Talked to the Insuance Co. They won't cover a midwife :(

[ani'smommy]

I am so bummed. DH's company just switched to United HealthCare and I was so hopeful that they would at least partially cover a homebirth/midwife. It would even have made me feel better about pay twice as much per month for health insurance.

I called them and they said that there was no mention of the word midwife in the plan so that meant that it wasn't covered. I know others here have said that they have had UHC cover some of their expenses, and I mentioned that to the woman on the phone, and she said that the employer decides what services they will cover.

So now I don't know what I am going to do. I don't think we are going to be able to afford a homebirth. Sigh.

[alegna]

I seriously doubt they can choose to not cover any midwives if they're legal in your state.

-Angela

[ani'smommy]

So do you think there's a pretty good chance that if we just go for it -- the homebirth and the midwife bills the company that they'll pay?

Did I screw things up by asking the insurance co?

[alegna]

Yeah- I think they'd end up paying. I don't think you screwed it up by asking.

-Angela

[Midwife Kris]

United Healthcare is one of the best payors of midwives in the state of Colorado I hear from the midwives who have a lot of clients with that company. I mostly have clients who pay cash or don't have maternity coverage so I don't know that to be true personally.

[ani'smommy]

Well that's good news. I wish we could know in advance what they would cover because it would probably effect which heathcare plan we chose, and it would go a long ways in convincing DH to HB. I think I'll call some local midwives tomorrow and see what they say.

We're in MI, and I know that CPM are legal here.

[saratchka]

Definitely talk to the midwives. They've got a lot of experience with this.

Here's what I understand about this. Depending on your plan, there's a good chance it could be covered. If you have the right to choose your own providers, it should be cake. Is your plan an HMO or PPO? If so, does it include out-of-network benefits? I don't think many homebirth midwives are network providers, so they're usually coverd at the out-of-network rates.

Never completely trust what the insurance rep tells you. Bizarre as this may sound, the company isn't bound by their quotes or explanations. I got three different answers about homebirth coverage from my insurance company. My midwife was able to get the details from them much more easily. Turns out our coverage kinda stinks, but that's what happens when employers cut back on the available insurance plans.

[pamamidwife]

Originally Posted by alegna

I seriously doubt they can choose to not cover any midwives if they're legal in your state.

-Angela

ah, but they can and they do. see, each insurance company has specific plans that employers can buy. based on what is covered in these plans, there is a huge range of what the premiums cost. so, they can cover midwives under one plan, but not another plan. it all depends on what the employer has purchased.

it sucks.

[alegna]

Don't some states have laws preventing that? Someone recently posted something about this or something similar- some federal law that says they can't say you have to birth in a hospital, so they have to cover someone that doesn't or some such..... I'll have to see if I can find it...

-Angela

[Defenestrator]

In Michigan, they have to cover a CNM if they provide maternity services. There was a law signed to that effect in 2004. A CPM might be a different story. I would look at what your policy says instead of what the insurance customer service rep says. Could you dig up your policy and see what it says about maternity coverage? If it doesn't say "services covered when provided by a physician" or something like that then you have a compelling case for nurse-midwifery care and could probably get a CPM covered if you made a big enough stink.

I think there has to be a miscommunication here in terms of midwives not being covered at all -- first of all, they have to, and secondly, i have worked with insurance companies long enough to know that they usually have a core of services that they provide and then the company can elect certain options that cost more, like providing chiropractic care or birth control or fertility, or whatever. Why would an insurance company exclude a class of providers who are cheaper? I know, I know, I'm counting on them behaving logically, but I have not heard of midwives being excluded for this reason in the past. I have heard of them being excluded because the ins. co. as a whole had only enrolled physicians as providers or only accepted bills which were submitted through physicians, but not because a particular company had not decided to cover midwifery care.

Who knows, you may be able to find a CNM close enough to Grand Rapids who bills through a physician anyway. I know that when I go to my CNM for well-woman care the bill makes it look like I saw one of the doctors in her office. From the insurance company's perspective, I did. I see a practice at a large teaching hospital (UofM) and so I would assume that their method of billing is pretty standard.

Good luck!

[ValarieR]

Suggestion

I ran into a similar issue with my insurance last year- the insurance company would cover my procedure, but my company did not...

