getting homebirth covered by insurance

[gwinna]

Hello, I am trying to get some advice on getting insurance to pay for my homebirth. So far, I have submitted a claim to my insurance company and have gotten a denial back, stating that nurse midwives aren't eligible unless working under the direct supervision of a physician. Anybody have any luck with getting their homebirths covered? Thanks for your advice!

[mamaroni]

I don't have advice, but I am in the same boat, and looking for advice also.

Here is where I'm at: talked to my insurance company, and they said "just send in the reimbursement form for out-of-network care" like it was no big deal. I prodded with questions, and finally came to this: they need a provider code, which is where the OB comes in. So, unless I get them to change their policy, it seems unlikely I'll get this covered.

I wouldn't even know where to start!

[Spark]

This has been my experience in getting my homebirths paid for. (this is x-posted on the midwives/doulas board)

With my first I had Health Alliance Plan. They said that my midwife was out of network and would not pay for her. But, I had submitted a few $100 charges here and there and got them reimbersed 100%. I ended up having to pay all but $200 out of pocket. I then, proceeded to write letters, make phone calls, etc for a whole year and managed to get them to pay for 100% of the birth around my son's 1 year Birthday. The way they paid, is I kept repeating, "If you didn't pay for the $200, I would have discontinued services with my care provider, but I was under the impression, you were going to cover my care 100%." Also, they were never billed for the birth, but rather prenatal care. They liked that better, since they don't believe birth takes place outside of hospitals.

With this pregnancy I have Blue Cross/ Blue Shield Empire Blue PPO. They will cover 80% of out of network care after I have paid the first $250 out of pocket. That's a drastic savings. Yeah! I'm happy. They seem to jerk me around less than my old insurance.

Now, since you babes are due next year, your other option is to switch insurances if your current one is unfriendly. Your midwife might even be willing to not bill you until 2004, so all the care would appear on your new insurance, not your old one. I think you have options besides paying for it all. You may have to wait to be reimbersed and be diligent, but in my experience, you will get paid (at least some) back.

So, Gwinna -- I think I'd try finding out some more information from the insurance co you have. Midwives need to be working under a Dr., but then can't the midwife bill the insurance co? What if your MW switched what she's billing for? Women's health services instead of prenatal? Or pap-smear testing instead of pregnatal? Sometimes changing the services provided will make things a-ok. Try submitting a smaller claim like $35 or $50. Do they cover out of network providers? Then, that's exactly what your MW should be considered.

Colleen -- My MW has a provider code and... she's a lay midwife. Did you ask your MW if she has a provider code? She just might. You can try sending in a small claim to test the waters. Pretty much it seems like if they reimberse even a little bit, then you can do what I did for my first birth, be diligent and keep saying, "You paid for part of it, if I didn't know you were going to stop reimbersing, I would have switched providers..."

Insurance is a tough racket, but you can get your homebirth covered some of the time. It just takes some leg work and persistance.