insurance guidance, of any kind? a bit of a rant and plea. - Mothering Forums

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#1 of 11 Old 12-02-2008, 01:39 PM - Thread Starter
 
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open enrollment is here! and my baby will soon follow...
also, i live in Virginia (which may sometimes couple with DC and MD)
typical scenario, have been seeing an OB on the preferred list of my current PPO but have seen the light(designated for me at least) and am transferring out of the care and hospital arena to choose one of the lovely local midwives in the DC/NoVa area. would love to take advantage of the best insurance provider available(ie best reimbursement and coverage of all things deemed 'alternative') before the end of enrollment (first week of december) but have become more and more frustrated in my search.
current plan: Federal BlueCross BlueShield, who only acknowledges the CNM license as an available reimbursement situation. 2009 benefits only seem to get worse with percentages and deductables. they do however, like every other prospective nationwide PPO provider gloat on and on about the incredibly large list of physicians and hospitals that will 'accept' us and cover 100% of everything. is this wondrous birthing event really treated like an illness? like some sort of life-threatening open-heart surgical procedure? a choosy face-lift?
in my search (listed far below) i have only found the same disturbing realities from incompetent customer service representatives for the maternity/mother/newborn care for 2009: no licenses are recognized unless it is that of a preferred or out of network CNM. are there work-arounds? how can this be possible? i have even tried to call numerous times to speak with various representatives of the same plan.

consequently, my options are A) i can blindly choose one of the PPO's for 2009 and hope that they could offer better assistance with reimbursment rates and understand the appeal process a bit better if i'm clever enough with a paper trail...or B) unwillingly stick with Federal BlueCross BlueShield regardless of the known fact that they are disregarding more home birth 'situations' and my percentage of reimbursement completely disappearing in '09 as there seems to be no hope in the world of helpful insurance providers anyway

assistance? reassurance? being that the list i have available to me equal to the same form of a 'benefit plan' does it truly matter if i switch or not? how can such inexpensive (in comparison to hospital births) natural rituals become such a dilemma? how awful!

thanks so much for reading.

just to get an idea, here is the list for my choosing of 2009 healthcare providers (maybe somebody, somewhere can shine a bit of light or clarity on what i've already mentioned on my findings/rant above) FFS=PPO, with the nationwide selections typically being a priority:

- Aetna HealthFund -CDHP- Most of Virginia CDP 877-459-6604 VA
- Aetna HealthFund -HDHP- Most of Virginia HDP 877-459-6604 VA - - - Aetna Open Access -basic- Northern/Central/Richmond Virginia Areas HMO 877-459-6604 VA
- Aetna Open Access -high- Northern/Central/Richmond Virginia Areas HMO 877-459-6604 VA
- APWU Health Plan -CDHP- Nationwide FFS 866-833-3463 Nationwide
- APWU Health Plan -high- Nationwide FFS 800-222-2798 Nationwide
- Association Benefit Plan -high- Specific Areas FFS 800-634-0069 Specific Groups
- Blue Cross and Blue Shield Service Benefit Plan -basic- Nationwide FFS Local phone # Nationwide
- Blue Cross and Blue Shield Service Benefit Plan -std- Nationwide FFS Local phone # Nationwide
- CareFirst BlueChoice -high- Northern Virginia HMO 866/296-7363 VA
- Foreign Service Benefit Plan -high- Specific Areas FFS 202-833-4910 Specific Groups
- GEHA Benefit Plan -high- Nationwide FFS 800-821-6136 Nationwide
- GEHA Benefit Plan -std- Nationwide FFS 800-821-6136 Nationwide
- GEHA High Deductible Health Plan -HDHP- Nationwide FFS 800-821-6136 Nationwide
- Kaiser Foundation Health Plan Mid-Atlantic States -high- Northern Virginia/Fredericksburg area HMO 1-877-574-3337 VA
- Kaiser Foundation Health Plan Mid-Atlantic States -std- Northern Virginia/Fredericksburg area HMO 1-877-574-3337 VA
- M.D. IPA -high- N.VA/Cntrl VA/Richmond/Tidewater/Roanoke HMO 877-835-9861 VA
- Mail Handlers Benefit Plan Consumer Option -HDHP- Nationwide FFS 800-694-9901 Nationwide
- Mail Handlers Benefit Plan -std- Nationwide FFS 800-410-7778 Nationwide
- Mail Handlers Benefit Plan Value Nationwide FFS 800-410-7778 Nationwide
- NALC -high- Nationwide FFS 888-636-6252 Nationwide
- Panama Canal Area Benefit Plan -high- Specific Areas FFS 800-424-8196 Specific Groups
- Rural Carrier Benefit Plan -high- Specific Areas FFS 800-638-8432 Specific Groups
- SAMBA -high- Nationwide FFS 800-638-6589 Nationwide
- SAMBA -std- Nationwide FFS 800-638-6589 Nationwide
- UnitedHealthcare Insurance Company, Inc. -CDHP- Virginia CDP 877-835-9861 VA
- UnitedHealthcare Insurance Company, Inc. -HDHP- Virginia HDP 877-835-9861 VA
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#2 of 11 Old 12-02-2008, 01:51 PM
 
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I'm not at all familiar with your plan options, but I can tell you about my experience so far and maybe that will help? I live on the west coast and have a Lumenos CDHP. They're merging and changing names next year...Anthem is the new name I think.

