Home birth and insurance coverage in NYS - Page 2

[Caroline0617]

I have not tried them yet...that will be my next move!  Please let me know how it pans out for you!!  

[cjeanjot]

hi Caroline 0617 (and others),

For my first birth (not a HB but at a birthing center) the insurance gave me a hard time - quite similar as for this one: no option in network but impossible to have an in-network exception. The Attorney General office was very responsive and when they sent a fax to the insurance the reaction was quick: they finally accepted to cover the birth and i just paid my $300 copay.

At least in NYS we have the insurance law on our side so the AG office is a very good ressource

There is a parralel thread here on the same topic:

http://www.mothering.com/community/t/1363110/fighting-with-your-insurance-company-for-a-homebirth-in-new-york-state-youre-not-alone-lets-help-each-other#post_17134291

Good luck!

[Caroline0617]

Thanks again cjeanjot!  You've been super helpful and I really appreciate it! :)  

[JaiMaMaV]

Hi ladies!

I am in the same boat with GHI. 16 weeks pregnant and planning a home birth, but they will only pay the "allowable amount", which is less than half of my midwife's costs. Apparently, it is impossible to get an in-network-exception because I have out of network benefits (honestly, I don't see the benefit here) even though there are no in-network providers. I guess I have to start the long process of calling and talking to supervisors. 

Any advice would be appreciated. Has the attorney general's office helped at all with this? It's good to know that we're all in this together. =/

[cjeanjot]

hi JaiMaMAV,

Yes, the attorney general office has been super helpful with me. 

As mentioned before they helped me with the coverage of my first birth (in a birthing center so not a HB but the struggle was the same). 

This time they were very helpful too. I contacted them and received a claim number. When I called back i received the contact info of the person in chage of my claim. I sent him an email with all the details of my contacts with the insurance company and the day after they sent a fax to the insurance requesting a reaction within 30 days.

It's been approx 20 days - no reaction yet but i keep my fingers crossed!

The best advice is to keep note of everything and prepare a file with all these notes and the correspondance with the insurance company. If you are unsure of your rights contact the AG office. Otherwise try to obtain coverage and use all the appeals you can. If you still don't have a result contact the AG office and ask to fill a complaint

Good luck!

[zekedancin]

Hello ladies! I am so sad to hear how hard it is for us to have homebirths!

I had an unplanned, unattended homebirth with DS 2 years ago after fighting hard (like it was my part-time job) for months to get it approved though insurance. It never was really approved, but we didn't make it to the birthing center... ;)

Now I am pregnant with my third (6 weeks along), and I am wanting to start this process again as early as possible.

I live in NYC

We have Oxford

I need to find a new OB/Midwife anyway since I just called to make my first appointment, and found out she moved to California

What are my first steps?

[Caroline0617]

Hi Zekedancin, Congratulations on your pregnancy!!  If you are planning a homebirth, here's a resource for some local certified midwives http://www.nyhomebirth.com/.  My midwife is Jeanette Breen (Nassau County) and she's wonderful, with a sort of "hands off" approach...which seems like a good thing for you since you managed just fine on your own anyway! ;)

Here is another story with details from one woman's battle with the insurance company, eventually leading to 100% coverage  http://www.gentlebirth.org/archives/CFMInsurance.html

I believe that Oxford is one of the companies that reimburses more, so that's the good news.  However, they will probably tell you that they can only reimburse you according to the "allowable" amount, based on "usual and customary fees" for the services provided.  And if you're anything like me, you want it to be covered 100% anyway....so start building your case now!  

cjeanjot is currently in the insurance battle as well, and I can't agree with her more that the best advice right now is to keep note of EVERTHING and make a file of all correspondence with the insurance company.  Also, cjeanjot told me about choices in childbirth.org - check them out as well.  Hopefully if we all speak loudly enough, someone will hear us and make necessary change in women's healthcare and childbirth!    Best of luck and be well! 

[KateHNM]

Hello I live in New York state as well and my insurance company is CDPHP.  My midwife works with a billing service so for a small fee ($18) they verified my benefits and appealed to the insurance company for me so that I could get an exception for my home birth midwife (at an in-network rate).  I just got an e-mail today saying that my pre-approval for coverage was approved!  I'm still waiting to find out exactly how much they will be covering.  I'm 95% sure its everything though.  It said the in- network provider rate was 100% of the allowable covered with copay.  It looks like from my packet I got when I signed up that they will cover 100% of maternity physician services with no copay and there is no benefit maximum so the "allowable" amount should be 100% of my midwife's fee right?  Or not necessarily?  

I guess it doesn't say midwife and she's not technically a physician but it made it look like all maternity care would be covered in full and when I called to ask before I contacted the billing service, the representative that I spoke to assured me after doing some research that as long as I received pre- authorization which is what it sounds like I just got, they would cover the whole $7000 fee.

