Insurance WON'T cover homebirth...

[tsfairy]

Hi - I've been lurking on this board for a while and I'm loving the vibe. This is a fabulous place!

For years I've known I wanted a homebirth and now that DH and I are finally TTC I decided to check out what my insurance will cover... well lo and behold they will cover NOTHING. Nada. Not one cent. Won't cover a midwife in ANY capacity, won't cover a "planned birth at home." And there aren't even any birthing centers on the plan! The insurance company "will cover if there's a state mandate" BUT my plan is self-insured so even that wouldn't apply.

I'm just so irked. It's not even the money so much but the PRINCIPLE. And because of the way the plan is set up, I don't think I can appeal or anything... so I guess we'll just plan to use our income tax return next year.

Thanks for letting me vent.

[Ligmom]

First of all...welcome to MDC I totally understand your frustration about insurance not covering homebirth--it's so wrong, and it closes the door for so many people. I was also in this position w/ my homebirth, and paid all of my birth expenses out of pocket. That said, it was some of the best money I ever spent Unfortunately sometimes you get what you pay for, and even though the hospital birth would have cost less $$$, it would have been far more emotionally costly.
Congrats on TTC and on your decision to have your baby at home

[pamamidwife]

I'm not sure what state you're in, but I'd have your mw bill anyway after the birth. You might be surprised! (Unless, of course, you have Aetna, which totally sucks!)

I've had clients that were told "NO WAY" to a homebirth, but when I billed, I was able to reimburse them 70-80% of my fee! Sometimes mentioning homebirth with insurance companies is a mistake - it's all about, "do you cover licensed midwives?" or something. It depends on which state you live in.

[sugarmoon]

Yeah, what pama said. My ins. also told me no, but my mw said, oh, let me call them, and it was no problem...

[Graceoc]

My insurance also does not cover hb....so we will be paying totally out of pocket. BUT with my first birth at a hospital we had a PPO health insurance plan which we had to pay 10% of the cost and it was MORE then what my hb will be costing me! (of course my second birth at the birth center was totally covered with our HMO and I only paid $15 co-pay )

Good luck TTCing!

[tsfairy]

I'm in Texas, and yep, it's Aetna HMO. And self-funded no less, which basically means my company makes up it's own rules and doesn't have to cover diddly-squat if they don't want to. Grr...

What really stinks is that I would have to pay a grand total of $20 (yes that's TWENTY dollars) for a hospital birth AND all of the prenatal care. How crazy is that?

I'm definitely still going to do a homebirth though - I might be able to change to a different plan at the end of the year (although since it's the company making the rules it will probably be the same story). Or when DH gets a job maybe HIS insurance will cover it. At any rate I'm glad I found this out now so I can stress out about it BEFORE I get pregnant LOL.

Thanks for all the replies and warm welcome!

[Mom2baldie]

My insurance doesnt cover homebirth either. We are paying about $2600 out of pocket, which is about the average for this area. I know it will be worth it though, so I dont really even mind the expense.

If you dont mind my asking, where are you in TX? I am close to DFW...

[tsfairy]

I'm in the Houston area.

[georgia]

In my experience, self-insured plans are the best to go around what the policy is and get it approved. Financially, hbs are WAAAAY less expensive for them. I've now gotten two hbs covered (yeah!!!!) for the most part, though mws and hb have not been "covered." There are many angles you can approach them with for pre-approval of benefits. We took ours to the president of HR, but I realize in many instances, the company doesn't take an interest in helping . So, if you're not up for a fight, or if you can't seem to find the right person to get things done for you.....an out-of-pocket hb is one of the best investments you can make for you and your family. <FWIW, my first birth cost $5. You would not believe the trauma that $5 bought us.>

I agree so much with ligmom. There is a huge difference between the price (financially) of a hb and the cost (emotionally, physically and spiritually) of a hospital birth if home is where you want to be.

[Yama]

Yes........ definetly check with your local midwives first. Insurance companies are all scattered anyway... they representives may not know what the heck your talking about because homebirth is not a typical thing to do. Check with the midwives first. They can take your insurance info and call in and check...you might be surprised.

Same thing happend to me. I called my insurance company first to see if they would cover my homebirth..... my first birth was in a hospital and I really wanted a homebirth...... so I called and they told me "NO"... so I figuired even though I'm broke, can't afford a big bill, let me AT LEAST see how much it would cost to have a homebirth... in my area (NJ) homebirth midwives are around $4,000. Things were looking grim, but I still wanted to see, maybe I could work out something with the midwives. So, I interview two midwives to get a ball park figuire of what I could be paying....... one of the midwives, during the interview, took my insurance info right there and told me that my insurance covers 80% of the cost! Also a friend of mines insurance company did not offer any midwives at all in network and because of that, that would leave her with no options, they wound up paying for the entire cost! Good luck to you.

