Well the issue is that the billing person for my MW said they usually don't have problems with my insurance (I live in a big city and they're familiar with all the different plans) so from the start I wasn't that worried. But now there's a possibility that my plan in particular will cover the service as long as there's a PHYSICIAN present at the birth!! Which for HB is ridiculous! There's this one nurse at my insurance company that's been making the process really tough for my billing person and keeps saying I either have to birth at a facility or have an MD present and the billing person is starting to doubt my plan. It's such crap.
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Anybody here planning a homebirth? - Page 7post #121 of 34712/2/12 at 6:54pmpost #122 of 34712/3/12 at 8:33am
Loogiejane, I would contact your insurance company directly and keep going up the chain until they send you a letter approving your home birth. Insurance companies can be very stressful to deal with, but the sooner it gets sorted the sooner you can relax about that. I live in Florida, where it is law that insurance companies have to approve out of network providers IF they don't have a network provider within 30 miles that offers the same service. My network has NO home birth providers, so by law they had to approve my CNM as if she was in network, which should have then cost us just the deductible and copays. The reality though was that when the CNM's billing person submitted the claim they kept saying that some of it wasn't covered and eventually said that the midwife had to eat the cost of those things as network providers don't get to claim them. So we paid the difference, because our midwife deserves to be paid her full fee. In the end we ended up paying nearly 50% of her fee, and if we had just left it as out of network we would only have paid the deductible & 30% of the remainder.
So make sure you get everything in writing, AND if need be threaten to sue for refusing coverage, as inisting on a doctor being present is the same as refusing to cover, its an unrealistic condition. Make them justify it in writing, as once you have it in writing you have proof that this nurse is denying you care, and she may be forced to back down, otherwise take it to whoever her supervisor is, and don't take NO for an answer.post #123 of 34712/3/12 at 9:55am
Trust me, I know about the not taking no for an answer. My sis had 2 HB's and I learned very early on how much of a headache this can be. Our laws are similar here in NY as they are in Florida it sounds like. Problem is, while by law NY has to pay for HB, the law doesn't dictate how much. So the insurance companies get tricky with that.
The billing person from my CNM is well versed in what to do and she is pretty on top of things. But when she called me last week to tell me she got a call back from this nurse woman (she said she's never gotten a call like that before, which is why is concerns her) it kind of sounded like she didn't take a good tone with the nurse and the nurse did not react kindly. She and the nurse keep missing each others phonecalls and the nurse told her she would not be making any more calls. So I stepped in and offered to call this nurse. She never answers her phone so I have left two voicemails so far. I tell her that I know it's hard to get through to my CNM's practice but I am happy to have her call me on my cell. Essentially all we need to know is that she received a fax from my billing person with the name of the Dr. my CNM has an "agreement" with (read: it's not her back-up OB, it's this man who she is able to consult with on any medical issues a client might have. She is required by law to have an agreement with a Dr.) So all I need to know is that this woman got this fax but she is being difficult and won't respond.
The billing person from my CNM said if worse comes to worse we'll go to the surgeon general to nip it in the bud. The only problem I'm worried about though is my billing person said she is concerned there might be this deeply buried clause in my insurance plan that requires a physician for HB. Which we all know would be a ludicrous demand. And if that IS the case that means they wouldnt cover any homebirth with any CNM. And I'm like "what...and then I just don't get to have a HB?" She said "well as you know we do require our patients to be responsible for the balance amount" and I told her it's just way out of our budget she said something like "well we have had patients in the past who have gone on a 2 or even 3 yr payment plan with us" and I'm like "um....yeah." No matter how long it would take us to pay it off, it's too much $$ for us. As it is we're paying close to $1,500 out of pocket before the time of the birth. This was the amount estimated by our billing person that my insurance would not cover. That's in addition to the $1200 doula my CNM requires us to have as first timers.
The billing person doesn't get a sympathetic tone with me until I start to cry or tell her I need a margarita. It's very stressful.
post #124 of 34712/3/12 at 10:16ampost #125 of 34712/3/12 at 10:19am
Do you purchase your insurance yourself or is it through work? I would try to get the HR person with the company who manages the insurance to try to advocate for you. I was fighting BCBSofTX (we live in LA) to preauth my midwife, and they were giving me a h ard time, until I got the company rep to make calls for me. We got a letter in 2010 saying midwives were covered, but there are no midwives within 80 miles that they actually cover, because they are requiring a CNM. I couldn't get them to agree to cover my very experienced midwife until the company rep called, and somehow pulled strings, within a week they agreed to cover her "out of network" which is 70/30, and not bad (granted I don't know what the "allowable" amount that they pay 70% of is).post #126 of 34712/3/12 at 10:35am
Yea the fees for *every*thing here in NYC are high. My MW has this one woman (who is both a midwife and doula) who she likes working with and recommends. My MW told me her fee was actually $2400 but that she pays half to make it more affordable to her clients which is how it's $1200. $1000-$1500 is pretty standard here. I hope to take a Bradley class after the new year though and I'm going to see if the teacher is also a doula and what her fee is.
