Fighting with your insurance company for a homebirth in New York State? you're not alone - let's...

[cjeanjot]

hi there,

DH and I are struggling with our insurance company to obtain the coverage of a homebirth for our second child due in March 2013.

A long but sucessful fight for our first baby resulted in a full coverage of the free standing birthing center we wanted.

This time I'm going for homebirth and am ready to fight again!

Anyone out there in the same situation? Let's discuss, exchange tips and support each other. It is a difficult process but it is worthwile and we are lucky enough to have the law behind us in NY State.

Interested to hear from you if you are in another state too but keep in mind that the legislation is different in every state and that it can change a lot in your fight with the insurance company.

looking forward to hearing from you

Caroline

[LadyK]

I am just starting to look into health insurance coverage for a homebirth and I'm also in NYS.  I have no idea how complicated and time consuming this process may be!  I'm happy to learn that NYS is ahead of the curve in supporting us.  Good luck!
 

[cjeanjot]

hi there,

It will depend on your insurance but I think it is a complicated process in 95% of the cases.

Let keep in touch, good luck to you too

C

[LadyK]

I have Oxford Freedom - a high deductible plan accompanied by a Health Savings Account. I just called customer service and my deductible is $4,000 for an In-Network midwife, homebirth, or hospital birth.  If I can prove that none of the providers offer what I need (home birth) they will cover an out of network person at In-Network rates, but of course I still need to pay my deductible.  I'm not sure how much HB costs, but this doesn't sound terrible ...
 

[homebrewer]

Hi there. I'm in NYS and planning a homebirth in January. It doesn't always have to be a fight, and so far for me it's seeming much easier than I expected. When we started with my midwife we had United Healthcare Choice Plus. My midwife said they usually had no problem with them. Her billing person applied for gap coverage to treat her as in-network and it was granted two weeks later, so all costs would be covered, no deductible or copay. 

Then, a few weeks ago we suddenly get notice that our insurance will be switched to Aetna 2 weeks before my due date. That threw me into a brief panic, but my midwife says Aetna is usually no problem either, it's just a matter of applying for gap coverage again. 

If you have a deductible even for in-network providers, or are unable to get your midwife treated as in-network, most midwives will sort of over bill your insurance and then not bill you for your deductible by the way. Several midwives I interviewed offered to do this for us if the gap coverage was rejected. 

I'm very happy that I chose a midwife with a billing person though. I hate dealing with insurance companies. 

[cjeanjot]

Hey Ladyk;

good for you but based on my experience for my first birth it is not always easy to prove that none of their providers offers a homebirth. My insurance company (Cigna) sent me a 16 pages list of people that are suppose to be midwives. These contacts are either outdated/wrong numbers or hospitals / medical center who have no idea why they are in a midwives list. It takes time to call all of them and prepare a convincing document to send to your insurance.

Good luck with that!

[cjeanjot]

hi homebrewer,

great to hear a more postivie experience.
I've heard that my insurance (Cigna) is especially bad with homebirth and heard good things about Aetna.

My request for in network exception was rejected so I sent letter to appeal to that decision. Next step, attorney general...

C

[mnm83]

So happy to find this forum. I am pregnant with baby #4 due in May. My first 2 were induced and I had horrible birthing experiences. My last one came on her own time and was an unplanned homebirth but I loved every minute of it. I would love to have #4 at home. I can only convince hubby though if I can get our insurance company to pay for it. If I have baby at hospital we only have $500 deductible, compared to $5000+ for homebirth. 

We have excellus blue cross blue shield. Does anyone know what is the best way to first go about finding out how to get the insurance company to cover it? We also have the option of putting myself on medicaid. Does anyone know anything about medicaid and HB's? I'm guessing since its state run they wouldn't cover it. I've tried researching it and have found no information out. Thanks!

[homebrewer]

I don't know anything about medicaid or BC/BS from personal experience, but what I would do is contact a couple of midwives that will do the billing for you and ask them what their experience is with BC/BS and with medicaid. Midwives have a lot of experience getting reimbursed for their services and may be able to reduce/eliminate your deductible with BC/BS, or to recommend ways to work around it. My midwife has a billing person who handles all the insurance details and it's great not to have to think about it. They were able to tell me at the interview appointment how billing would work, their experience with my company, and how much I would likely need to spend out of pocket (in the end, only the cost of birth kit, pool rental and doula). They may even be able to tell you over the phone or via email.

For what it's worth I googled "NY medicaid homebirth" just now and found 2 women who left comments on another bulletin board saying that they had their homebirths covered 100% through HIP, which I guess is one of the NY medicaid options?

In NY you have the law on your side since insurance companies are legally obliged to cover it. It doesn't mean it will be easy getting it done or that there will be no deducible, but it's doable.

Good luck!

[kgdg]

you do realize thats fraud, right?
 

[LitMom]

Originally Posted by kgdg 

you do realize thats fraud, right?
 

What are you referring to? Overbilling is fraud. But gap coverage and getting a home birth covered is not. 

I had good luck with BCBS in NYC though that was over 5 years ago. There was a fair amount of paperwork and approval, but it was all fine and the midwife's billing person took care of all that. They were also very good about my son's hospitalization stay when he was a few weeks old. It was unrelated to birth, but it was in the gap between his birth and getting birth certificate and him added to insurance, etc. Another paperwork hassle. 

