I'm so disappointed...

[chalynm]

Just got a call from the insurance today. They have declined to provide network gap coverage for the birth center because they consider the maternity facilities in our area to be adequate. Those are the exact words the woman used. The facilities are considered adequate. I couldn't believe it. I asked her if I was correct in understanding that it makes no difference that I don't agree w/ the active management approach to labor and delivery that the hospitals in our area take, and she said, "No, it makes no difference. We consider the facilities to be adequate and are therefore refusing to cover the birth center you requested."

I don't know about the midwife coverage. They assigned a different person to evaluate that part of the request. But I can't imagine that they would consider the maternity facilities to be adequate but the medical professionals not. I'm sure I'll be hearing from an equally unsympathetic customer care coordinator sometime soon.

I called dh w/ the news, and he exploded. "Let's just have the :censored baby at home and :censored them all." I have to admit part of me was thrilled to hear this response. But I was good and told him that, while I would be perfectly happy to do so, I thought it would be best if we sleep on it and talk about it more tomorrow. I'm all for UC, but I don't want dh to agree simply because he's upset w/ the insurance.

I just can't believe their response, ya know? Just because a given facility or practitioner is adequate in no way means that they are appropriate, to say the least. Beside, how many people do you know that celebrate their adequacy? I don't recall ever seeing a single hospital or doctor's office include the word adequate in their advertising.

I'm not really sure what I expected from the insurance company, but this certainly wasn't it. What a colossal waste of money.

[AutumnMama]

:hug
I'm sorry, that stinks!
I'm glad your husband said that though. Probably what I would've been feeling too!

'Adequate', sheesh :hopmad

[BirthFree]

What a royal pain. That's crummy they don't consider beyond "norm" stuff acceptable. If you want to explore, ask the midwives at the birthcenter if they take barter or payment plans. They may be open to lots of different options (most midwives are). Really too bad that you're having to deal with this at all... just not something I think should happen (pg and worrying about stuff like that). Hope you find a solution soon!

[SammyLucasNHarper]

:censored insurance company...

I have a feeling mine is going to be a PITA too...

Persistance though.....

I had a NEED for a good breastpump (mastitis more times than i would like to admit) and my doc prescribed it...insurance denyed it the first time...I had them re evaluate..it took a year...but they paid...and then they paid the whole thing too! I didnt have to pay a THING for it! persistance....I would try again. But make sure to have your reasons...not just a "because i want too"

[chalynm]

Update:

I just talked to someone in the benefits department at dh's work, and she was outraged at the way the insurance has responded. She has a meeting w/ an insurance rep this afternoon, and she's going to bring up my issues and see what she can find out. Wish us luck!

[marymamma]

With my daughter, my insurance company told my midwife that they didn't pay for homebirth. I don't know exactly how she filed it, but she got paid anyway. I think she just filed for the midwife services only. There was just no paperwork filed that directly stated "homebirth".

Would any of the midwives at the birth center be willing to do a homebirth with you? If your insurance will cover the midwife's fee, that may be an option. Or, maybe they could file for the midwife services, and not mention the birth center? Good luck!

[Mimi37]

I just talked to someone in the benefits department at dh's work, and she was outraged at the way the insurance has responded.

Hey, that's great she's going to bat for you. It boggles my mind -- a midwife would be CHEAPER for the insurance company... It's not like some insurance companies haven't figured this out -- mine encourages us to use midwives by making us pay only one office visit copay for the whole pregnancy (unlike one copay each visit with an OB). If I thought insurance companies did things at all rationally, I would suggest pointing this out to yours... unfortunately, I don't have any such faith in insurance companies... Can you talk to the boss's boss's boss (etc) of the rep who turned you down?

GOOD LUCK!

[EJWB]

I feel for you, you shouldn't have to worry about things like this while you're pregnant!
Hope all turn out the way you want to though despite all the trouble you're going through for it right now.
I live in the Netherlands, where you usually have to pay (some part of) a hospital birth if there's no special reason for you to have a hospital birth. So here homebirth is encouraged, although increasing numbers of women decide to give birth in a hospital none the less (I don't believe the fee the insurance companies make you pay is very high).

[Evergreen]

So, did everything turn out okay?