Now considering unassisted...

[chalynm]

Grrrrr...just got off the phone w/ the insurance. I am so furious right now.

They do cover m/w & birth centers, but not the one we're already established with, which, by the way, is an hour away and still the closest thing. Doulas are not covered; we can make a special request, but we have to prove that it's medically necessary. And...get this...if we don't notify the insurance ahead of time that we plan to use an out-of-network provider, they charge us $300. The insurance charges us $300! That's not "raising" the deductible by $300, that's the insurance sending us a bill.

What a load of ! It costs them less anyway if we use someone out-of-network. (They only cover 60% after the deductible for out-of-network stuff) What do they care if we tell them beforehand or not? And why does a doula have to be medically necessary? Same as w/ the network crap...having a doula reduces the chance of costly intervention, which therefore reduces the total cost to the insurance, so why would they pitch such a fit about approving one? Right now, I am this close to running away to live in a cave and eat insects and have no contact w/ the rest of the human population anymore, especially stupid insurance companies.

Anyway...this has only served to strengthen my resolve to have an unassisted birth. I wanted to have one w/ this little one from the beginning, but dh said he wasn't confident enough. I've convinced him to at least resume discussion when he gets home (FYI, he drives a truck and is only home on weekends). We'll see how that goes. I think I've mentioned in another thread or two that the only thing that typical convinces dh is numbers, but it's going to be hard to find numbers for this since, by definition, the people who would do the studies aren't invited. (I want to do a lotus birth, too, and am having the same problem. It's relatively new, especially in the US, so there isn't much quantitative analysis yet.)

Any words of encouragement would be most welcome. I'm feeling very down about things right now...

[chalynm]

Quick Update

I just got off the phone w/ the care coordination department, since I'm required to notify them of our intent to use out-of-network services. I am so insulted. I had to explain, well, defend really, our choice to use a m/w and birth center instead of the in-network OBs and hospitals closer to us. As soon as the words "I don't agree" came out of my mouth, the coordinator's whole tone changed. It was like all the sudden he realized he was dealing w/ some hippie nutjob. He started talking down to me and "explaining" things in great detail, like I was too stupid to understand otherwise. AND...after going through all that, they still don't guarantee they'll cover even their measely 60%. All they did today was "document the request for network gap coverage." This is really unbelievable. How can anybody w/ a conscience actually work for these people?

[BirthFree]

I'm sorry... I understand though, they can be nasty and I've had to deal with them before. If they start to get snippy or super slow and antagonistic with their conversation I ask for their name and department number. Figure if we're going to play then count me in but I'll pull out all the shots. Document what time you called, who you talked to and what the end resolve ended up being. Often persistence gives you greater results than anything... I've had a 45 min. conversation with a head of a department before and all I basically kept repeating when he would say something was... "I'm sorry that it is working out this way but one of your employees told me this would be covered for my son and now you are saying it isn't - I realize that there may have been cross-communication within your group but this isn't my problem at this point and someone there should need to pick it up, $600 is a lot of money for me". I think I said it in a different way about 300x. (One of their employees guaranteed me that my son's therapy would be covered with the current way that they had my insurance documented, but that turned out to not be true...). Anyways, they picked up the tab - as they should have.

Also, check out www.bellywomen.net for a low-cost or free doula in your area (I list there for free though typically I charge $300). And you know, a midwife could likely write up a letter as to why a doula is medically necessary... I know I could write it up (statistically) as to why it will save them (the ins. carrier) money.

Sorry to hear of your trouble, I'd be frustrated... insurance companies are beyond irritating when you have to battle over those kind of things. Make your choice to UC (if you do) not based on money or insurance though... because those kinds of things can be worked on (many midwives take barter or payment plans). Good luck!
~Julie

[Guest*]

I used to feel bad that we couldn't afford health insurance (we're self-employed and it's too darned expensive), but your experiences and hundreds of others who have similar experiences have led me to believe that health insurance is a joke and not worth it. It seems that anytime you want to use it, it's not covered or a huge hassle. What's the point of insurance then?

