Why why WHY?! Insurance vent

[smittenmom]

I would like to deliver my next baby at home (we're hoping for spring 2005), and was happy when I checked our insurance stuff and it didn't say that it wouldn't pay for a home birth. I thought, well, if they put up a fight I can argue it and probably get them to pay.

But today my dh brought home a new booklet outlining the *new* benefits, and the maternity section has been changed to specifically say that they won't cover home births! WHY would they do that?! It makes no sense to me! A home birth is so much cheaper than a hospital birth... why would they WANT to pay more? Of course it also p!$$es me off personally, too, because I don't think we'll be able to afford a home birth out-of-pocket, and I don't want the decision of where to deliver to come down to money.

Oh, it's just not a good day. Maybe we'll find a solution in the next year and a half.

But WHY!!!!????!!!!

[ja mama]

We had to deliver in a hospital to have ins cover it, and we couldn't afford to do it at home, either. I even tried negotiating with the ins company that if my homebirth needed to be sent to the hospital, they wouldn't have to pay for both. The thing that really baffled me was I'd already had one birth at their hospital, totally natural, totally normal no risks to consider... And my second pregnancy was 'normal' too. We ended up birthing in their se but I brought a doula(who is very outspoken) and my dh and essentially kicked the hospital personel out of my room and let nature take its course. It ended up being a great experience, better than I thought possible in a hospital setting.

[shelbean91]

I'm in the same position. Just found out I'm pg, due in June and insurance won't cover homebirth which is about 1/3 the cost. There is NO way we can pay out of pocket- no matter how flexible payment arrangements are.

One thing I considered is using our flexible medical reimbursement. I don't know if that's an option for you or not, but it's something to consider.

[kama'aina mama]

That sucks. Call the company and try to find out why. But, in the meantime, opene an account and try to squeeze $50 a month out of your budget and put it aside. You will have about $1000 plus interest by then.

[rubelin]

our ins doesn't cover homebirth, AND has NO midwives on the plan either. Last time we went with an OB and hospital because we couldn't afford a HB, but we got what we paid for this time I will be at home, and we will find the money to do it, no matter what.

I hate that where you birth ever has to come down to money, and that I might end up with an unassisted birth (which is not my preference) because we might not be able to pay for a midwife.

[pamamidwife]

Is your plan Aetna? They're one of the few that has specifically stated NO HOMEBIRTH COVERAGE.

Ah, sure it's cheaper for them. But, it's about politics, not always money in the long run. Plus, they want people who are covered by malpractice insurance and most homebirth midwives are not.

[liz-hippymom]

not trying to steal the thread, but my health insurance is Aetna, and i was going to try this-
my plan is a PPO so they will cover 80 % of out of network providers, SO i was going to try to have the pay for "prenatals" through my midwife, and hopefully cover most of he cost.
shouldnt this work??

[Wildcrafter]

It cost about $20,000 to have a birth and c-section in a hospital. To me it's all about greed and control. Their standpoint is liability which is ridiculous when you take into account the number of problems that occur in hospital births compared to homebirths.

Incidentally, our insurance only paid 80% and what we had to pay out of pocket is more than a home birth costs. Have you checked into a home birth? Around here you pay $1200 and that includes monthly home visits and the birth. I was shocked at how inexpensive it was. Maybe instead of throwing you a shower, people could donate to this cause?

[Wildcrafter]

By the way, if you plan to have a home birth and also go to insurance paid prenatal visits, plan to be dropped. More than likely if you tell you OB they will tell you my way or highway, I believe they have to because of liability. I was going to plan a homebirth and go to prenatal visits to appease family but was told no way. So homebirth it is next time around!!!!

[Arduinna]

Insurance companies like to have control, the last thing I want is an insurance company telling my midwife what to do. While I sympathize with the problem of paying out of pocket, I think in the long run it would be bad for insurance Co to get their foot in the home birth door. My midwife charged 1200 dollars and was quite flexible with payments. I'd beg borrow and steal before having a hospital birth.

