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Problems with Insurance

post #1 of 5
Thread Starter 

A few months ago I found out that my insurance (united healthcare ppo) is refusing to pay/cover midwives, period. I got my insurance in Florida, but I'm in California now. In Fl, there's a law requiring insurance companies to cover midwives completely (prenatal, postnatal and women's care) (See below). Is this still valid legally?  Also, since I'm in California now, is there a similar law here? I'm sick of my ins only paying 10% (pre-pregnancy med bills) and getting away with paying the bare minimum (I found out my ins refused to pay for my 3 hour glucose test because my doctor lied to me and told me I failed my 1hour, this is why I swapped exclusively to a midwife).


Our midwife is charging $6K plus the cost of birth kits ($200) and any lab work done is separate. My partner has a different insurance, is it possible to send the claim to his insurance for reimbursement if mine denies us (he has aetna or blue cross blue shield hmo)?



Florida law requires that maternity care coverage include the services of certified nurse-midwives and midwives licensed pursuant to Chapter 467 and the services of birth centers licensed under ss. 383.30-383.335.--emphasis supplied (see Florida Statutes, s.626.6406; s.627.6574; and s641.31(18)). In requiring such coverage, Section 467.002, F.S. specifically recognizes the need for a person to have the freedom to choose the manner, cost and setting for giving birth. The law requires that maternity coverage include midwifery services and provides that an insured or enrolled be given the option of choosing the setting for receiving such services. Therefore, no HMO contract or insurance policy may directly or indirectly deny reimbursement for midwifery services rendered in a home birth setting. 

post #2 of 5

We have UHC but live in Oregon.  It will cover our MW as an out of network provider: she is licensed and part of a birth center team of midwives who also do home birth.  So we're responsible for about 1/3 of the cost after our out of pocket limit and all that.  But we have the PPO plan: under a different plan by our same company and also with UHC, we would have to pay entirely out of pocket.


As a payment option, you might try to get a benesyst or FSA card.   Its before taxes so at least you get that savings.  Or, keep good receipts and file for a tax return (you can either figure it out yourself, or hire an accountant this time, because if you make less than 40K, your medical costs would almost definately be tax deductible.  If you make more than that it depends on way to many other loopholes for me to remember at this hour.  :)


As to your partner's insurance, he can always ask his HR department if you would be covered if he married you before the baby is born but (obviously) after conception.  And what their homebirth coverage is like for his particular plan.  A husband's insurance covers his wife, partners not so much.  


Finally, you might ask other women with UHC who did homebirth about thier experience, starting with anyone at your office who you know did HB, and your HR department.  The find your tribe section of this website is sometimes helpful, and if you live near a homeschool group or church that doesn't do Sunday school, you might find some good advice (and support) there.    

post #3 of 5
Thread Starter 

Thanks for the info honey!! I've tried using Larsen Billing, but they got an email from UHC saying that any of the UHC people who accept a homebirth claim would be fired, so we dropped Larsen. So annoying!! I'm thinking we'll just end up looking into laws and forcing my ins to pay up or see what my partner's tax person can work out. I haven't worked since moving here (May 2011) and since getting pregnant (due to potential medical problems, which have yet to happen but I'm too far along to start working). We've been so lucky so far not to have any other problems! Thanks again!

post #4 of 5

:) Anytime!  Anything you can get will be worth it, but in the end, your health is priceless.  My DH kinda prodded me on home birth, its still ALOT more than a hospital birth for us.  But if your health will likely benefit, its 100% worth it.

post #5 of 5
Thread Starter 

In Florida, 12 years ago, my mother paid $5000 for my brother's (uncomplicated) medication-free hospital birth. So, it's not much different than what we're paying the midwife. On top of that, due to my having only 1 kidney, we HAVE to be ABSOLUTELY sure that no medications are being used so we can pin-point whether or not the pregnancy/birth adversely affects me. I'd much rather pay the extra $560 for our homebirth and know without a doubt that I'm having an "organic" birth.


My partner was totally against homebirth, but the midwife convinced him. Now, if I could only get him AGAINST mutilating our son's genitals. Ugh.

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