The way it works is my company sets aside an amount for me every year and that covers all my expenses at first. If I use all that money, I have to pay a bridge amount, then I go into traditional coverage where they cover a flat percentage. If I *don't* use all that money, I roll it over from year to year. So I've been rolling money for several years now and have lots of money in my pool to cover expenses. The real benefit of this plan is they do cover chiropractors and NDs and such - but they also cover home birth as what they call an HRA extra. Basically, they will cover it but if I go over my yearly allotment and don't have extra money in my pool, I could theoretically end up paying it back. This plan works REALLY well so far as my regular doctor is an out of network ND. The flexibility of this pool of money helps to ensure that she gets paid and I don't get stuck with huge deductibles. Plus, the paycheck deduction is less than with regular PPO plans. Theoretically, the entire cost of my home birth should be covered. We'll see what happens in June...

Another similar option is called the HDHP and it has even lower paycheck deductions and only covers preventative care. BUT you can put pre-tax money into a healthcare savings account. The HSA is controlled by IRS regulations and it is like a bank account where you keep the money - and I think you can use that money for any medical expenses. So you might be able to just stash money, then pay for your birth that way. I don't think it matters if your plan "covers" it or not. You would have to look into it more to know for sure. The key with this one is to look for a plan that includes an HSA.
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#3 of 11 Old 12-02-2008, 02:10 PM
 
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We did Lumenos one year too. We ended up going through the set amount of money much faster than anticipated and it ended up not being the best deal for us since our medical expenses were much higher than anticipated. (Though it was nice that they covered all co-pays for routine appts!) I didn't use them during a pregnancy. But I can understand where it might appeal to someone doing a homebirth who has very low medical needs normally. We decided to gamble on it and luckily had enough that we could pay for the 20% of other unexpected medical expenses. Personally, I wouldn't gamble on it with a birth since I'd worry too much about what if I end up with a baby who needs the NICU. But everyone's financial risk level is different!

I'm not in VA so I'm also not familiar with the specific plans. We use the most expensive plan that covers the most for peace of mind in the years when I'm going to birth a child. It turned out that my DH had a surprise of testicular cancer during this year too - despite no risk factors other than being male! Between me currently having a high risk pregnancy and the treatment he needed for the cancer, I'm very grateful that we payed a bit extra for insurance to get the best coverage possible.

*In the state I give birth in, midwives who don't do hospital births aren't technically "legal," so insurance won't pay for them unless you do a midwife in a hospital setting. But midwives are "legal" in the state I live in so some insurance will help out - a plan like Luminos does if you're willing to take the risk of less coverage in case of an emergency. (The coverage is still 80% with Luminos after you pay the bridge. But that 20% can add up fast if something serious happens).
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#4 of 11 Old 12-02-2008, 02:15 PM
 
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I have the Federal BCBS and they are covering my planned birth center birth (attended by CNMs of course) except for the normal copay...I don't know where you are in Virginia, but it's about a 1 hour drive from Tysons to my birthing center (Special Beginnings) in Annapolis which I do recommend. The Federal BCBS website does let you search for CNMs specifically. Your government insurance options are pretty limited re: homebirth, if that is what you really want. GEHA for example covers an attending CNM, but not a birth center (around $1500). I don't think any of the insurance plans available to govvies are down with homebirth, or if they are, they have such expensive premiums that you'd end up paying over $3000 anyway. That's the rub with the HSA plans...they take so much money up front, the deductibles are huge, etc. Plus I don't know how you would file a claim for a homebirth with a HSA? It is so iffy, I sweat every time I submit a claim for bona fide medical stuff like braces and copays, and always have to fight for reimbursement. I think if you find a CNM and stick with Federal BCBS or GEHA it will be worth the $2-3000 savings and generally will just be easier. also check this: http://virginiamidwives.net/
and this link:
http://www.mothering.com/discussions....php?t=1001815
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#5 of 11 Old 12-02-2008, 02:16 PM
 
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You might be best off finding a practice that you would like to work with and asking them what insurance they recommend. The billers in the offices know who they have trouble getting reimbursements from, who has large co-pays, etc.
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#6 of 11 Old 12-02-2008, 02:20 PM
 
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Without seeing all the specifics on the various insurance plans, I can't comment too much..

