great birth, horrible financial mess!

[chicagomom]

I had a fabulous home birth two months ago using a physician-assisted homebirth group as my care provider. It was uncomplicated, lovely, private, and well, wonderful. Except...

Now we are in a financial mess! They were out of network for our insurance and despite having a 'contract' with them that said our estimated cost would be 750 we are now looking at 7K worth of bills! Ouch! The group has billed the insurance company and the insurance company has asked the grup for more detail on the bills, but the group is not forthcoming, and is now billing us directly. I am so afraid of this ruining my credit rating and don't know why they didn't give us a better picture of the <i>real</i> cost of a home birth with them, esp since they work with this particular insurance company a lot and I know they have a good idea of the actual cost to the consumer.

I am really angry and frustrated about the whole thing and frankly, if I had known how much it would cost I would have chosen a hospital birth with a midwife. I am now facing having to put my dd in daycare so I can work just to pay off this horrible bill - something I <b>never</b> would have agreed to up front. I am having nightmares about this. What should I do?

Carolyn

[Clarity]

Call the group and talk to the billing person...you might be able to jump start the "more details" process...nothing you've described is unusual...asking for more details does not mean they will reject, sometimes they just need the right billing codes...wait and see and appeal everything in writing if denied. You may be out some for the difference with usual and customary. Providers always bill the patient while waiting on the insurance comapny...just get in touch with them and let them know you really need to persue the ins. thing...by billing you they are protecting themselves too. i always get bills while waiting for ins to resolve, I will note there is often a big difference in price between what the bils are "officially", andsometimes what they bill to cash/needy clients. The estimate of 750- may be what they thought you would owe after the ins. don't worry about credit yet...most meducal don't refer things to collections or report to credit until well after rejections and appeals are finished...esp if you are in touch with them. if you totally get rejected by ins you can also work on negotiating a lesser total with the medical group. Be calm! It'll work out! It's just long...

[mahdokht]

*

[Mommy StormRaven]

WOW! I jsut read up on this kind of thing happening with medical claims. first appeal it as many times as you can, then Take it tothestate insurance regulation board - insurance companies count on you being naive aboutthe appeal process. Readers digest jsut had a great informational articel on jsut htis kind of thing.

Celestial.. DEM's legal status is ambiguous here (ohio) and underground as well but 5000.00 for a CNM? I thought 3500.00 was bad! My CPM charges a flat 1750.00 for attending homebirht and all prenatal care. She is out of network but accordign to my insurance company (humana) she will be covered for all expenses under 2000.00 due to the reasonable and customary fees. I've verified this with her and the insurance company. in the end her patients with Humana coverage usually have ended up beign completely covered due to her fees beig so low.

[Mommy StormRaven]

WOW Celestial! I guess youcannot put a price on a safe homebirth though so the amount really doesnt' seem much in comparrison to the joy of the care you want!

[chicagomom]

The birth was normal - no drugs or special procedures. The OB wasn't even there for the birth - he showed up ten minutes after, in time for the placenta to arrive. When I was pg I comparison shopped with a midwife and the ones in my area were 2500-3k.

Thanks for the advice - I will try to chill out and start sending letters. It just came as such a surprise - I was led to believe that our out-of-pocket would be 750, so I feel duped.

Carolyn

[Lucky Charm]

WOW though, 7k for a homebirth?

thats unreal.

my hospital birth with an epidural cost less! when i had my third child with a cnm at the hospital, it was less than $6000, her fee being somewhere in the $1500-$2000 range.

[Katana]

Hi Carolyn,

Congrats on your birth.

Could you please PM me with the group you went through? If it's the one I'm thinking of, there is a way out of this mess. I want to help. There's no reason you should have to pay that much. At all.

I'm assuming you're located in the Chicagoland area and had the birth in the same area from your user name. I hope that's right. I'm in Chicago myself.

My homebirth in '99 was $1800, and my hospital birth for dd (the birth part) was $3,000, and that was in a high risk hospital. Both in the Chicagoland area.

[valeria_vi]

Alison,

I just sent you a pm.