So things are sounding pretty good so far.  I have to say I'm really thrilled with this billing company (Larsen Billing Service), they asked for a reasonable fee and went through all the trouble of dealing with my insurance company and getting me coverage.  And they responded very quickly in my opinion!  I filled out a form online with my insurance info and the name of my midwife on the 8th and they just e-mailed me my answer and confirmation number today on the 16th!  Now they will mail a confirmation to my midwife and let her know.  I barely had to do anything!  Just hoping to hear that they will in fact cover everything like it appears they will.

[cjeanjot]

hello,

Glad to hear some of you have successful fights! Sounds like some insurance companies are more open to homebirth than mine.

No good news on my side (see other thread http://www.mothering.com/community/t/1363110/fighting-with-your-insurance-company-for-a-homebirth-in-new-york-state-youre-not-alone-lets-help-each-other#post_17231074 ) after months and months the insurance company suddenly came up with new arguments that were never mentionned before.

I've left a few advice on the thread mentionned above - let's all keep in touch

All the best

Caroline

[Caroline0617]

hi gals, 

Well, it seems as though this battle has come to an end for me.  I contacted the attorney general's office and they were lovely, however, the original decision to deny in-network coverage for my out-of-network midwife is being upheld.  Even though an in-network home birth midwife does not exist, the explanation for denial remained that it was "contractual."  

From the attorney general's office: "The response states that since your City of New York plan has out-of-network benefits, the contract language does not allow for any other method of reimbursement, like an in-netword exception, for a non-participating provider like your midwife.  The response goes on to that your benefit was reduced by your plan's $1500 deductible for catastrophic coverage (which includes maternity services) and a $200 basic medical coverage." They then go on to recommend that I contact my midwife directly to "negotiate a reduction."  This is a PPO plan, and according to the attorney general's office, if I had a more restricted plan such as an HMO that does not actually offer out-of-network benefits I would be able to get an exception made.  So that's that.  Make sure you read the fine print of your insurance contracts, ladies!  That catastrophic "benefit" is a killer.  If anyone has the same GHI plan (New York City Comprehensive Benefits Program, NYC/CBP. PPO plan) and has had a different outcome, please let me know!    Thanks and good luck to everyone!  

[motherhendoula]

Originally Posted by Caroline0617 

hi gals, 

Well, it seems as though this battle has come to an end for me.  I contacted the attorney general's office and they were lovely, however, the original decision to deny in-network coverage for my out-of-network midwife is being upheld.  Even though an in-network home birth midwife does not exist, the explanation for denial remained that it was "contractual."  

From the attorney general's office: "The response states that since your City of New York plan has out-of-network benefits, the contract language does not allow for any other method of reimbursement, like an in-netword exception, for a non-participating provider like your midwife.  The response goes on to that your benefit was reduced by your plan's $1500 deductible for catastrophic coverage (which includes maternity services) and a $200 basic medical coverage." They then go on to recommend that I contact my midwife directly to "negotiate a reduction."  This is a PPO plan, and according to the attorney general's office, if I had a more restricted plan such as an HMO that does not actually offer out-of-network benefits I would be able to get an exception made.  So that's that.  Make sure you read the fine print of your insurance contracts, ladies!  That catastrophic "benefit" is a killer.  If anyone has the same GHI plan (New York City Comprehensive Benefits Program, NYC/CBP. PPO plan) and has had a different outcome, please let me know!    Thanks and good luck to everyone!  

We have GHI - PPO plan  (my DH is a NYC teacher)  and i didnt even SPEAK to, e-mail, or in any way contact my ins. co before I had my last HB  (8/21/2010)   - i live in Nassau Cty - used Gaia Midwifery and their biller took care of everything.....i was always told that New York State has assured me the birth of my choice - if i want a HB, but no CNM's  near me take my insurance,  my insurance will still cover them as if they were an IN NETWORK provider.   MY HB cost $600 - that was a fee from the MW  - which i think had more to do with her on-call fee than anything else.   Everything else was paid for  - no questions asked.   I think having a competent biller at the MW group helps SO MUCH!      I have never heard of a 'catastrophic benefit'  and ive had two family members hospitalized in the last 3 years - if that wasnt a catastrophy - i dont know what is!  

I wish i could be of more help - it certainly sounds like you have fought this battle well - im sorry it didnt end in your favor!! 

[JaiMaMaV]

motherhendoula - that's so awesome! 

I am a nyc teacher and having the same problem as caroline0617 with ghi. my midwife even has her own billing person who said that once the insurance company answers that they have out-of-network benefits, there's literally nothing that can be done. 

I'm wondering if this is something they started fairly recently to get out of paying for so many homebirths... even my midwife said she's had a lot of nyc teachers in the past with ghi who had no issues. seems like they're just out to get us now =(

[Caroline0617]

I am totally amazed, motherhendoula.  Thank you for your response on this thread.  I am going to make every effort now to have that experience the next time around.  It's all so crazy to me!  Thanks a million      

[newmama13]

@cjeanjot- I also have Cigna and am trying to get them to cover my home birth in NYS.  Did you manage to get any info or help from the NYS Attorney General for home birth?