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Homebirth & insurance - Page 2

post #21 of 26

Pregnancy as a pre-existing...

Becky, there is a federal statute prohibiting insurance carriers from not covering insureds for pregnancy; pregnancy can no longer be considered a pre-existing and thus not covered - so if your carrier is telling you this, point out the federal statute and bite them with it:

The HIPPA (aka Health Insurance Portability Act) act of 1996 forbids treating pregnancy as a pre-existing condition. Check this link for specific details on what the Act states:

http://www.auxillium.com/hipaa.shtml

Good luck!
ladybug
post #22 of 26
the only time the health insurance portability act applies is when you are obtaining GROUP health insurance. if you are seeking an individual plan, preexsisting conditions apply and you must qualify health wise to obtain coverage.
post #23 of 26
what the heck kind of insurance company is this??? do they have a office you could go to? That's nuts!
post #24 of 26
I guess it's time for an update on my situation...

My lovely blue shield hmo insurance STILL insists "maternity services provided by a CNM are a covered benefit at clinic... dr office.... hosp or at home"

but the CNM has to be in network. They have none
and they won't let me go out of network to get the benefit!

My out of network request was denied as was my 1 st appeal, I wrote the CEO of blue shield CA today, and I am filing a second appeal and a complaint with the DMHC dept of managed health care,

And I also talked to our risk management dept and my union rep and someone at the nation org of nurse midwives to try to get them to pay, this is all thru a school district so that's it's own buracracy. Some one mentioned maybe I could ask for a "rider" what the heck is that?

This is so stupid it's ridiculous!
So now I think it's time to revise my idea to " If it takes me 100 hours to get them to cover it I've been paid 38.00 an hour"

What next ? my congressman??
I could switch to the PPO but then that would totally screw up my husband's diabetes meds and his dr. care because the whole family must swich at once, and the reimbursement amount for midwives under the ppo is so low it's probably about the same cost to us anyway and then I'd have to risk 20 % of a hospital bill if i had a complication.
so I continue to
post #25 of 26
I used to work for an insurance company - here is a few tips on communicating with them:


Keep a log of your communications - make it VERY detailed!

Who you talked to (First and last name, title, department and direct phone number, as well as the phone number you called to reach them if it was an 800 number or something) You might also ask for their supervisors name and write that down. Do this for EVERYONE they transfer you to as well!!!!!

What was discussed and the outcome of the discussion

The date and time of the conversation

Copies of any faxes or e-mails and receipts or confirmations - be sure these are dated and timed as well.

If you say the word "attorney" in a way which implies that you have one, they are no longer required to talk to you - instead you will have to hire an attorney for them to talk to.

I guarantee you that EVERY phone call you make to them is noted in the system - now all departments may not use the same systems (IE: Pre-auth would have a different system than say disability) but your calls are all there somewhere!!!! BE VERY CLEAR ABOUT WHAT DEPARTMENT YOU ARE SPEAKING WITH!!!

Bear in mind that while most ins companies WANT to provide you with the options ESPECIALLY if they are cheaper, it is like trying to turn a large ship in a rough sea - they just don't turn fast! Be persistant and keep plugging and you WILL get what you want.

If they do not have CNM's on thei provider list then they need to get some! And they are denying you access to appropriate care if they fail to do so, feel free to point that out!

UGH - I could NEVER work for an insurance company again - Just keep calling until you find the person who can help you, if the first person you speak with is uncooperative, hang up and call again and get someone else. Ask to have a nurse case manager assigned to your case to help you - some ins companies will do that - Also - ask for a medical review.
post #26 of 26
gauge14iv great sugestions.

This is a great thread. I am not preg but I am thinking about it. I have always had bad experiences with Insurance Co but now I'm ready for a fight. They better not mess with me... loosers.

Has anyone had any experince with Cigna?
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