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Sample Appeal Letters for Homebirth Coverage - Page 3

post #41 of 46

Sample Appeal Letters for Homebirth Coverage

Overview - Basic Principle: Maternity Care is Expensive. Homebirth is Less Expensive, has Better Outcomes and more Satisfied Customers
Here's one midwife's explanation of maternity care economics, which will help you to lobby better for yourself!
This graph shows 2003 facility charges for labor & birth. Facility charges are JUST for the facility itself, i.e. either hospital or birth center. The facility charges do not include:

additional anesthesia services charge for an epidural - around $2000-$3000.
additional newborn care charge - up to $5000 [Numerous charges, including nursery fees, pediatrician fees, medications]
additional maternity provider charge for all births - around $3000-$5000 for the average four hours a doctor spends with you during prenatal care, the birth, and quick postpartum checks during hospitalization. [Procedure code 59400]
To get the current bare-bones Medi-Care reimbursement rates for your area, go to the Medicare Physician Fee Schedule Look-Up, selecting the default "Single HCPC Code", "Pricing Information", and then changing the "Carrier Option" to "Specific Locality", and keeping the default "Default Fields (Pricing Information Only)". Copy the Procedure code from each of the procedures above into the HCPC field, select the "Global" option for the Modifier field, and then select the Carrier Locality that applies to your area. Remember, the prices shown on this web site are the bare-bones prices paid by the biggest, cheapest plans, such as Blue Cross and Blue Shield. Higher-end insurance plans usually pay about twice the Medi-Care rate.
(In case you're unable to download this .pdf file, here are the Facility Labor & Birth Charges, U.S. 2003 By Site and Method of Delivery: NOTE - These prices are nationwide averages. The cost in the San Francsico Bay Area is about 3-4 times that of the least expensive areas.)
post #42 of 46

Sample Appeal Letters for Homebirth Coverage

Overview - Basic Principle: Maternity Care is Expensive. Homebirth is Less Expensive, has Better Outcomes and more Satisfied Customers
Here's one midwife's explanation of maternity care economics, which will help you to lobby better for yourself!
This graph shows 2003 facility charges for labor & birth. Facility charges are JUST for the facility itself, i.e. either hospital or birth center. The facility charges do not include:
additional anesthesia services charge for an epidural - around $2000-$3000.
additional newborn care charge - up to $5000 [Numerous charges, including nursery fees, pediatrician fees, medications]
additional maternity provider charge for all births - around $3000-$5000 for the average four hours a doctor spends with you during prenatal care, the birth, and quick postpartum checks during hospitalization. [Procedure code 59400]
To get the current bare-bones Medi-Care reimbursement rates for your area, go to the Medicare Physician Fee Schedule Look-Up, selecting the default "Single HCPC Code", "Pricing Information", and then changing the "Carrier Option" to "Specific Locality", and keeping the default "Default Fields (Pricing Information Only)". Copy the Procedure code from each of the procedures above into the HCPC field, select the "Global" option for the Modifier field, and then select the Carrier Locality that applies to your area. Remember, the prices shown on this web site are the bare-bones prices paid by the biggest, cheapest plans, such as Blue Cross and Blue Shield. Higher-end insurance plans usually pay about twice the Medi-Care rate.
(In case you're unable to download this .pdf file, here are the Facility Labor & Birth Charges, U.S. 2003 By Site and Method of Delivery: NOTE - These prices are nationwide averages. The cost in the San Francsico Bay Area is about 3-4 times that of the least expensive areas.)
post #43 of 46
I'm going through an interesting version of this. In January, my attempted homebirth turned into an emergency cesarean due to cord prolapse. I'm currently trying to get United to cover at least my prenatal care, since we pre-paid our midwives. Has anyone ever dealt with this specificity? Obviously the whole argument about saving money by covering homebirths doesn't apply to us in the least.
post #44 of 46
I've heard that it's next to impossible to get them to pay for the prenatal care if you transfer. But that doesn't mean it can't be done.
post #45 of 46
I get news that my insurance is asking my midwife to pay back the money they paid for my homebirth.. stating that they do not cover homebirths. (even though she has had 5-6 births through them and they paid for each of them) My daughter is now 6 months old and we are just receiving notice on this!
I don't understand how the insurance company can PAY for services, then come back and say "Oh sorry we did an audit and you need to pay us back!" They said something about not covering newborns that were born at home. Can they do that? Is that legal? Is there anyone I can call?
post #46 of 46

Wow.  I hope your midwife didn't pay them back!!

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