Out of network provider question

[gratefulmama2isaac]

Hello all. I'm a doula who has a client who really wants to use a practice her insurance doesn't cover so she can have a waterbirth, or at least the possibility of one. I've seen posts on here about requesting an out of network provider in order to use a birth center, and am wondering how that works. Does anyone have any experience with this, clients who did it, what they said, suggestions? TIA

[crsta33]

I sucessfully got an out-of-network approval for my birth center for my first birth. My insurance was BCBS of MS. I just called at talked to a rep (I had to call anyway to "certify" the birth) and asked for the allowance, they did the center, but not the midwife, who knows why. But the birthcenter was able to bill in such a way as the midwife was covered too.

Write down who you talked to, when, and what they said and make sure to ask for it in writing...they mailed me a letter stating what they'd agreed to over the phone and I had to use it when they tried to not pay after the birth. It just took one phone call and saying, "but I have a letter from XXX that says..."

Oh, and if the phone call doesn't work, ask for an appeal and/or write a letter asking for an exception. It may take several phone calls and/or letters to get it done.

Christa

[gratefulmama2isaac]

Thank you so much, this is really helpful information!

[alegna]

The magic phrase is "gap exception"

-Angela