Homebirth coverage denied as well as coverage in the event of a transfer? - Mothering Forums

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#1 of 12 Old 06-22-2013, 05:00 PM - Thread Starter
 
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I have been going back and forth with my health insurance for months now about getting my midwife, who is an in-network provider with my insurance company, covered for my homebirth. Up to very recently they reimbursed 100% for home birth but for some reason they are refusing to cover ours. We always knew that might be the case and have the funds saved to pay out of pocket, but what we were not expecting was a letter that arrived today saying this:

 

"Maternity home deliveries are not covered. This includes any charges incurred for the arranged home delivery of a newborn. Charges related to complications arising from a non-covered home birth will also be excluded."

 

We had NO idea that if we had to transfer from the home we would have to assume ALL of the costs associated with that transfer. At least that is what I think that statement means. Does anyone have any experience with this? I am currently 38 weeks pregnant so I don't have much time.


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#2 of 12 Old 06-22-2013, 05:08 PM
 
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Insane, but I wonder how they would even know. Call your local hospital and speak with billing maybe to find out if they code it differently than a normal birth. I mean what if you accidently had the baby at home or in the car?

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#3 of 12 Old 06-22-2013, 05:08 PM
 
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Yes, they will not cover complications associated with HB including transfer.

 

Insurance company is all about money. They expect higher rater of complication with HB and they also know that many HB practitioners do not carry malpractice insurance. So, they do not  assume risks.

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#4 of 12 Old 06-22-2013, 05:11 PM - Thread Starter
 
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So basically, if I had never contacted the insurance company to request coverage for a homebirth, they would have no record that I was even attempting one and would probably cover me in the event of a transfer...Great. I am screwed simply because I tried to get something covered.


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#5 of 12 Old 06-22-2013, 05:14 PM
 
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Not true. If it is their policy and  you were HB transfer they would have refused charges anyway. It would be in your chart.

 

1) You can appeal. There is probably 1800 number there.

 

2) Proceed with HB and hope that all goes well. However, accept possibility of bankruptcy as result of medical bills

 

 

3) Give birth int he hospital.

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#6 of 12 Old 06-22-2013, 06:08 PM
 
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Alenushka, do you have experience with this, or do you have special knowledge regarding health insurance policies/law, or are you just guessing?

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#7 of 12 Old 06-26-2013, 06:38 AM
 
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Quote:
Originally Posted by talldarkeyes View Post

We had NO idea that if we had to transfer from the home we would have to assume ALL of the costs associated with that transfer. At least that is what I think that statement means. Does anyone have any experience with this? I am currently 38 weeks pregnant so I don't have much time.

That was not my experience in CA. Have you spoken to your MW (or whoever does her billing)?  I had a HB transfer in CA and what I understood at the time was that my insurance would only cover ONE provider for the birth so when I transferred I needed to be aware that my HB would not be covered. When we did transfer we just let the hospital do the billing and because my MW's charges were so low (and included universal billing), we did not really pay anything above our copay out of pocket. I even contacted insurance about it and it seemed a non-issue for them. 

 

Now, I DID have coverage for HB so it's a different ball game but I suggest you look further into this...  

 

 

Quote:
Originally Posted by talldarkeyes View Post

So basically, if I had never contacted the insurance company to request coverage for a homebirth, they would have no record that I was even attempting one and would probably cover me in the event of a transfer...Great. I am screwed simply because I tried to get something covered.

 

I wouldn't get bogged down in this. For one, I just hate that mothers have to fudge their birth circumstances in the event of a transfer because of freaking insurance or poor HB/Hospital birth relations. It is less safe if you can not divulge all the details of your transfer so, if I were you, I would be at peace that you are open about that choice. 

 

Quote:
Originally Posted by ma2two View Post

Alenushka, do you have experience with this, or do you have special knowledge regarding health insurance policies/law, or are you just guessing?

 

Thank you for asking this ma2two. Alenushka, I have asked you to mention to our HB mamas that you have never had a HB when posting your opinion here in the Homebirth forum here at Mothering. As I explained our new members are right to assume that responses in the HB forum are from members with experience and support of the option to homebirth.  

