Florida statue that midwifes covered as in-network?

[Damien]

I'm fighting United Healthcare (UHC) on coverage for the birth of our second child. We went with a midwife and her fees are not being covered because they say she is not an in-network provider. The thing is that we received a letter from UHC stating that she would be covered in-network, but now they're basically denying all of her claims - she sent them in a claim one way, they return saying they needed it another way, she re-files the corrected way, then they say she's not covered. I've got several statues (641.31, 627.6574, 627.6471) that say she must be accepted as a provider and that post-pardum care must be covered, but I can't see anything that says she has to be covered as an in-network provider. As a result of this, they're denying that we paid our in-network deductible and so are putting it towards the hospital bills (emergency c-sec), so the hospital is also looking for their money. At this point we are at 90 days after the birth and everyone wants their money. Anyone have any clues? Thanks.

[Damien]

Well, after calling it seems that the claims are still in appeal, and that it would take up to 30 business days after my 6/12/07 request before they would have a response. I still haven't found anything regarding it being covered in-network...

[GatorNNP]

you could try looking for a pro bono lawyer.

[fourgrtkidos]

Oh Damien,
I'm so sorry. First your birth doesn't go how you and Jen wanted and now this. Health insurance, hospitals and health care in general in this country sucks!! We pay such high insurance premiums and then they deny our claims......

Hope you and Jen are doing well. You may be in for a fight, but another pt. I know had this same situation last year and won in appeal meeting with the insurance agency. You are on the right track with your research.

Best of luck,
Student Midwife~ Michelle

[bryonyvaughn]

Some insurance companies will play people slow. They might take 29 of the 30 days to respond and then tell you, "Oh, we also need documentation D" and, once you submit documentation D get 30 more days to respond. This can play out over and over again.

In Michigan (I don't know about other states) health insurance companies are generally not liable for services over one year past and the full responsibility for the bills lands on the patient/policy holder. The only way I know around this is to sue the insurance company before the year is up.

While I hope it never comes to that point for you, I urge you to get a free consultation with a lawyer or two to see if Florida has any tricky regulations/statutes like that so can more knowledgeably navigate the insurance billing/reimbursement processes.

Good luck!

~BV

[Damien]

Thanks Michelle. Yeah, sometimes things just don't work out like you hope.

To quote the wondeful Babylon5:

"It's like I always say, you get farther with a kind word and a two-by-four than with just a kind word."

The two-by-four has been called into service..

[Damien]

bryonyvaughn: thanks, if it isn't sorted out when I hear from them on the 30th I'm going to do up a long letter detailing everything and send a copy to the state legistlator, just for good measure, and I may do as you said and contact a lawyer. I'll see how it goes.