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Home Birth Midwives for Gaithersburg area Question and UnitedHealth Care PPO Insurance

post #1 of 5
Thread Starter 

Hello Ladies, 


I'm currently 23 weeks pregnant and after reading lots about home births and the birthing experience, I finally decided I wanted to go pursue my dream of having a home birth. With my 1st child I wanted to deliver at a birthing center, but there were no birth centers covered by my insurance and I wasn't as well read on the benefits of the birthing space. My 1st ended up at CWC practice and was able to deliver without pain medication, but ended up having to be hooked up to an IV the whole time, I was hungry, and I had to get pitocin because my waters were broken for more than 12 hrs and w/ a hospital birth they only allow 24 hrs of water being broken before they feel the need to give a c-section, which i'm totally against unless absolutely medically necessary. Anyway, I really don't want to have to deal with the bureaucracy of the hospital, plus I already have a 2 year old at home and I think leaving him to go to the hospital will hinder my birthing more than help (if that makes sense), and I would just like to have the most natural birth possible. All the birth centers in my area are at least 35minutes away without traffic, and I don't feel like I should have to worry about getting to a birth center while having a baby.


I have UnitedHealthCare PPO and they will only cover for a CNM. There is only 1 CNM in network (as far as my searching on their website proves) that does home births, Evelyn. Unfortunately, Evelyn is fully booked with patients at the moment. The other CNM's in my area are Joey Pascarella and Erin and Mairi of M.A.M.A.S. I have spoken with Joey and she seems really nice. I haven't contacted MAMAS yet, about their availability but will do so tomorrow. Anyway, both Joey and the CNM's of MAMAS are out of network for me. I was wondering if anyone has tried to get United to pay at an in network rate in this area with an out of network provider? I know people have gotten in network coverage with out of network providers with United from reading the home birth boards, but since our area has so many CNM's I wanted to see if there was anyone in this area who can give me advice. Also, if you have United PPO and didn't get the in network coverage, how much did you end up paying TOTAL out of pocket with out of network coverage (especially if you used either Joey or Erin)? I believe they say they cover at 70% after the deductible and my deductible is $400. 


Also anyone currently getting care from Joey or Erin/Mairi? I've seen only positive things about both groups, but wanted to see if anyone was currently working with them to see how they felt. 


Thanks so much!!! Sorry about all the info!

post #2 of 5

Erin and Mairi have a great billing service - a woman in CO who only bills for home birth midwives. I spoke with her about strategies with United and the likely pay back rates. But we have CDHP, not exactly PPO. 

post #3 of 5

I birthed with Joey last September. She attended my HBA2C. We have Cigna and were prepared to pay about $2000 out of pocket. She bartered with us (we paid a deposit in cash and then my DH worked on her farm for about 2ish months on Saturdays). Our insurance ended up paying nearly her entire global fee. She and her husband do their own billing and they are VERY good about doing it in a way that gets as much as possible back from the insurance.


As my MW, I loved her! She stood by me even when most MW's would've risked me out. I birthed at 40+6, on a 20 month old 2nd C scar, grossly large for dates (fundal height meauring 44w at birth, down from 47 weeks the week prior before he dropped), with high BP and late onset pre-eclampsia. She sat on my birth ball and watched me labor and only touched me to do a HR check on baby (which I honeslty didn't even notice) and when I asked her to. I had only one check during my labor, at my request.


She is an incredibly natural CNM. I'll be honest and say I was worried about going with a CNM for fear she'd be more medical. She was very much hands off and let me call the shots, including refusing to do an ultrasound hen I continued to measure very large. She is a wonderful MW and I highly recommend her! 2 of my friends have also birthed with her after me and they both had wonderful birthing experiences.

post #4 of 5

I got an exception to have my CPM covered at the in-network level with Anthem BCBS. Unfortunately, I still had a lot of out-of-pocket expense because the amount they pay for an in-network provider is still lower than her rate so I had to make up the difference, plus with my plan they only paid, I think 70% of the allowable amount. But I did get that exception.

post #5 of 5
Thread Starter 

Thanks for the feedback. My husband just got offered a new job at a different company, whose benefits are terrible compared to our current United Benefits. UGH!!! Anyway, I am hoping to go with Joey as Erin and Mairi do not come to my area of home births. Looks like I'll be paying a lot more out of pocket regardless of if it's in network or not. I am still going to file an appeal to be considered for a gap extension to get in network coverage, since I'm sure they have no in network CNM's that do home births in my area. With the new company we have Aetna POS II, the deductible is ridiculously high compared to what we currently have. I think I'm going to get the ball rolling with our current insurance and see where we end up, and hope things transfer over with Aetna.


Fe- Thanks for the positive feedback on Joey. I was hoping to get more positive information about her from mothers on here. I just got her information packet and was reading through it, it seems like she's very organized and through. I have to email her and find out about all the extra cost - birth assistant and birth supplies, so I have a full picture of what we will have to pay out of pocket.  

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