The only two ways to fight it are: Get an appointment with the companies HR department head and try to convince the company to change their policy for you, or in general. Also, though it is less effective, get in touch with your areas insurance commishioer- they will at least know what your legal rights are.

Hope this helps

~Valarie~

[prettypixels]

Originally Posted by ani'smommy

I am so bummed. DH's company just switched to United HealthCare and I was so hopeful that they would at least partially cover a homebirth/midwife. It would even have made me feel better about pay twice as much per month for health insurance.

I called them and they said that there was no mention of the word midwife in the plan so that meant that it wasn't covered. I know others here have said that they have had UHC cover some of their expenses, and I mentioned that to the woman on the phone, and she said that the employer decides what services they will cover.

So now I don't know what I am going to do. I don't think we are going to be able to afford a homebirth. Sigh.

My husband had United Health Care and they covered my MW... have you gotten online to their system to search? If you go to myuhc.com you should be able to log in and search for people near you. If he is on one version of the UHC plan it might be worthwhile to you to upgrade; my husband did switch us after we found out I was pregnant. I don't remember which to which, it's like choice to choice plus or something. But either way they would've covered some part of our expenses (don't remember how much), and when we switched it was almost 100%.

Oh, shoot... I just read what you said about the employer, sorry! That is wierd to me! Does the employer cover any birth related expenses at all??? If yes, how do they get to choose which TYPES of coverage they offer???? That is crazy! Maybe inquire into how much it would be for you to just purchase some additional coverage??? At least to find out...

Ack that is wierd, I'm sorry mama

[onlyboys]

United Healthcare here in FL has in network and out of network. So, they might not cover a CPM totally, but they would pay some of it. Whatever your in and out of network fees are.

[Emmeline II]

Originally Posted by alegna

Don't some states have laws preventing that? Someone recently posted something about this or something similar- some federal law that says they can't say you have to birth in a hospital, so they have to cover someone that doesn't or some such..... I'll have to see if I can find it...

-Angela

Here it is:

http://www.mothering.com/discussions...d.php?t=549035

I posted in that thread about "Federal Regulation Title 45: PART 146—REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET" . You should also check your state insurance laws. Whatever may be in the insurance handbook they still have to adhere to federal and state laws (of your state; doesn't matter what state they are in).

I live in Texas where CPMs can be state licensed. My insurance BCBS of Illinois told me that they only cover homebirth with CNM or MD, or Birth Center with a CNM. My midwife called and said "Title 45 , etc." and got paid; it took a few phone calls though. She has never not gotten money out of an insurance company.

[mwherbs]

do you have a copy of your plan? If you decided to not do an HMO but flex care or what ever prefered provider plan they have so they pay out of network people - just with possible differences---- Ask the insurance companies what plan would cover LMs-- and what is the cost of that plan

at DH's work I found out that it is the job that desides on if good grades/or college is a criteria for adult children... they can be covered under your plan even if they don't go to school-(of course you have to pay for them) but the employer has the descression-- since I discovered this in an insurance plan meeting at DH's work- the HR department was there when I brought it up and many employees heard that it was the job's choice- so they couldn't "wiggle" out of it and say it was the insurance company rules... and so our kids have insurance..
It could be that at DH work they did not know that part of the plan needed to include midwives...

[velcromom]

the gentlebirth.org site has some great info on getting insurance companies to cover hb. Use their search for "insurance" and you will have a lot of reading to do!

[Belle]

I have united health care and my mw is cover as an "out of network" provider. Every mw that I interviewed said that United health care is really good about paying homebirths.

[MamaVolpe]

Some advice from a former insurance rep.

As long as the policy does not specifically state that it does not cover Midwives, then you should be ok. The midwife would have to be a licenced provider and if you have a plan with in network benefits only then they would also have to be participating with your plan. The best thing you can do is see if you can get the EOC (evidence of coverage) booklet and look thru the exclusion section. If it doesnt specifically exclude midwives then you should be covered. Also check in the exclusions to see if they have something that states ie: midwives are only covered if they deliver at a par facility. If so then they would be covered but not for homebirth. Make sure you check the wording. And if the claims get submitted and are denied you can always appeal. You will have two levels of appeal with the insurance co then you can appeal to the Insurance Comissioner for the state. PM me if you have any specific insurance questions that I may help with.