[smittenmom]

$1200? Really? I was assuming it was more than that--like double that. But I haven't actually asked around yet. If it's actually that cheap around here, we could probably swing it somehow. I mentioned to dh the idea of starting to save now, and he seemed okay with that. The thing is, I'm not 100% sure that home birth is the way I want to go, but the more I learn, the more I think I want to do it. And I certainly want to have the option!

Pam, our insurance is Atrium, which I think (don't quote me on this) is an extention of Blue Cross Blue Shield. Apparently they're not the only ones putting restrictions on home birth, though...

Arduinna, you have a good point about the insurance companies controlling what happens during birth. Looking at it that way, maybe it's a good thing. But of course it would still be nice to have a home birth paid for. The best thing would be if everyone recognized that it's a safe option and it became the norm! Then I bet they'd have to start paying!

[rubelin]

$1200!! WOW! that's amazing! around here's it's average of $3500 for the whole she-bang. I've actually been putting off meeting a MW because I don't think we can swing it financially and don't want to get attached and then have to leave to do it alone.

[Greaseball]

What about Medicaid? They cover home births (at least in my state, check with yours) if you apply during the last trimester. You can keep the insurance you have now, then cancel when you are 7 mos and get Medicaid, (which will cover you for 3 mos postpartum and the newborn for a year) and then switch back to your other plan. That's what I'm doing.

You don't have to be quite so low-income if you are pregnant. Try asking if any midwives in your area will accept it. All of them around here will.

Or, you could call some midwives and tell them you have absolutely no money and your only option is to deliver alone. That might freak them out enough to agree to have you delivered by a student midwife for free. One that I know of will even accept goods and services for payment.

[Arduinna]

My midwife was a DEM or lay midwife. Yes, LA is alot more expensive (lived there for over 30 years).

[Nosy Parker]

Originally posted by Arduinna
Insurance companies like to have control, the last thing I want is an insurance company telling my midwife what to do. While I sympathize with the problem of paying out of pocket, I think in the long run it would be bad for insurance Co to get their foot in the home birth door. My midwife charged 1200 dollars and was quite flexible with payments. I'd beg borrow and steal before having a hospital birth.

ITA While it would be nice to have the ins. co. pick up the tab, it comes with a trade-off. In order to be covered by health insurance, usually the practitioner has to be licensed. In order to be licensed, a practioner usually has to carry malpractice insurance - and that's where the trouble starts. A midwife's malpractice carrier can tell her how to practice. Instead of just you and your midwife making decisions about your care, there will be an actuary in Omaha making decisions for you. They can tell your midwife, "No home VBACs. No homebirths post 41 weeks, etc."

Malpractice coverage is very, very expensive, and is a big part of your cost in a birth with a CNM, MD, or LM. My state doesn't license DEMs, so malpractice coverage isn't availiable to them. My homebirth cost me $1300 plus supplies, and my midwife didn't answer to anyone but me. I prefer it that way.

[momto l&a]

About hb costs, somewhere on Mothering Boards there are at least 2 threads where posters state where they live, the fees and whats included in those costs.

I live in Idaho and pay 1,400 for birth and post birth care. Prenatals are $35. My mw will consider trades and I know for somepeopel she cuts her costs so families can have the births they want.

[Spark]

Am I missing something? Why are people telling their insurance that they're planning a homebirth? Why does the insurance company need to know?

The "truth" the insurance company cares about is that you're using an out-of-network provider or "I've found a wonderful nurse that covers prenatal appointments for Drs in the area. I love her. How can I get my appointments with her covered?" They don't need to know where you plan on giving birth or how.

Your midwife can write you up bills for prenatal care. Then, one for the birth and then some for post-natal care. If they cover the prenatal care, they most likely will cover the birth and will certainly cover postnatal care. If they don't cover the birth, then low and behold have some more prenatals you forgot to send in to the claims dept.

This will be my 2nd homebirth covered by 2 different insurances (one HMO, one PPO). Neither time have I mentioned the word "homebirth." It did take more leg work than getting a hospital birth, but in the end my PPO covered 100% and my HMO will cover 80%.