[Peppamint]

Oh, I think I know who you went with. Hmm... ouch very expensive!

BTW, I've gone to collection for when I was hospitalized with dd for PIH. I went because my Dr. told me all the 'risks' and said I needed monitoring. The ins. co. decided what was "reasonable and customary" and thus I was left with over $2k in hospital bills. I was supposed to be covered 100%.

Needless to say, I was making phone calls last month (27 mo after the fact) and still getting the run around from the hospital, the ins. co. and the collection agency.

I don't even care any more.

BTW, my homebirth with a lay midwife is so much better. I already paid her half and will be giving her the other half next week. End of story.

[Ragana]

Chicagomom,

I am also in Chicago, and I think there have been discussions before on these boards about that particular group's billing practices (I'm assuming it's the one that advertises on NPR). Maybe you can do a search and see what advice other people had. BTW, my midwife is charging $3500.

Also, I have learned from a couple of friends with medical problems that you should never be tempted to put medical bills on your credit card to get them off of your back. Apparently they have no choice but to work with you unless you put it on a credit card, in which case you're only dealing with the CC company.

Good luck with straightening this out.

[Clarity]

really? After follwing the normal process if the rpactice seems to be less than ethical about billing...I would talk to your state medical board! I don't know how often they deal with those sorts of issues, but I thin it would be worth a complaint.

[HomeBirthMommy]

Hi Carolyn! I'm so sorry you're having to go throught all of this. I just wanted to encourage you to keep up your fight. I used to work in the claims dept. of a big national insurance company. One thing I learned-if you annoy them enough and especially if you threaten legal aide, they will take your claim seriously!!! We had several claims that were "ify" as to coverage, but the policyholders raised such a fit, calling everyday, letters from attorneys, etc. that the claims were paid. Make sure you keep meticulous notes about date, time and person you spoke with. If they promise anything, ask for it in writing immediately. Sound confident and keep up the fight!!! Keep asking for supervisors/superiors and seriously call everyday and ask what progree they've made. One more thing, be confident, be slightly annoying, but don't be ugly-they have the right to hang up on you if they feel you're being abusive!
Also, follow up with your doctors office, get a copy of all of your records, so if the insurance needs those, you can send them instead of waiting for the dr's office. Tell them that you are concerned and that you really need their help to get them their money.
Good Luck with all of this and let us know what happens.
Feel free to pm me.

[panda]

Yikes! This sounds like an incredibly frustrating situation. I hope you can find some peace while everything gets worked out. Has the physicians' group given any explaination of why the total is so much higher than they estimated? Good grief, and the doctor wasn't even there for the birth!!

I'm in Chicago as well, and I wonder if I'm using the same group of doctors, since I know physician-assisted homebirth is quite rare. Is is bad to list the name of the group here? I'd love to know who's giving you these problems.

I wasn't sure if our insurance would cover a homebirth, and when I asked at the doctors office how much I would have to pay if insurance didn't help, they said $3500 (not including ultrasound and glucose test, if those become necessary). She said that they have a special program for people without insurance coverage, though, so I wouldn't have to pay nearly that much if it came to that.

Now I've heard back from my insurance provider, and they've agreed to cover almost everything. Reading this post makes me very nervous, though! I had actually read elsewhere that the group I'm using has strange billing methods, but I've been watching pretty carefully (I've only had 2 prenantal appointments so far) and haven't noticed anything out of line.

Best of luck!

[Sara29]

My goodness! What in the world came to 7 grand with an uncomplicated birth???? Did you get an itemized bill? Shoot my homebirth midwife charged $700(half that of insured clients) and a bit for a birthkit.No more than $800 total.
What a shame that people..ob,midwife,whatever will charge people so much.
Hope it all works out for you!
Sara in ohio

[heps]

EEKs!! I am sorry you are going through this. I too am in the Chicago area and I think that I know the doctor's group you are talking about. I had planned to go there, but now I don't know if I want to deal with this mess. The doctor's seem awesome, but the billing department does not. Please update us to tell us how it all goes.