your clients and insurance coverage

[bekkanak]

Hello -

I can imagine that a great hurdle for you many of you (at least your clients) is getting insurance coverage for births.  I am having troubles of my own in this department, and I thought, that perhaps since you all have been there, done that you could help me out.  And also, the information that would accumulate here would help you help your clients. 

I just had a great third baby (third homebirth) last month.  Now I am fighting with my insurance company.  The midwife's very reasonable fee was 3700.  My insurance company is only covering about 1500 or it, because they argue that that is the amount for the code that they would apply to an uncomplicated, vaginal delivery (prenatal, birth, and postpartum care) for a CNM (presumably in a hospital).  However, as you all know, a homebirth midwife wears many hats, and provided a great deal of the services that would have normally been provided by the nursing staff in the hospital. My line is that a homebirth should not be treated as the same procedure as an in-hospital birth.

My question for you - have any of your clients had success with this line of argument?  Can you think of a better argument?  I hope that information here will help midwives get insurance coverage for their clients.  It is crazy that clients have to pay MORE for a service that actually saves the insurance company oddles (especially when the OBGYN was against vaginal birth for my 10 lbs 10oz baby...with my midwife, born after two hours of labor and just a few pushes....grrrr...but that's another rant).

Any help appreciated!

Riva

[Millicent]

She needs to bill separately for more services.  Extended prenatals, fetal non-stress test, post-partum in home care, extended labor support, post dates prenatal appointments, breastfeeding counseling, baby exam, etc.  There are a ton of things you can bill for outside of the normal delivery (since they are outside of a normal delivery) and each one has its own specific billing and diagnostic code.   There are special codes for home visits (prenatals) which have really high reimbursement rates since most medical people only do them in extraordinary circumstances.  And you can still bill them for this stuff apart from the claim you just made.  There are some really great professional billing companies out there that have this stuff dialed in.  Most midwives that i have heard from end up with a lot more money and happier clients when they use them.

[bekkanak]

Thank you...I will ask my midwife about this.  :) I hope this information helps someone else.  I will post the results when I am done with the appeals process.

Regards,

Rebecca

PS: Alaska...cool.  I grew up there.  Best wishes!