For those who have insurance and using HB MW in FL

[naturallyspeaking]

We have Blue Cross Blue Shield and one mw's assistance I talked to said, we might need to pay them "up front" and collect the money later by billing insurance and get the money from insurance, heh? (We'll hear more with the mw when we see her for a free 1st consultation in a week).
How many are doing this? Are we able to bill the insurance afterwards (after baby is born, I guess) and would insurance reimburse the total cost back (without being picky)??
Tell me how you pay your mw, per visit or up front by insurance or you?
I only have one more local mw and we used her last time when we didn't have insurance. Hopely her policy is different.

[nashvillemidwife]

I'm not in FL, but there are a lot of midwives who require full payment before the birth and reimburse you when they receive the insurance payment. I usually only require half paid up front when clients have insurance, but require full payment when clients have Blue Cross because they are so difficult to work with.

You cannot expect them to reimburse 100%. The claim will be subject to your deductible and copay, plus any amount they consider to be more than "usual and customary". "Usual and customary" varies from company to company and even policy to policy within the same company and you can't know until the claim is filed how much they will refuse to pay.

[MommytoTwo]

I had United healthcare but my mw billed them in increments and they paid her back in increments. I didnt have to pay up front. But they did deny some payments later on and I had to then pay her teh cash and then fight the ins company

You probably know its the law that FL based insurance has to cover midwifery care/homebirth.

[lscozzari]

I too am looking for a midwife in FL anf have run into some confusion regarding health insurance. please keep us posted about your discoveries and if possible, who you are using.

thanks

[Treeof3]

I hb'd in FL with a mw under BCBSFL PPO plan. (HMO may be different?) My particular mw did not make me pay up front all of it. She verified what portion they would cover outside of my deductible and then we set up payments for the difference (They only paid 80% or something) So prior to birth I paid her my deductible plus the 20% that wasn't covered by ins. I know that for self-pays she divides her fee into monthly payments that have her fee paid in full by 36 wks. That's what I would expect your mw to do. An alternative would be to get a letter from your ins stating what they will cover and paying her the difference if they won't cover all of it.

[nashvillemidwife]

The problem with that is the most of the time (in my experience) insurance companies are going to write off part of the midwife's fee as "above usual and customary" and only pay their 80% on the amount they choose to cover, leaving you would a couple hundred dollars balance in addition to your copay and deductible.

When an insurance company declares something to be more than "usual and customary" is does NOT mean that the midwife charges too much. Insurance companies are really wonky on how they determine that amount, and it varies widely not only from company to company but from policy to policy among each individual company. In my experience, usual and customary is usually determined by writing off a certain amount from what the charge is rather than being a predetermined set amount.

Some midwives "get around" this scenario by billing insurance more than they bill the client, which is totally illegal.

[onlyboys]

I have heard of this, but honestly I think it's sketchy. I know the reason--the midwife wants to be paid her full fee, and I don't fault her for this, I guess.

So basically, it's a way for the midwife to get reimubursed for her whole fee instead of what the insurance company contracts for. Meh. I think that if you plan to accept insurance, you should just take the usual and customary price that they will pay you. Or, don't accept insurance and just take cash pays.

But it doesn't mean that the midwife isn't a good midwife, just that she wants her full payment, you know?

[meredyth0315]

I have BCBS PPO and I had 2 copays of $45, one at the 1st actual appt, then the other $45 was due at the birth. Her fee was $3200 of which insurance covered $2500. You can track claims online and see what gets paid if your mw bills that way. I know some choose to have an outside party file claims and so on. I have heard that BCBS causes some issues after the birth by not wanting to pay, so just something to keep in mind. GL with your HB

[nashvillemidwife]

Originally Posted by onlyboys

I have heard of this, but honestly I think it's sketchy. I know the reason--the midwife wants to be paid her full fee, and I don't fault her for this, I guess.

So basically, it's a way for the midwife to get reimubursed for her whole fee instead of what the insurance company contracts for. Meh. I think that if you plan to accept insurance, you should just take the usual and customary price that they will pay you. Or, don't accept insurance and just take cash pays.

I think we are talking about two separate issues here. I'm talking about out-of-network reimbursement, which is what most homebirth midwives fall under. You're talking about contract rates, which is for in-network providers and it doesn't work the same.

[manamakeri]

I'm in Florida and having a homebirth with a midwife. She requires the full amount to be paid by 36 weeks. After the birth, they will then bill my insurance, and I will be reimbursed. I'm actually covered under two insurance policies (one through my husband's work and one through mine). Hopefully we will see some of the money back.

