordinate with his employer's insurance liason at work, I could have a good chance of obtaining coverage.
Any experience on what is the best way to go? Should I start with a letter to our insurance company, a phone call, contact with the employee insurance liason?? I am currently 19 weeks and have had 4 appointments with our midwife so far. Thanks much!!
Yes! to everything MonkeysInk wrote. That's great information.
I'd also say -- start as early as possible. Getting it worked out takes months, in my experience. I went through this recently (still waiting to hear from my midwife's billing person how it's all worked out), but what I did was:
1. Called the insurance company to talk about homebirth coverage. Got the run-around. They claimed I'd need to be having a midwife birth in an "approved facility" even though home birth wasn't explicitly mentioned in my company's plan.
1b. Also, my midwife's billing person contacted the insurance company several times to ask different people questions about preauthorization, etc. She was feeling good about my prospects and thought they'd probably cover most of the costs after the fact (at least as "out of network") even if they wouldn't admit that beforehand. She did say it can be good to call several times, so that you talk to different people. Take notes and write down the names of people you talk to and what they say.
2. Emailed my HR person, who contacted the insurance company and got the run-around. She was told she couldn't approve me on an individual basis, which was what I was hoping they'd do.
3. My HR person emailed the benefits person in the company that OWNS my company, and she talked to our insurance rep, who said some sort of misleading things about home birth not "typically" being covered for their clients. Basically, the insurance company wouldn't say whether they'd cover my birth or not. They were hedging their bets, I guess.
4. The company that owns my company actually re-wrote my company's insurance plan to add the phrase "including home births" to its maternity coverage in the Summary Plan Description. But I was lucky in that I got pregnant in 2010 and they were able to make this change during their normal yearly update period so that it was in place by the time the 2011 plan coverage details were issued (I gave birth last month).
I did talk at length to the staff in my midwife's office to get lots of helpful info on state law and insurance coverage so that I had "boilerplate" phrases and points to make when talking to everyone involved. I took a lot of notes! And I contacted other midwives in the area to see what their experience with my insurance company had been. Turned out some people had been paid with no problem, which gave me courage even before my plan was updated.
I know your situation and the timing is different, but I hope this helps somehow. Good luck!