Help me convince my insurance to pay for a midwife

[lmonter]

Last month I went to my midwife to fill out paperwork, get a pap, and do a well-baby visit for ds. The midwife billed my insurance company, and I got my EOB today. It says "Your plan does not cover services rendered by this type of provider." But I get to appeal (and boy am I going to).

My plan of attack is to get them to cover routine stuff, then when we do get pregnant and do a homebirth, if they waffle about paying it I can come back and say that they covered previous services.

So... can you give me your most compelling arguments as to why my insurance company should cover my midwife's services? (I do have some, but I want to *really* convince them.)

TIA!

Lanna

[JennP]

I would first see if there are any laws in your state mandating coverage of Midwifery services.

I am in Iowa but have a BCBC out-of-state plan and while Iowa initiated health plans must cover midwifery service that would be paid by a physician if a physician would have performed the service, the out-of-state plan does NOT have to follow those rules. I am VERY upset about this.

I am researching the cost of care difference between a Dr, OBGYN and midwife. Including the cost of the hospital stay.

Sorry I don't have any better ideas for you. I know many say it is a choice and if you really want a home birth or a birth center birth you will find the money but if insurance covered it my dh would be more likely to switch to a midwife.

I will be watching for more responses.

[~Megan~]

I can't imagine why they would cover a well baby visit from a midwife. Is your midwife trained in pediatrics?

[paloma]

Probably not specifically, Amarrasmom, however, plans do pay for ARNPs to do the same. Look through the booklet you got with the plan and formulate your argument from there. Some have a clause that says they will pay for a svc. provided in the home if the outcomes are similar and it is cheaper than the similar service provided in the hospital. Let me know what you find.

[alegna]

Actually my insurance paid for the check on my dd after she was born (and at a week and 6 weeks)

-Angela