I understand why the midwives do it that way. In my county there are only 2 homebirth midwives. I feel its important for them to stay in business so even though it is no fun to pay $450 at every appointment, at least I know I am putting it toward having the birth I want. The midwife explained that insurance companies are way more likely to reimburse the policy holder versus paying the midwife. They tried for a while doing it the normal way (mom only pays copay, they bill insurance, etc) but many of the insurance companies were not paying out in a timely manner. It's hard to run a business, especially one that has an office, if you don't have any money to pay the bills.

My only criticism of the way the midwife does the billing is the global billing after the birth. I understand that I am currently paying for services that have not yet been provided and that is the reason why they don't bill until after the birth. I do find it annoying that it will be sometime next year before I see any of the money back. Also, when they do labs, the company that performs the tests bills my insurance. It doesn't seem as though they gave them both of my insurance cards. So far they have only billed Signa and not even billed BCBS.

[Birdie B.]

I am on Capital Health Plan, and my midwives accept this insurance. They bill the insurance directly, I only pay $250. I know this means they have to accept less than their usual fee, and I am really grateful that they do. I think they accept all forms of insurance, because they want everyone to be able to have the homebirth.
However, my midwives work at a FSBC, and bill the insurance as such, even though they will be attending me at home. I think that's an advantage of using this midwife practice, because they have the birth center as a base, so don't have to tell the insurance company that it is actually a homebirth.
Good luck

[ZoeyZoo]

Not in FL but insurance companies have to cover MWs in my state too. I had to do the same thing.

Just be prepared not to get the money back for a while. My insurance company usually pays very quickly for office visits and labs with in-network providers. I've been waiting a few months now and keep calling to find the status. My insurance covers birth centers and has no out of hospital exclusions so I didn't think it would be so difficult.

I think part of the problem is the codes my MW billed under. She billed under "home services" instead of "global delivery".

[CanidFL]

I am in FL and used a home birth midwife. She did not ask for payment up front but has sinced changed her policy and everything must be paid in full by 36 weeks then we bill the insurance company later.

The law is very clear in Florida. If the insurance company pays for maternity care, then they must cover midwives. If there is not a midwife in their network, then the must pay the "usual and customary fee - 10%". So if my midwife charges $4,000 and the other 4 midwives in my city charge $4,000 then they must pay minimum $3,600.

Don't except any less. If they don't pay then appeal as many times as possible. If that does not work then sue them. Also, it's important to talk to them before hand and get a reference number with them stating the pay for marternity care.

See my thread on suing my insurance company

http://www.mothering.com/discussions...urance+company

[CanidFL]

misunderstood the pp

[nashvillemidwife]

The poster was talking about midwives who contract with insurance companies. She right, if you are going to enter into a contract then not only are you ethically bound to accept that negotiated payment, you are legally required to do so. This is why most midwives DON'T contract with insurance companies.

Remaining "out-of-network" and holding clients responsible for the remaining balance is an entirely different story.

[nashvillemidwife]

Originally Posted by CanidFL

The law is very clear in Florida. If the insurance company pays for maternity care, then they must cover midwives. If there is not a midwife in their network, then the must pay the "usual and customary fee - 10%". So if my midwife charges $4,000 and the other 4 midwives in my city charge $4,000 then they must pay minimum $3,600.

Do you know whether the law states that "usual and customary" can be based on what the company pays for in-network fees? More and more PPO plans are moving toward this. Rather than formulating "U&C" based on what providers are charging, they are making their decisions based on what they would pay the midwife if she were in-network, which is considerably less.

[CanidFL]

Originally Posted by nashvillemidwife

The poster was talking about midwives who contract with insurance companies. She right, if you are going to enter into a contract then not only are you ethically bound to accept that negotiated payment, you are legally required to do so. This is why most midwives DON'T contract with insurance companies.

Remaining "out-of-network" and holding clients responsible for the remaining balance is an entirely different story.

oooh ooops! Sorry I misunderstood.

Do you know whether the law states that "usual and customary" can be based on what the company pays for in-network fees?

The law does not say specifically so it is up for interpretation. While suing, we got the fees of all the midwives in the area and presented that as the usual and customary fee.

[loraxc]

FWIW, I homebirthed in FL and ended up only paying $250 or so because I switched to an HMO that covers maternity really well; but when I was still on BCBS PPO we discussed payment and it was due at 36 weeks, I believe, but *but only my portion* (not the full amount). My MWs employ someone to do their insurance.