HIP is NYC insurance that many city employees have. I used to have that. They were good, but no home birth experience. They probably have a medicaid version as well.

[cjeanjot]

Could you explain what you mean? 

In that debate one thing is very clear: it is against NY State Insurance law to deny in -network exception to a homebirth midwife when there is a network deficiency as it is often the case. Insurance companies constanly violates law when they give us a hard time to chose the birth we want 

[cjeanjot]

As mentionned eartier I heard Medicaid HIP gives good homebirth coverahe. That is one of the provider with whom my midwife had good experiences.

i would follow homebrew advice: contact a few midwives in your area and try to get an idea of your chances with your current insurance.

Good luck!

[cjeanjot]

hi there,

When I started this threat I was up for a fight with my insurance in NYS...

After months and months of phone calls, letters and wait it turned out that my insurance company considers me as being "sitused" in DC (because the main office of my employer is located there).

The law is different in DC and does not mandate coverage of a homebirth. This final argument that was never mentionned to me or my midwife's office after more than 9 months of contacts seems to be very definitive.
Even the Attorney General office can't do anything.

I wish I had better news to share to encourage all of you but here's my advice for the ones who are still fighting:

- start early

- take notes of everything

- prefer written contact to phone calls

- use all the appeals you can

- if you have been denied the last appeal or do not receive answers quick enough: contact the Attorney General office. They did a great job for this and my first birth (first birth in a birthing center was paid entirely thanks to them), were very responsive and quick.

- if you are in NY State (first check that your plan is not sitused in another state): the insurance law is with you so you can be confident. Here is a quote from the letter sent by my insurance company to the AG office: (...) the NY insurance Law 4303 c (1); that mandates the coverage of Certified Nurse Midwives and home births for New York HMO plans " It is not common to see that law clearly quoted especially concerning homebirth and especially coming from an insurance company so please use this quote, this is your most definite argument!

For the future:

I'm more than ready to help others - let's keep in touch!

I wish there was an organisation that was fighting with/for us. In the meantime we can help each other and try to advocate our rights.
There are many opportunities to attend event about natural birth, choices of a different experience etc... and many books available but if the insurance companies are working against us all these nice discussions are useless.

Choices in childbirth is not just a philosophical questions, it needs to be a possible choice financially!

I'm wondering if Obamacare will change anything about that. I've read an article about chiropractor lobbying in certains states to obtain coverage - anyone knows if midwives are involved in that kind of lobbying? It's really a state by state thing but New York has the advantage of the law (as i painfully discovered some States are in much worst situation)

I'm due at the end of March, will keep you updated on my uncovered homebirth...

All the best to all of you

[pissyrabbit]

cjeanjot-
Thank you so much for all of your excellent advice. We also have Cigna and when I called I got the same list of dozens of midwives that I quickly realized were hospital midwives after specifically asking for HB midwives. Thats when I realized exactly how much of an uphill battle this is going to be. 
My wife's aunt is a HB midwife in NYC and even with her experience in dealing with insurance companies, Im expecting it to be a long arduous process. But Id prefer to deal withthe stress of dealing with insurance companies when Im not giving birth than to deal with the stress of being in a hospital while I am giving birth.

Off topic but Im curious as to what your emergency transfer plan is, if you feel comfortable sharing. Im finding that is also an issue because since St Vincent's closed and  hospitals require a dr to basically "sponsor" HB MWs now. We are looking into Maimondes in Brooklyn since it seems to be more HB friendly. It seems that most midwives are using Woodhull as their emergency plan but Im not comfortable with that hospital at all. My wife is totally supportive of the HB as long as we can get the insurance sorted and we have a solid and realistic emergency plan. I agree with her completely even if the chances of us having to use it are small.

Thanks again for your fantastic information.

Jenn 

[Kathleen78]

Cjeanjot,

    I am holding off on getting pregnant until the insurance company agrees to cover a home birth. I am in Staten Island NY.  I have Aetna EPO. When I first called they outright told me no. I called again and luckily reached a woman who is willing to research this more. There is some legal jargon stating they cannot rule out home births so she is trying to see exactly what this means.

Kathleen

[cjeanjot]

hi pissyrabbit,

Good luck for your fight with Cigna. As indicated in my post #14, they know very well that they are suppose to cover for your homebirth in NY State (" (...) the NY insurance Law 4303 c (1); that mandates the coverage of Certified Nurse Midwives and home births for New York HMO plans") so if they don't manage to find a complex reason not to cover you like they did with me you have very good chances.

As for the back up plan, if I needed to be transfered to a hospital I guess it would be a real emergency situation and in that case I will not be picky. I'm  one block away from SUNY Downstate and Kings County so I guess it would be one of them. In that case the insurance would cover it without a problem (and if in the meantime they accepted to cover your homebirth there will be a complex administrative procedure to see how much they would pay the midwife, but that's the job of your midwife staff)

I hope this help.
Don't hesitate to PM me if you want more details, I can also send you some example of letters I sent to the insurance

Good luck!

[cjeanjot]

hi Kathleen78,

Check out my post #14 with the quote by my insurance - that is the law you should indicate to the insurance.

I hope this helps!

Best of luck

[Kathleen78]

Thats what the agent read to me exactly what you said.  So now i await a call from her later to get a definitive decision.

Kathleen
 

[cjeanjot]

good luck Kathleen!