Insurance covering homebirths? - Mothering Forums

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#1 of 12 Old 02-28-2011, 08:50 AM - Thread Starter
 
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Hi Ladies,

 

DH and I are meeting with HB midwife (CPM) next week for a consult.  We have blue cross blue shield PPO insurance in Mass.  The midwife said she'd had some luck with BCBS reimbursing for a HB after the birth by the way it was coded and billed, but I forget the details now.  This makes us a little nervous if they don't end up covering it, because that is a lot of money to pay out of pocket. ($3500).  I'm also leery about calling the insurance company and explicitly stating now that we're planning on a HB, because they are technically excluded from the policy. 

 

Anyone here successfully navigated the insurance thing for a homebirth?  I'd love to hear some encouraging words, even though I know each insurance company and each state is a little different.

 

Also, any Boston-area HB mammas want to share their insurance experience?

 

Thanks all!


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#2 of 12 Old 02-28-2011, 09:12 AM
 
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I was fortunate that my last homebirth ended up being covered by insurance, but it was a bit of a fight.  We (myself and also my midwife's office representative) called them up several times and were told that it would *not* be covered, no matter what, but the office rep kept trying a few more times, and eventually got someone who gave her a certain code to use for billing which allowed it to be covered. It's insane!!!

 

This time, I don't know what my insurance situation will be.  Right now I'm uninsured, and working on applying for either Medicaid or Colorado's supplemental program for non-insured individuals who don't qualify for Medicaid.  I've heard vaguely that homebirth isn't covered by medicaid, but is possibly covered by the state supplemental program.  But honestly, as soon as DH gets a job (pray that it's soon!!), I'll be on whatever insurance his company offers, and who knows whether it will be covered or not.

 

Also, the midwife I'm interviewing this week only gives you a sheet to submit for reimbursement, so I'd be paying out-of-pocket anyway, and who knows if it will actually get reimbursed or not.  I mean, I can totally see an insurance company saying, "Well, they already paid for it, so we're going to do everything we can think of to deny coverage!" 

 

But, I think it's worth it to me.  $3000 is a lot of money... but to save me the stress and anguish of being in an environment that just doesn't work for me OR for DH.... I'll do it.  As long as I can manage it, I'll do it.  But boy, would I sure love to see the insurance environment be more eager to cover these homebirths!  It's a win for everyone when they do.


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#3 of 12 Old 02-28-2011, 10:32 AM
 
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Yeah, I keep thinking about the costs they'd save on epidurals, episiotimy repairs, pitocin, c-sections...covering homebirths-which are cheaper than hospital births in the first place-would save insurance companies so much!!

Ours won't even cover midwives at all unless they are "affliated with an OB", which means they must work with an OB in the office. I'm jealous of all the families who are able to have homebirth(or at least the midwife!) covered. This is going to wear us down financially but there's no way I'll EVER give birth in a hospital again under normal healthy circumstances. We had an unassisted birth last time.


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#4 of 12 Old 02-28-2011, 10:51 AM
 
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I had a PPO plan in California that covered our licensed midwife at 60% as an out-of-network provider for #2. I had to pay upfront and was reimbursed. I saved my insurance company SO MUCH MONEY but they sure as heck did not pass that savings on to me- my same birth at the hospital that would have been covered at 100% would have been more like 10K. Instead they covered about $2400. And the hospital would have probably been more- since baby had jaundice and judging from my experience of #1, they would have aggressively treated that and boarded us both in the hospital for several extra days, which is a pretty penny!

 

Anyway, I just called up and asked. They clarified that as long as she is acting within her license, then she is covered as a "doctor". It was not a specifically excluded category.

 

If the home BIRTH is excluded, maybe your MW can shift how she bills to make more of it eligible? More for the Prenatal and PP care, and less for the actual birth itself? (since her global fee covers everything...)

 

Dunno how Mass works, but have you posted over in the homebirth area? People may have ideas.

 

I am now in NY and have heard that some people get the HB 100% covered and that there are some billers who work with the midwives here who are really good at getting it covered. I will likely have medicaid, and apparently that will cover HB if you pick the "right" managed care plan and bill it right. Exciting! I hope its true in my case.


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#5 of 12 Old 03-01-2011, 03:07 PM
 
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lurk.gifI live in MA (Gloucester) also, so I'll be interested in what you discover.

Quote:
Originally Posted by Amy May View Post

Hi Ladies,

 

DH and I are meeting with HB midwife (CPM) next week for a consult.  We have blue cross blue shield PPO insurance in Mass.  The midwife said she'd had some luck with BCBS reimbursing for a HB after the birth by the way it was coded and billed, but I forget the details now.  This makes us a little nervous if they don't end up covering it, because that is a lot of money to pay out of pocket. ($3500).  I'm also leery about calling the insurance company and explicitly stating now that we're planning on a HB, because they are technically excluded from the policy. 

 

Anyone here successfully navigated the insurance thing for a homebirth?  I'd love to hear some encouraging words, even though I know each insurance company and each state is a little different.

 

Also, any Boston-area HB mammas want to share their insurance experience?

