HMO insurance question

[2sweetboysmom]

Has any one (specifically in California) successfully fought their HMO to cover a midwife attended/home birth? If so then how? I am grasping at my last straw.
TIA

[crbyard]

Which company, specifically, are you dealing with? I had Kaiser and there was no way, no how that they would chip in for a home birth. They just don't do outside practitioners unless it's physically impossible to get to a Kaiser facility. Even then, they would want you rushed via ambulance to the nearest non-Kaiser hospital.

My friend had Blue Cross of CA and had no problem at all getting them to pay for 50% of the midwife costs. Due to trouble during labor, her midwife transferred her to the hospital, so at least she had coverage there as well.

I have switched from Kaiser to Blue Cross specifically for this reason. I absolutely will not be another cog in the babymaking factory that is Kaiser with my next birth.

Good luck to you. I will lurk to see if anyone knows of better options.

[ericswifey27]

I hate Kaiser. That is where I had my first son.

I have Pacificare POS right now, and I will probably be reimbursed for the prenatal and postnatal care, but not the actual homebirth. I haven't decided if I have the energy to try and fight the homebirth itself being covered.

[sparklett]

long response, sorry....

I have blue cross HMO and Health Net HMO. I live in So Cal, too. I have called both HMOs monthly to see if they would cover HB/MW, and they said no, no, no, no. I document every call. The only reason was becuase there was no MW in my network. So they DO cover the midwife care (probably not the HB), and I think I've got a fighting chance at getting something back becuase they cover midwives in other areas. They won't cover me becuase my stupid primary care doctor won't refer me out of the system to a local MW, and the closest MW within the HMO system is over an hour away (the HMO's won't cover prenatal services outside of a 50 mile radius from my house). :

So here's what I'm doing. Today I went to the human resources office at my work and explained how unhappy I was with my benefits. They gave me the number to our benefits broker, who is apparently good in helping in these situations. I gave him a call today and am awating a response. He's going to get an earful.

Also, I am going to torment my health care provider (a big regional medical group) until they agree to refer me out of the system to a MW. It seems that, becuase of malpractice reasons, Obs in my area don't like to treat women who are also seeing midwives (this is according to my MW). In fact, they will actually dismiss us from their care. There are only three OBs employed with the medical group, so my plan is to be dismissed from every single one of them until there's no one else to refer me to within the system. It will be a long process, but heck, what have I got to loose? Once I run out of OBs, I will request that the health care provider give me the referral I want, since no one else will see me.

I know, I know, it sounds like a lot of effort and time, but I'm determined to figure out a way to beat this. Between the broker and pure determination, I hope to at least have 1/3 of my midwifery care covered.

I'll let you know if it works.

[Cadence]

I have Blue Shield HMO in central CA, and am in a similar situation as Sparklett. I was told to do basically what she is doing- get referral denials from you primary care doc, and all the OBs in your group (in writing) I have 3 to choose from. Then appeal- Ugh.

Sparklett- I'm so impressed with your energy!! I can't stand talking to most docs about homebirth, I find it stressful and draining. So, I've been avoiding the situation. You rock! I'll try to become more inspired- since only consumers can really change the system!!

However, I did find one OB willing to order labs etc., so we don't have to pay out of pocket for these as well. He is also willing to be the backup if we need to transfer care for whatever reason-and knows about our homebirth plans- so this is a minor miracle.

Good luck to all of us- post if you find a strategy that works!

Be well,

Candace