Anyone get UHC to cover a cpm homebirth?

[hokuao2003]

We have United Health Care PPO. When looking through my benifits book it clearly states they cover C.N.M's. Nothing about CPM's. I live in Texas if that helps anyone. Just trying to figure this mess out!

[RachelK]

Yes, I was able to get 100% coverage.  It took some letter-writing and lots of followup phone calls, but they will pay!

[Friday13th]

I did, in MA. They actually almost all of the midwife's fees minus the ~$1000 we gave her upfront AND the hospital transfer and csection. It took some back and forth between our midwife and the insurance company but we got it eventually.

[nightingale]

I live in TX and in 2010 had a homebirth with an out of network CPM and UHC covered 90% after my HSA deductible, which had already been met for the year. It took a while, but was great. My MW used a medical biller. From my understanding, UHC is one of the best about HB.

[Turquesa]

Apply for them to work with you on a "clinical gap in coverage."  This means that if there's no facility (in this case, a freestanding birthing center or homebirth serivce) of a particular type within a 30-mile radius from you, they cover you at an in-network rate.  Call Customer Service and ask them right away to transfer you to someone who can help with that.  (The front-line CSR's know nothing about this and will always respond to your request with "no."  Skip right past them).  The person you're transferred to will ask for a bunch of billing codes, so get those beforehand from your CPM.  Also, they'll want a timeframe in which to apply the coverage, so factor in 2-3 postnatal visits. 

I've gone through this whole rigmarole three times with success. 

[MonkeysInk]

Yes, twice.

Ours specifically lists midwifery coverage and the closest covered midwives are 25+ miles away.  Since I'd already decided on a homebirth midwife, I requested that she be covered at the in-network rate based on continuity of care and on the fact that 25+ miles in DFW traffic can be an hour or more.  

And....to make it even more interesting, when I originally applied for the appeal for my second baby, they only approved 59400 (the global CPT code).  However, since I ended up transporting in labor, neither the CPM or the CNM used it - one billed all of the labor codes and the other billed the delivery.  In the end, I was still successful in getting everything covered as in-network, but I mention this as a word of caution: get every code the midwife *might* bill on the initial appeal request.

Each plan is different - each employer gets to customize their plan with UHC, so while mine says "midwifery", it sounds like yours says "CNM".  Still, it's worth a shot.