Our insurance in through DH's work. I spoke with people from HR and they were useless. This was before we came across this issue though so who knows, maybe they could help. They're so clueless on HB though and the billing person through my CNM said that "health advocates" from big companies have made things even worse for them in the past, that they have just messed things up. But who knows, perhaps this situation would be different.post #127 of 34712/3/12 at 11:51am
I'm with AnthemBCBS out of Ohio (Company HQ for where DH works) with a high PPO, so they should have paid 100% of maternity costs in network, in reality they pay just under $2000, and the rest fell on us.
Loogiejane it would be worth trying to talk to someone in HR to find out if there is a clause in your maternity coverage, as at least that way you'll know where you stand. We can download a full copy of our coverage, so you might be able to do that and look for yourself. Otherwise you can request a copy of your coverage be sent to you by the insurance company, they can't refuse, and then you can check through it to see what the policy actually says. It is also worth getting a copy of the laws in your State that require them to cover your birth, so that you can use that to force their hand.
I also think that its a bit much for your midwife to insist on having a doula, and the extra cost involved. A lot of people are stretching their budget just by having a home birth, never mind being forced into extra costs. Also $2400 sounds like a lot of money for such a service, even in NYC. If you don't have a doula will the midwife drop you from care? Seems as though the doula is for the midwife's benefit rather than yours if that is the case. This is the first time I've heard of a midwife demanding you use one, normally that is the choice of the mama. I'd definitely look around for someone less expensive, maybe even a doula in training who would do it for minimal costs just to get a birth under her belt for certification.
It does sound like both the midwife and the insurance company are trying to back you into a corner, not exactly what a pregnant woman needs in her life. Also log all your attempts to contact the insurance company (date, exact time & phone no used) and who you speak to and what they say, and let whoever you speak to know you are doing so, as they are less likely to put you off if they know you can get it traced back to them if you need to escalate the proceedings. But definitely start by finding out exactly what is in your insurance coverage.post #128 of 34712/3/12 at 12:25pm
I definitely educated myself on my plan before signing on with my midwife. The plan indicates I have no out-of-network coverage, no exceptions. Then they said they would only consider an out of network midwife if no one else within 50 miles would perform the service. And to my understanding no HB midwives in my area are ever in network. I don't feel like my midwife is backing me into a corner. I do believe she is one of the best midwives in the city, in high demand, and I am glad she has a separate billing person rather than dealing with it all herself. And the billing person really is good at what she does, or so it seemed, but the tone she gets is discomforting. I do need to get my hands on the NY laws though, true.
I don't mind that she requires a doula. I have attended a HB before but it's different when you're the birthing mother. And DH is pretty useless, except for rubbing my back and kissing my cheek. He has no idea how to deal with me when I'm in pain and he is not quick on his feet. A doula could provide calm, lower back massage, and overall knowledge that DH might otherwise be at a total loss for. I've emailed the teacher of the Bradley class I'm signing up for to ask for her fee. But I wouldn't be surprised to find out if she charges $1000. Who knows, maybe she gives a discount to class participants.
post #129 of 34712/3/12 at 12:30pm
oops- meant never in network. What I meant was if no one else in-network within 50 miles performed the service. They gave me a list of midwives. Half we were hospitals (read: hello, they're not doing HB) and the other half were out of service numbers.