Sorry you have to deal with this.

As far as numbers...there was a recent study in BMJ about midwife-attended homebirths. It shows that homebirths are as safe as hospital births but are MUCH less traumatic.

Unattended births usually only have slightly higher death and trauma rates. You could show him that study.

http://bmj.bmjjournals.com/cgi/conte...505/1416?ehom_

I hope you can get this resolved soon.

[chalynm]

Originally Posted by BirthFree

Make your choice to UC (if you do) not based on money or insurance though...

Thanks for the support, ladies. I took a nice nap while dd was taking hers and am feeling a little better about things, though still frustrated.

I would never decided to UC simply because I thought we couldn't afford any other way. And it wouldn't be a huge hardship even if we had to pay the m/w completely out-of-pocket. It's more the principle of the thing, I guess. We just shouldn't have to.

Like I said, it's something I've wanted to do from the beginning w/ this one. All this crap w/ the insurance just gives me more motivation to fight for what I want and more ammunition in the discussions w/ dh. (He's all about the numbers, and this definitely involves some big ones.) He kept saying he didn't feel confident enough to UC, so we compromised...well, not really. He was always ok w/ the birth center, so it really wasn't a compromise at all. I guess what I should really say is that I gave up.

Anyway...we agreed on the birth center. I figured it wouldn't be a huge difference for me and baby, and it would make him feel better, so what the heck. But now, if the insurance is going to be a bunch of turds about the whole thing, I'd rather restrict their involvement as much as possible, just to checkups and the like. I don't think I'm quite ready for the leap to unassisted pg. If we do UC, since it would be our 1st time, I'd feel better having the m/w check that everything is going like it's supposed to.

You know, they actually told me that I'm supposed to call the instant the baby is born so they can put the correct date in the computer? Otherwise, it may not process correctly and could cause problems w/ paying the claim. And I had to tell them right then on the spot how many visits w/ the m/w I'm going to have. If I guessed wrong, I'll have to put in a whole new, separate request for the overage, which of course will delay payment of the claim. (Why does this sound like I'm talking about a cell phone bill?)

The more I read about UC and the more crap I run into w/ the insurance, the stronger I feel about it. We had a good birth w/ dd, but how much more beautiful would it have been if it had been just the three of us? I really want that experience of completely trusting my body to do what it's supposed to do w/o that constant little voice in the back of my head, saying "well, there's always plan b in case you can't get the job done." I know there are risks, but right now, I think they're totally worth it.

DH should be home in a couple of hours, and we'll finally get a chance to talk about all this face-to-face. We'll see how it goes...

[sapphire_chan]

Originally Posted by chalynm

And I had to tell them right then on the spot how many visits w/ the m/w I'm going to have. If I guessed wrong, I'll have to put in a whole new, separate request for the overage, which of course will delay payment of the claim.

So you told them that you'd have 85 visits, which is 2 a week (even going to 42 weeks) plus a few extra?

Insurance companies are I mean, you try to save them money by both going to a less expensive provider *and* avoiding expensive interventions (epidurals are quite pricey and c-sections are worse) and they whine that you'll have to pay $600. Sheesh. I wonder if there's a way to get them to pay the $20,000 or so for a hospital birth while you actually have the birth center birth? Hmm... probably, but it'd take some criminal skills I don't see most of us possessing. (Why can't the twits who come up with viruses to crash our computers put their minds to manipulating insurance company policies into having at least the commonsense of a fruitfly?)

Seriously though, a UC does sound like a good option if you can get your dh on board. And meanwhile, look at switching your insurance coverage to a bare minimum "very lengthy and expensive illnesses only" policy. By the way, have you asked the birth center if they're in-network for any company?

[BirthFree]

I didn't mean to imply that is why you would make that UC choice... I know it isn't.