 

Thanks all!



 


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#6 of 12 Old 03-01-2011, 06:16 PM
 
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Try searching around the forum. I found some pretty good info on PPO's covering HB's in MA (I think.. if I remember correctly.) It seems as though MA insurance companies will only cover CNM's and it's illegal for CNM's to attend HB's in Mass (One again, I think. Aren't I full of useful information? lol). But I think people have found ways around it. I live in NH and have an HMO.. so I'm totally screwed. There's no way around it for me. It's really heartbeaking. :(


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#7 of 12 Old 03-01-2011, 08:27 PM
 
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I have Tufts, and haven't found any information that is hopeful.


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#8 of 12 Old 03-01-2011, 09:20 PM
 
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I have Tufts as well.


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#9 of 12 Old 03-02-2011, 07:08 AM - Thread Starter
 
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Thanks for all the info, ladies.  I find that really frustrating too, that HB is SO MUCH LESS EXPENSIVE than a hospital birth.  I read in Henci Goer's book, The Thinking Woman's Guide to a Better Birth that because hospital equipment are so expensive (anesthesiologist team & emergency obstetrics team for epidurals, and electronic fetal monitoring) they have to maintain something like an 80% rate of use in order for the hospitals to break even.  How is that designed to save insurance companies (and taxpayers) money?

 

I'm also a little annoyed today because of the new laws for flex spending accounts and OTC medicine.  My claim for vitamins (extra folic acid, B6, prenatals) was rejected because first I need to go to the doctors, pay the $15 copay, and get a prescription.  I can, however, have a vasectomy or buy an artifical limb without a prescription and have it covered by my flex spending. 

 

I'll look at the other forums, and give an update after our consult with the MWs. 


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#10 of 12 Old 03-02-2011, 08:52 AM
 
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Amy May, I too am in MAhola.gif. I have explored the HB option but DH is totally against it. We're checking out a birth center on Monday. Back to your question, I have BCBS too. They made some changes to their policies last October that make it more difficult now. If you head over to the FYT Massachusetts forum you might be able to pull up some of the threads. I did speak with several CPMs and one said she has been successful getting it covered with BCBS. However, be prepared to pay first and then fight, dispute and fight some more with BCBS later. She told me that I would most likely be successful getting a HB covered because of my (documented) fast labors. With that, I could give documentation that by traveling to a hospital, I could possibly be endangering my health and that of the baby by possibly birth in a car (not a prospect I'm looking forward to).

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#11 of 12 Old 03-03-2011, 02:03 PM
 
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Emma - NYS law requires policies written in the state to cover HB. (Self insured companies are exempt from state law though.) The issue with Medicaid is that it underpays so badly that most NYC midwives can't afford to take it. They pay some ridiculous amount for global pregnancy/birth, something like $1200 or $1800. (Heck, a lot of OBs can't afford to take Medicaid patients because of it.) Legally, you can't balance-bill Medicaid patients--by accepting them, you're agreeing to accept Medicaid's fee and no more. So any midwife who tried having the client pay the difference is taking a big risk.


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#12 of 12 Old 03-04-2011, 06:36 AM
 
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In my experience (this will be HB #2, in state #2), the midwives are an excellent resource in letting you know what actually gets covered and how to do it "right" from the get-go.

 

Quote:
Originally Posted by AlexisT View Post

Emma - NYS law requires policies written in the state to cover HB. (Self insured companies are exempt from state law though.) The issue with Medicaid is that it underpays so badly that most NYC midwives can't afford to take it. They pay some ridiculous amount for global pregnancy/birth, something like $1200 or $1800. (Heck, a lot of OBs can't afford to take Medicaid patients because of it.) Legally, you can't balance-bill Medicaid patients--by accepting them, you're agreeing to accept Medicaid's fee and no more. So any midwife who tried having the client pay the difference is taking a big risk.

Two different HB midwives I've talked to here in NYC, as well as the biller who works for most of them, have said that as long as I choose the right group plan (HIP) it will cover the entire HB no problem. The only issue is that if I end up having a C/S, then I may be left with a balance for their fee. In that case, we'll set up a payment plan and they said they will work with families on that. They must have some way to deal with billing it that is not illegal. The ones I think I'm going with (met them yesterday, loved them) say normally there is no balance to pay and they don't require me to pay up front. They say they ask me only to pay for the birth assistant (which is $500) and they'll do a payment plan for me.

 

Actually they seemed more concerned with the possibility that DH will get a raise that puts us above the medicaid limit, and that its harder to cover it fully with the other state plans. Anyway, we figure if he gets that raise, we'll still net out more $$ for our family than with the free medicaid HB and lower income, so I'd certainly prefer that scenario in the long run.

 

The MWs also have a referral to a family practice doc who they say is excellent and very natural-minded, does peds and adults, and who takes medicaid.

 

I am delighted b/c our thought that I'd be back at work next fall is obviously not going to be happening. Despite the paperwork and bureaucracy headaches (which I've always had with private insurance as well), having GOOD medical care of our choosing covered by these programs is really a godsend for us. WOW, its like we live in Canada or England or something...


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