Other than I work for Medco (A prescription benefit manager.) and FEP (the Federal blue cross plan) is raising co-pays for a lot of their prescription plans. In some cases it's nearly double for brand name medications. Even if there is no generic alternative.
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#7 of 11 Old 12-03-2008, 06:13 PM - Thread Starter
 
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many thanks for all of your sincere replies...

i might begin to throw myself to random billing departments pleading for help (like my previous OB), and am even trying to work with any contacts of the CPM's that work in the DC area that use a billing service for assistance. (know anybody in Virginia?) hopefully they can at least peruse the most recent births and view the most cooperative insurances to share.

yes, it is very true that most federal plans, especially in the dc area with it's plethora of top providers it has to offer, is funny about licensures and homebirth, and even alternative treatments (clearly ruling out homeopathy and naturopathic reimbursements, for instance) but i suppose whatever is not clearly stated in their plans could become a work-around? Virginia does acknowledge the CPM and LM licenses, and given a lucky situation when doing births in the home, i've been told that these women are covered as an out-of-network provider after a certain percentage. when i began searching for a birthing facility early in my pregnancy, all those on the preferred list (which is unfortuantely far too few) were already booked, as were the CNM's that were associated with them. it's as if you must book with a CNM in one of those preferred provider facilities prior to conception! regardless, i am set on a homebirth, if all permits

though practically all similar in form, i've been able to gather some of the .pdf's for some of the 2009 calendar year providers for clarity. if by for some odd reason, or even out of curiosity, someone else could pick them apart on a whim, here they are:

Association Benefit Plan: http://compassrosebenefits.com/docum...BPBrochure.pdf

Foreign Service Benefit Plan:
https://www.afspa.org/home/pdfs/2009FSBPBrochure.pdf

NALC:
http://www.nalc.org/depart/hbp/Benef...I%2071-009.pdf

GEHA: https://webaccounts.geha.com/public/...ghBrochure.pdf

Samba:
https://webaccounts.geha.com/public/...ghBrochure.pdf

United:
http://staging.uhcfeds.com/files/fea...-HDHPFINAL.pdf

AWPU:
http://www.apwuhp.com/openseason/2009Brochure.pdf

Federal BlueCross BlueShield:
http://fepblue.org/benefitplans/open...re_English.pdf

Aetna:
http://custom.aetna.com/fehbp/pdf/20...ochure-AHF.pdf
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#8 of 11 Old 12-03-2008, 06:29 PM
 
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We live in MD and use NCAS Carefirst Bluecross/Blueshield through my dh's employer. They have two plans (at least through my dh's employer) and we pay for the more expensive one (I think it's $15 more a month). We have no complaints—except they put you on a silly "well baby" marketing thing (I asked them to remove me and they obliged). They are paying for most of our visits and care through our birth center (all midwives). They also covered most of our Level II sonogram. I was also pleasantly surprised to find they cover part (or all) chiropractic appointments, too.

Edit: BTW, I second Bedheadmaestro's suggestion for Special Beginnings. If they aren't too far of a drive for you, they are totally worth it! We live 50 minutes away from them. Even though the commute isn't easy, I wouldn't go anywhere else. They are wonderful, and—as prenatal care goes—I feel they are actually more thorough and attentive than any OB/GYN I've been to. While I've yet to birth there (cookin' my first ) I've heard only great things about them from local NFL boards—as well as the MD/DC/DE Tribal area here.

Enjoying the adventure of NFL with my partner-in-crime , DD 03.09 , , &
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#9 of 11 Old 12-03-2008, 09:18 PM
 
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Your best bet might be to call the CMN's you might want to go to and ask them if they are participating providers for any of the plans.

Mama to DS 10/06, DD & DS 08/09
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#10 of 11 Old 12-03-2008, 09:32 PM
 
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I don't know about Federal BCBS, but we have Empire (NY State) BCBS and I can tell you about our experience.

We're having a homebirth with a CNM. The CNM's office manager told us that Empire BCBS is one of the best plans in terms of covering a homebirth (in NYC at least), and that they almost always cover everything. Everything, wow, right?

I think how it works is that there aren't any in-network CNM's who do homebirth, so they get one of those out-of-network exception things that reimburse my out-of-network CNM as if she's in network.

I like the idea of finding a midwife you like, calling her office, and asking for their advice on choosing insurance. If you don't already have a certain midwife in mind, that's not a lot of time to choose though. What about calling a bunch of midwives (homebirth midwives, if that's what you're planning on--like in NYC there's only 10 midwives who do homebirth, so it wouldn't be too unrealistic to call all of them) and asking for insurance recommendations, and then going with a plan that most of the midwives recommend? That might give you more flexibility later in terms of choosing among the midwives.

Mama lady to my lady baby born 3/09 on the kitchen floor.  Looking forward to seeing which room's floor the next one will be born on in October.  love.gif
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#11 of 11 Old 12-04-2008, 12:46 PM
 
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Not sure where you are, but have you checked out Birthcare in Alexandria? We have Anthem BCBS and are planning a homebirth with them. I know they accept various of the govt plans, but some of them may require you to use the birth center (birthcare does both homebirths and birthcenter births). I'm sure if you call them they would be able to tell you if any of the govt plans cover homebirth. Good luck!
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