Personally, I would sell fruit roadside to pay for my homebirths out of pocket, but it's nice to be diligent and just get insurance to pay for it.

Remember, too, UC is an option. And, it's the best for your pocketbook! Best wishes!

[wildthing]

Just my experiences

When I had my firs hb, we started out the pregnancy with a PPO, which would pay 70% for an out-of-network provider. Didn't matter who it was or what it was for, no questions asked. However, the day after I turned 7 months pg, dh's company switched to an HMO. Now, I amnot sure if this is policy or law, but the HR department at dh's work told me that they could not force me to change care providers in my 3rd trimester. So, basically, we fought and got the HMO to pay my midwife. They tried to negotiate her fee down to 1/3 what she charges, and she and I both adamantly refused to accept it.

For the next 3 homebirths, we knew there was no way to get insurance to cover it, so we didn't bother. Our HMO does not cover any out of network providers. So, we negotiated with the mw, and she agreed to let us pay $100 a month until it was paid off. She gave us a discount for being cash paying. Her regular fee was $2900, but she charged us $2500. (I live in San Diego, for the record) It usually takes us a while to pay it off, but it gets done. In fact, I am expecting now, and still paying off the last birth.

Now a new twist....I am not going to the previous mw for this birth. I foun another mw that I loved speaking to, and felt an instant connection with. However, she told me her fee, and I froze. there was no way we could pay it. I was so upset, I cried. I would prefer an unassisted birth, but dh wants a mw, and this person was perfect. Anyway, I told her we couldn't afford her fee, and I told her how disappointed I was. She e-mailed me back and said YES I can afford her! She told me to tell her what I could afford, and we would definitely work it out. I am so relieved. I didn't know who to find to ease dh's concern's and still maintain the wished I have for my birth.

Additionally, we have a flex plan through dh's work, and w have been able to get reimbursed for every one of our homebirths, no qustions asked at all.

[rubelin]

Sparklin, I'd love to hear how you got your HMO to pay for your homebirth. I don't even know where to start in asking questions. Our HMO medical group (where our Primary Care Physician is a member) only contract with ONE OB's office and even the In-Network choices for PPO (which we dropped last year because the cost doubled) does not list a single MW.

I think our hands are tied on this, but I'd love to get even a small amount of our birth paid for.

[Spark]

I got it mixed up with my HMO my birth was covered 100%. With the PPO it's 80%.

Rubelin -- this is how I got my HMO to cover my homebirth. I was always very honest with them, I just never mentioned the word homebirth. Before I submitted a claim I found out more info about their rules and regulations. My primary care provider did not do OB work. So, I went to "a wonderful nurse who does prenatal appointments" instead. Her first bill was $30-50. I submitted it and she was sent a check a little later. It did take a few phone calls to make this all happen. Every time I took down the name of the other person on the phone and the time/date I called. I repeated, "No she's not on the list because she works with care-providers at St. Joseph Hospital, but her costs are much cheaper." It's true my midwife does work with care-proviers at my mandated hospital, but only when she has to transfer a client. Then from there we just kept on billing. They covered about $600 more with no problems, but then a flag was thrown somewhere. I was slow to submit bills and by this point I was 9 months along. I forgot about the insurance company until my son was a little older. Then, I wrote/faxed/called them once a month or so (always keeping my log and saying who told me it would be no problem). My argument was, "You paid for these bill, so I continued care. If you had denied my bills up front I would have just gone to the expensive busy hospital Drs for prenatals wasting my time and your money." (that was the only thing would qualify as dishonest -- I would have still planned a homebirth) Finally, on my son's first birthday a check was sent to my midwife for the remainder of the homebirth. I think it would have arrived sooner if I had called once a week, but I was busy with babyland. (My HMO was HAP -- Health Alliance Plan)

I know that I'm not the only one that got an HMO to cover their homebirth. A couple of my friends did, too. Most took similiar route that I took. Although one woman got a referrel from her Dr. to use a LM. That seemed to work beautifully. She didn't have to call as many times as the rest of us did. She also had a really cool Dr.

Best of luck!