Midwife covered by insurance? - Mothering Forums

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Old 07-26-2006, 07:40 PM - Thread Starter
 
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My insurance it being dumb, and I can't get a real person on the phone. My first appointment with the midwife is Monday, and it would be great to know if insurance will cover me or not. I have Humana insurance (I think a PPO). Did you all have trouble getting coverage? Or even finding out if it was covered? Thanks
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Old 07-26-2006, 07:52 PM
 
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That's a LOADED question. Every plan is different (even within Humana). It might be best if your midwife called to verify benefits. She will know the right questions to ask.

Is your midwife "attached" to a free-standing birth center, OB/GYN office, or hospital? This may make a difference as well. You are entitled to coverage by a practitioner "working" at a covered facility even if the particular practitioner is not contracted.

In addition, if your policy entitles you to birth with a CNM or Freestanding BirthCenter but there is not a contracted provider within a certain distance (usually 50miles), then you can petition your plan to cover an "out-of-network" provider at in-network pricing.

I would also keep in contact with your (or DH's) HR department regarding your coverage ~ they should be able to help you get accurate information.

ALWAYS, write down the name (& ID# if poss) of anyone you talk to, the date & time, and what they said. Call several times and see if you get the same answer. If you get multiple answers ~ ask for a supervisor and ask them to fax you a copy of the policy where it describes midwifery care specifically.

p.s. I used to be the office manager at a free-standing birth center, and part of my duties included verifying benefits. Not to mention that I delivered DS at a birth center and was a hospital transfer for DD (that is also a bundle of dealings). If you want to PM me, I can try to get more specific for you.
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Old 07-26-2006, 07:59 PM
 
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I didn't mean to freak you out.

We did have a patient (Humana) who paid NOTHING for her care b/c of the way her policy was written.
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Old 07-27-2006, 12:50 PM - Thread Starter
 
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Thanks so much for the response. DH and I did some more research last night, and it looks like it could go either way, depending on who we get to talk to at the insurance (based on others' experiences). I really want to give birth at a birthing center, but I don't think we can pay it all out of pocket. I don't feel comfortable with a homebirth because DS had to spend 2 weeks in the NICU when he was born... I don't think I'd be able to relax at home. Anyway, thanks for the information.
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Old 07-27-2006, 01:38 PM
 
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You can also petition/appeal your ins to cover birth center care even if it is not specifically stated in the policy. (I would work with your HR dept on this).

Also, check w/the midwife. She may have a sliding scale or cash options that allow you to pay less than "list" for her services.

The birth center is a facility ~ your ins company would still have to cover it at the "out of network" rate.

Best of Luck!
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