[SamuraiEarthMama]

i have had to pay every penny of my homebirth midwives payment out of pocket, and i consider it money well-spent! nobody but me and the midwives made my health care decisions, and i have three (with a fourth on the way) beautiful kiddos and great birth stories to show for it.

it always surprises me that someone will happily plunk down 15 grand for a car, but then complain that 2 grand is too much for a homebirth...

katje

[Hera]

I'm having this problem too, although we're in a different state and have a PPO. I did some research and wrote an appeal letter that I'd be happy to let you plagarize, although you'd have do rewrite a lot of it. PM me if you want it.

Even if they don't change their policy (my insurance sure didn't) I feel like it is good to at least express your opinion supported by evidence. Our insurance people have said that they are sending our letter along to their policy makers, to possibly discuss changing their minds in the future. If it helps some other family out, that's good enough for me. I guess. Though I wish they'd change their minds before the middle of July....

[2+twins]

Originally Posted by Hera

I'm having this problem too, although we're in a different state and have a PPO.

With my first birth we had a PPO and had no trouble getting reimbursed (70% of it I believe). I thought that was the whole benefit of paying those outrages PPO fees! Aren't you able to choose ANY provider and at least get something back? I don't think we ever mentioned it being a homebirth or anything. Just filled out the claim form & sent it in and voila, got our check in the mail. I'm pretty sure we had Aetna PPO in CA at that time, but I don't remember for sure. Which company won't reimburse you???

Now with this last birth we had Blue Shield HMO and I recently submitted a claim. Just waiting for the rejection letter to show up, but maybe I'll get lucky!

[Hera]

It's HealthNet. The Oregon insurance law does not recognize LDM's (licensed direct-entry midwives. Licensing is voluntary here) as women's health care providers. So, the state can't help me. We found out that they have an actual exclusion in the contract with Dh's company, they explicitly state that they won't cover out-of-hospital birth. (Which is bogus, since they'll do the birth center....)

Anyway, it's really poopy. As it turned out the coverage is 80% after a $500 deductable for the entire package (ie prenatals, birth, postpartum) not including lab work and ultrasounds (I'm not sure if they pay for all of that, or what.) So, it turned out to be something like a $400 difference for us. We decided we could afford that.

[pamamidwife]

Rebecca, that is interesting about the exclusion. Billing it anyway might help because they tend to look only at the credentials of the provider, not necessarily the place of birth (nowhere on the billing form does it state homebirth). I've been surprised by how many insurance companies freak about homebirth, but when I bill as an LM in Oregon, they pay.

[Breathless Wonder]

My insurance supposedly covered homebirth as long as the person delivering was "practicing within the scope of their license".

But it took over a year for my first homebirth to get paid (and that was WITH the HR person from my DH's large employer riding their butt).

And my second homebirth, was covered only 80/20 of "reasonable and customary" so I think they paid $1200 for a $2500 birth?

And when they did pay it, they billed it to some doctor my midwife didn't know, and it was billed as surgery?!?!?!

[ksjhwkr]

I am in the same boat you are. Insurance won't cover homebirth. It is rediculous, but rest assured, you are not alone. It IS very frustrating and just plain...well, I don't know...makes me mad Oh well, I'd rather pay the midwife than go to the hospital where my only option would be to have a repeat c-section.

[Hera]

uh-oh, we're off on a tangent here...

T

Originally Posted by pamamidwife

Rebecca, that is interesting about the exclusion. Billing it anyway might help because they tend to look only at the credentials of the provider, not necessarily the place of birth (nowhere on the billing form does it state homebirth). I've been surprised by how many insurance companies freak about homebirth, but when I bill as an LM in Oregon, they pay.

hmmm....I guess it's worth a try. They may know us by now, since we did make a big stink about it. I'll talk to Colleen, maybe she'll be up for trying. I know they did say something about having to bill through a physician's office, but then again the CNM's don't have to do that- it's in the insurance law. Worst they can say is "No" I suppose.

Hey, were you at a regional meeting with Colleen a couple of weeks ago? Those were my garden radishes in the salad...

[yasi]

Originally Posted by Hera

T


Rebecca, that is interesting about the exclusion. Billing it anyway might help because they tend to look only at the credentials of the provider, not necessarily the place of birth (nowhere on the billing form does it state homebirth). I've been surprised by how many insurance companies freak about homebirth, but when I bill as an LM in Oregon, they pay.

Actually this is not true. I do the billing for my mw and the insurance form does ask for place of service. However, it is usually not paid attention to.

I am struggling to get my insurance to pay the preferred rate right now. They are arguing that I had the choice to go out of network and could have had a network provider if I had birthed in the hospital. UGGGGG They paid the preferred rate for my son and are telling me that that was an exception.
Marisa

[Mamid]

I saw on gentlebirth.org that there's a lawsuit going on against aetna for lack of midwife coverage. Take a look for yourself.