Homebirth and Insurance

[Flopsy]

Has anyone had any luck getting reimbursed for a homebirth through an insurance company that "doesn't cover them?" If so, please share how you did it!

I'm in MN and seem to be insured by the only company that still holds staunchly to that policy. I'm not convinced they're completely anti-homebirth, but their policy says that a practitioner has to be in-network and there is no coverage for any one seen by an out-of-network practitioner. Homebirth midwives are out-of-network, of course.

I've been advised by several people to keep bothering my insurance company about this. Hoping to either get my birth (due in August) covered or just to be another voice asking for homebirth to be covered eventually. I'm not sure what to say, though. Share facts with them? Tell them how expensive c-sections are? (Like they don't know...)

Any suggestions? Advice?

[mjdecbaby]

I found this thread to be very helpful. We are just about to begin the process of attempting to get a gap exception with UHC in NY but I think there's very good general info in there about how to construct your argument.

http://www.mothering.com/community/t/1283407/insurance-covered-100-of-my-home-birth-and-here-is-my-letter-unitedheathcare

Good luck!

[Flopsy]

That's great news! Thank you for sharing that article. I think that will be a good way for me to start.

And good luck to you, too!

[MoonHasBeams]

I just received my gap approval letter from United Healthcare after more than 10 weeks of arm wrestling them. It was a slightly maddening experience, but hopefully worth the heartburn and hassle. I just wrote a blog post about the whole process, so I'll just link to that since I'm on my phone and stranded under a sleeping toddler. (I know I have this approval letter, but I still worry that they'll find some way to wriggle out of it. I'm 39 weeks and my midwife submits claims at birth and then at six weeks postpartum. We'll see...)

http://archmama.wordpress.com/2013/02/02/home-birthin-my-bebe-part-four-health-insurance-and-home-birth/

[jajo]

I also got a network gap exception for my home birth last year through Humana. My advice would be to get pre-approval from them if possible and write everything down. We got the authorization beforehand, but they still have us a hard time afterwards. Ultimately they paid, but we had lots if arguments and letters.

[htcmom]

So what if your insurance company will pay your midwife just as out of network. Is there anyway to get them to pay as if she was in network?

[Flopsy]

Thank you for these suggestions and examples! Moon - I haven't read through your blog post yet, but I'm headed there after this. :-)

htcmom - good question. I tried typing out a response, but realized I don't know jack, so I'll leave it to someone smarter and more experienced to help you with that one. I do plan to come back and update this thread with what happens in my situation, though.

[jajo]

Moon gave a great example of what you need to do.  I was thinking this morning that I wanted to tell you that the question you need to ask your insurance company is "do you have any certified nurse midwives who provide home births in network?"  If the answer is "no," which it will be, that is where the "network gap exception" comes into play, because it is a gap in their coverage.

[mjdecbaby]

Good luck with getting your insurance company to know the answer to that question. UHC said they didn't know if any of their in-network midwives did HB but it was up to me to call all 122 midwives in a 30 mile radius and ask. If no one does, then they will then transfer me to the exception department.
Hopefully your mw has a biller who is already familiar with navigating this procedure where you live and can help you. After I made that initial call to UHC and about 30 midwives I spoke to my mw's biller and she said she deals with gap exceptions all the time and she could handle. Crossing fingers she'll be successful!
Edited by mjdecbaby - 2/4/13 at 10:09am

[Vaske]

In MN health insurance is required by state law to cover prenatal care, except for any deductible you have.   But the amount that the insurance company "allows" for out-of-network midwife-based prenatal care has in my experience been quite low (especially compared to the amounts that were billed), and has always been less than our high deductibles.  I don't have any experience with trying for a gap exception--if that works for you, great.

[Flopsy]

Thanks for the heads-up, Vaske. I'm trying not to get my hopes too high about the gap exception. I'll give it a shot and we'll see. It sounds like there's also a chance DH would be changing jobs soon and we'd be able to be insured under a different company that DOES cover some costs of homebirths.

[GISDiva]

Originally Posted by mjdecbaby 

After I made that initial call to UHC and about 30 midwives I spoke to my mw's biller and she said she deals with gap exceptions all the time and she could handle. Crossing fingers she'll be successful!

Well, that's really interesting, my midwife uses a billing service now too.  I wonder if they have any magic touch.

I tried for a gap exception with UHC with my son in 2008 and it was in vain.  I finally gave up because it was just too stressful and we figured at least we were getting it covered out-of-network.  Here in Wisconsin, they had a different take on it.  They said that since there were CNM's, in-network, that we just had to use them, regardless of the fact that they didn't do homebirths because they were midwives, after all.  What's the difference?  *sigh* In effect, they were saying they didn't cover homebirths, without having to actually say it out loud.  I have since heard from my midwife that they are pretty much saying it out loud now, five years later.  

Now our out-of-network coverage is even less, but my employer has been putting money into an HSA - so if we do have more out-of-pocket, at least it technically wasn't our money anyway.  I'm good at rationalizing.  

[LittleBlackBug]

I just applied for an in network gap exception on Monday using billing codes from my mw's billed. The biller told me that patients have better luck pushing for.coverage than the mw. I got a call back Tuesday that they didn't find any in network home birth mw's and that they would cover my home birth in network. I was shocked as I was prepared to appeal until I got it covered. Now to.wait.until June when baby is born to see how billing goes. Good luck! Oh and it was through UHC.