Really I want too worried about getting majority of the coverage. But it's this recent bitch "nurse" who is essentially c-ckblocking the approval by insisting the midwife has to either work out of a facility or have a physician present.post #130 of 34712/3/12 at 12:31pmpost #131 of 34712/3/12 at 12:32pm
LJ - Sorry the insurance situation is so stressful. I'm in Canada and have no advice to offer since MWs are covered by public health care. I would second looking around for another doula. The price can range very drastically. I interviewed 3 doulas on the weekend. The first charges $650 but made it clear that she could work with us if that was more than we could afford (maybe that's another option for you?). The second charges $900, and the third charges $1100. They all have DONA training and are registered. They are all part of our city's Doula Association. The difference is in experience. The first has attended 20 births. The second, 40. The third, over 150. All had experience with both HBs and hospital births. I don't feel like I need the $1100 services. And I felt the most comfortable with Doula #1 so I am going with her even though she has the least experience.post #132 of 34712/3/12 at 2:03pmpost #133 of 34712/3/12 at 2:19pm
I think the most she does is a payment plan to not make someone have to pay in full. Technically we HAVE the cash but it would be like, 1/3 of our savings. I work very very part-time right now while I'm in school part time and plan to stay home, not working a pay job, with babe for a year before I enter grad school fulltime and won't be able to have a job. So it's not realistic for us to spend 1/3 of our savings on birth. Spending close to $3000 between doula and balance with midwife was the max I could see us paying. Even that is a lot for us. I just emailed another midwife in my area telling her I'm already having insurance issues with this other midwife and I'll wait to see what she says.And who knows, maybe her fee is even much lower.post #134 of 34712/4/12 at 8:08am
First of all, oops! I meant the attorney general, not surgeon general.
I just emailed the woman who I might take a Bradley class with and her doula fee is $800. So that's good to know. Not like $800 is even so cheap but it certainly is $400 less than $1200! The difference would probably pay for birth supplies and tub. We'll see if I even jibe with this woman. I really need to mesh with someone to feel ok with them touching me and being around my apartment for 2 days while I'm in pain. But if the $800 doula worked it would be great. I do like that that the woman my MW recommends is also a midwife (gives me an extra feeling of safety) but it really might have to come down to who I like better. And of course the difference of $400. I know that I could go on a hunt searching for doulas in training but I might cross that bridge if I dont either of these two other women.post #135 of 34712/4/12 at 8:39amQuote:Originally Posted by Loogiejane
First of all, oops! I meant the attorney general, not surgeon general.
I just emailed the woman who I might take a Bradley class with and her doula fee is $800. So that's good to know. Not like $800 is even so cheap but it certainly is $400 less than $1200! The difference would probably pay for birth supplies and tub. We'll see if I even jibe with this woman. I really need to mesh with someone to feel ok with them touching me and being around my apartment for 2 days while I'm in pain. But if the $800 doula worked it would be great. I do like that that the woman my MW recommends is also a midwife (gives me an extra feeling of safety) but it really might have to come down to who I like better. And of course the difference of $400. I know that I could go on a hunt searching for doulas in training but I might cross that bridge if I dont either of these two other women.
Oh gosh! Don't set yourself up for this expectation! Studies show that when we expect to feel pain, we feel more pain than we otherwise would. As the saying goes, "Don't plant seeds that you don't want to grow"!post #136 of 34712/4/12 at 8:44ampost #137 of 34712/4/12 at 11:29amQuote:
My mom had a 40+ hour labour. I was 4.5 hours with my first. Hopefully things will be different for youpost #138 of 34712/6/12 at 1:02pmQuote:
Gosh me too. LOL I am having a vaginal birth for sure, just not sure if it will happen at home or not. I'd love it to, I just know my body is slow going and I usually wimp out.post #139 of 34712/8/12 at 4:04pm
I am worried about insurance costs as well. I just recently decided to go ahead and start interviewing homebirth midwives. Of course this decision comes AFTER I maxed out my medical flex spending which drains my checks! Hopefully I can find some solution to the financial part of this problem and I am hoping that the HB midwife that I choose will have some answers.
Being a L&D nurse now (which I wasn't for my last birth) I have a new set of concerns for "emergencies" related to birth but I have found peace in the process at this point and am hoping the best for my HB. They think I am a crazy hippie at work anyway, but I don't talk much about my HB decision. When anyone asks me about it I either pass off jokes or tell them so flat out they don't questions me too much. My hospital's c-section is closer to 38% but we also are usually top 3 in the nation for the number of hospital births so it is def more of a "factory" approach. Since my son was born at home I don't think many eyebrows will be raised this time around, but I am not sure about my husband's family (this is my husband's first child). I am hoping he will keep tight lips about it so I don't have to talk about it much. I am a private person haha.
I hope to send my son away while I am laboring too. I think I would be too concerned about taking care of him instead of focusing on what I need to do. It would be great for him to witness the birth but he may be a little young to understand that its okay that mommy "hurts" . We shall see how it goes. I am def not going to wake him up at 3am to take him somewhere else.post #140 of 34712/10/12 at 10:53am
We're planning our 5th homebirth, but this will be our first one unassisted! We've recently moved to a different state, so unless we find a midwife that we absolutely love, we'll be going solo. I'm super excited about it, as this is something I've wanted to do for a long time. My hubby is on board, albiet a bit more hesitantly. Yay for home birth!
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