oh! I'm in denial about this insurance question, I think

[fireflies~for~me]

Our former policy specifically stated that homebirth was covered with no deductible even.

Well, our plan changed slightly and when I read it today, it doesn't mention homebirth either way. I does say that a Certified Nurse Midwife can act as an MD in the scope of her liscense. But then says that a midwife must be in direct supervision of an MD.

Is that bad wording!!! Please say that midwives know how to bill around little things like that. The midwife I want to use is a CNM (RN) but as far as I know doesnt use an MD backup.

Birth is covered with an in or out of plan provider so that isn't the issue and she can bill globally, but I'm afraid of what this answer might be!!!!!!!!!!!!!!!!!!!

Anyone with insurance savvy? Is it better to be direct with insurance companies or not spill the beans????

[pamamidwife]

well, the thing about looking things up is that nearly all insurance companies will NOT mention homebirth.

Rather than ask them about homebirth, I'd ask if they cover a CNM. Better yet, have your mw call them and ask them for you - she will more than likely know the language to use, etc.

No matter what, get the name of who you spoke to, the time and exactly what they said.

[Lydia_momma]

Homebirth hopeful

I am also looking for info on an insurance covered homebirth. I live in Mich. and have contacted my insurance co. They DO cover CNM's but not Lay (?) Midwives. ARGH!

I've only spoken with the first level--the Q&A people. "Out of hospital birth? You mean home birth? NO WAY. Only in hospital or birth center (with ties to hosp) with CNMs who work with a DR."

So, here is what I am planning on doing...
1. Write a letter to Priority Health PPO regarding having a H.B. (Find out who are the decision makers)
2a. Include my insurance bills from my c-section. (maybe that'll wake them up)
2b. Include chance of C-section if in hosp. AGAIN. $$$
3. Reference VBAC.com, Mothering Mag., books, etc. on c-sect. and hb.
4. Include info on midwife.
5. List other insurances that cover homebirths
6. Benefit of homebirth,$$$, quicker recovery, $$$ oh, did I repeat myself again!?!
Does this sound like a plan of attack or WAY to much?

[pamamidwife]

I'd start with asking if they cover a licensed midwife (do they have licensed midwives in MI?) or CPMs, do NOT MENTION HOMEBIRTH.

Nearly all insurance companies pay for birth based on the PROVIDER, not the location of birth.

I'd definitely talk to your midwives about their own experience in this. Really, the midwives can help you alot if they're experienced with billing. They can tell you what to ask, etc.

[hunnybumm]

If you decided to call your insurance co to ask, you could be very vague, not give them your name etc. Then if you have to "work around" the issue they won't say "Well we told you on this date that this wasn't covered".

[carlasher]

I dont know if it is wise to mention past c-section. They may not grant your homebirth request just for that reason alone.

Originally Posted by Lydia_momma

I am also looking for info on an insurance covered homebirth. I live in Mich. and have contacted my insurance co. They DO cover CNM's but not Lay (?) Midwives. ARGH!

I've only spoken with the first level--the Q&A people. "Out of hospital birth? You mean home birth? NO WAY. Only in hospital or birth center (with ties to hosp) with CNMs who work with a DR."

So, here is what I am planning on doing...
1. Write a letter to Priority Health PPO regarding having a H.B. (Find out who are the decision makers)
2a. Include my insurance bills from my c-section. (maybe that'll wake them up)
2b. Include chance of C-section if in hosp. AGAIN. $$$
3. Reference VBAC.com, Mothering Mag., books, etc. on c-sect. and hb.
4. Include info on midwife.
5. List other insurances that cover homebirths
6. Benefit of homebirth,$$$, quicker recovery, $$$ oh, did I repeat myself again!?!
Does this sound like a plan of attack or WAY to much?

[carlasher]

Not mine (Blue Shield of California). They specifically say: "hospital or birthing center only. No homebirths." Of course this an an HMO, if it was a PPO, they would cover it.

Originally Posted by pamamidwife

I'd start with asking if they cover a licensed midwife (do they have licensed midwives in MI?) or CPMs, do NOT MENTION HOMEBIRTH.

Nearly all insurance companies pay for birth based on the PROVIDER, not the location of birth.

I'd definitely talk to your midwives about their own experience in this. Really, the midwives can help you alot if they're experienced with billing. They can tell you what to ask, etc.

[Lydia_momma]

Feeling blue...

Ok, I've been back and forth on the internet, bouncing around on sites regarding, c/s, homebirths, unassisted births (yikes! Not sure about that one!) and then I run across an article about women who've had c/s. About 42% don't have other children, that's due to infertility from c/s.

We just started trying for another child...Lydia was oopsie-daisy right of birth control, and now that we are trying to conceive, makes me nervous to think about it...

Then I thought about the women I know who have had c/s and went on to have other children. Ahhh.. better...but still worried.

I've talked to others about the insurance covering hb, and the news has been pretty good...
1. POS is better, (what I've got)
2. Will have to pay midwife out of pocket first...and
3. claim will probably be denied, then I can take it to the next level.

I've heard of a woman who got it through, and was told:
1. don't do this again, and
2. don't tell anyone we've covered it.

soooo, there IS hope. Just hope my DH can come around to it.

Thanks for the info, All!

[Electra375]

Lydia Momma -- it's not worth your energy to fight the ins. I will state this much. Coverage is by provider not place, and if the provider is legal in your state, I believe your ins must cover it (in or out of network)
I'm fighting ins now, but on my side is the fact no mention of either CNM or CPM or mw in general and only birth centers are mentioned specifically -- no birth centers near by!
And DO leave OUT c/s info. they know it, INS was developed by doc to get reimbursement so it's a big conspiracy!!! Why should ins advertise they cover mw and cause the docs to loose out on the potential income???
That's my food for thought.

[fireflies~for~me]

Well, just an update from OP...the midwife we selected has had very good experience billing insurances and in our state, CNMs act as physicians. She bills successfully with BCBS, Etna etc. has a provider number, etc. So that is a good thing.

When I called our insurance company to inquire about any restrictions in our plan in using a CNM, she looked and looked and said "No". So I got her name and wrote down time we talked so hopefull all and all we are in the clear!!

Hooray!

[Lydia_momma]

BRAVO FOR Fireflies!!

Good. I'm glad you're having luck.
I used CNMs in a hospital setting, but it was intervention alley to C-Sec. Blvd. Mine worked under a OB. I just don't feel right going back to them again. I think they were under a time constraint, yet I wasn't even in the hosp for 12 hrs. before the one "recommended" C/s.

Me? I've stopped pining for insurance coverage. I'm not even pg yet! Tho' I have a feeling that will change in Dec. You know, woman's intuition.