Anyone pay cash to out of network midwife for homebirth and have to file on your own to insurance. My insurance will cover out of network, but we have already paid and I need to send in a claim. I have no clue how to break up the codes and amounts. We are filing or an in-network exemption, but doubt we will get it. I figure I can get back about a $1000 by filing. Crossing fingers :)
I don't know, but I would ask anyone else in the homebirth community in your area. A birth center might be able to help you with it, since they file this stuff alot. Even if they charge you (which, lets face it, midwives as a group are pretty laid back about helping each other out for free) it would be minimal compared to a successful filing/savings.
You can not request an in-network authorization/exception or GAP authorization (putting your midwife IN the network) AFTER the fact. This must be done at the onset of care.
You should file a 59400 code for Global Maternity/Obstetrical Care using the total you paid to your midwife.
Diagnosis code is V22.0 Supervision of normal first pregnancy or V22.1 Supervision of other normal pregnancy
Ask your midwife for ONE receipt with the total you paid, submit that ONE receipt with your claim form.
Your date of service (DOS) is the birth date of the baby. The place of service (POS) code for HOME is 12.
Good luck getting reimbursed. I HIGHLY recommend that MY clients allow my billing service to do their filing because when clients "do it themselves" they rarely get any money back (they just don't know enough to do the filing correctly).
Kim Mosny, CPM, LM
Home Birth Midwifery Service
This is based on my experience...
Depending on your insurance, you may be able to get an in-network exception AFTER the fact. When I was pregnant with my daughter in 2010, I didn't even know such a thing existed. I had Aetna and was planning a delivery at a free-standing birth center. They were out of network, just like the other birth center was where my son was born in 2007. My MW told me about this exception and Aetna easily granted it, so I thought, hmm...maybe they'd go back and refund some of my money from my son's birth in 07. Sure enough, they did! They granted an in-network except for my 1st child's birth, which occured over 2 years earlier! I got over $1K back! It's worth a try!
Now, if you happen to have BCBS, you're going to be in for a fight. Many BCBS companies won't grant an in-network exception at all. I have BCBS of NC and they won't. I'm working to get BCBS to change their policy on this all together. If you're interested in signing my petition so more women can get in-network exceptions and deliver with MW's and in birth centers, check this out: http://www.change.org/petitions/bcbsnc-executive-vp-and-chief-operating-officer-allow-pregnant-women-to-receive-care-at-any-free-standing-birth-center?utm_source=guides&utm_medium=email&utm_campaign=one_hundred_signatures