 

Talldarkeyes, I really encourage you to look further into this. This is obviously a somewhat regional issue (in CA some insurance providers do cover HB and/or transfer costs).  The case in MD is that I think some insurance did (up until a couple of years ago) cover HB. Because your insurance will not cover HB, you are in a unique situation and I think you need to get some feedback from other HB families who have similar insurance in a state with similar attitudes towards HB. 

 

Do any of our PA mamas have some experience to share and/or do any mamas with similar insurance coverage have some feedback for this mama? Transfer families, what was your experience with coverage? Does anyone had a complication as a result of transfer have reimbursement stories? 


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#8 of 12 Old 06-26-2013, 06:50 AM
 
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Two more things...

 

That wording is confusing. I suppose it's a CYA thing for the insurance in the event of a catastrophic birth where the child or mother is injured as a result of a homebirth. The vast majority of transfers do not result in "complications" though so I wonder if your transfer is excluded or if they are just trying to get out of paying for some majorly expensive complication?  

 

Also... 

 

This is an ongoing nag in the back of my head when there is an attempt to regulate where a woman can give birth (whether that's through public policy or indirectly through insurance coverage).  What about unplanned HB? We all know a lot of women who have had an unplanned HB. Is your insurance company trying to get out of paying for complications as a result of that?  I wonder...  

 

That gets back to the issue of trying to fudge your birth plans. Grumble, grumble...  Folks who oppose HB and try to improve it through methods like this are just up my crawl. You want women to birth in the hospital? Stop supporting obstacles to timely, transparent transfers. 


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#9 of 12 Old 06-26-2013, 07:31 AM - Thread Starter
 
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Thank you, Identitycrisismama! I have spoken with my midwife and she is going to call the state insurance board to see if they can clarify what this means or even if they are legally allowed to do that. My midwife is covered with many different health insurances in PA, including Medicaid, and up until recently was covered by my health insurance. My midwife informed me that with the last 3 clients she has had with my insurance the "denial of coverage" letter has become more and more harshly worded. The first few letters said that while they would not cover the universal homebirth fee, they would cover home/office prenatal and post Natal visits. That seems quite reasonable to me, so I knew we might have to pay out of pocket to meet her entire fee but my letter did not indicate any of that wording. It is extremely frustrating and confusing! Now we are left to wonder not only IF our insurance with cover any of the costs but if they will even cover the costs in the even of a transfer for something like a 4th degree tear!

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#10 of 12 Old 06-26-2013, 09:07 AM
 
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I have special knowledge of insurance policies.

 

I also had to deal as consumer because of my son and I had to educate myself on many aspect.

 

The first rule of dealing with insurance is 1) Do not assume anything

 

Second one is

 

  2) Appeal

 

And the third one

 

  3) Be clear on what is going to happen.

 

 

Because of certain laws and regulations insurance do have right not to cover some thing and there is  nothing you can do about it.

 

In CA, one awesome resource is this. They cover HMOs and because of some legal things that happened years ago they deal with Blue Cross.

 

http://www.opa.ca.gov/Pages/Home.aspx

 

You can also hire a private Patient Advocate. Some workplaces have it as a benefit.

 

 

It worth doing it ahead of time so you will know what will be covered and what will be not and whatever it worth it to you.

 

I also recommend carefully reading your insurance plan documents and chapters such as  "coverage" and "exclusions".

 

 

Insurances are very much guided by things like "standards of care", "liability" and "licensed providers".  Some of those thing vary from state to state.  Most of the time insurance will use Federal guidelines such as Medicare or Medicaid standards.

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#11 of 12 Old 06-26-2013, 09:30 AM
 
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Quote:
Originally Posted by talldarkeyes View Post

The first few letters said that while they would not cover the universal homebirth fee, they would cover home/office prenatal and post Natal visits. 

First, I want to say that I have encountered this -- not sure where though. I was pregnant between my first and second child (miscarriage), which is where I think we found ourselves in that situation. Or...maybe it was when pregnant with my second. My experience with HB coverage is with two states: CA (which I shared) and MD, which was unusual because I had three providers in two pregnancies.  For one, like you, they would pay for all pre/post-natal work form the MW but not the actual birth. That's an odd thing to deal with because of how most MW's charge for birth. I also experienced that some MWs (even unrecognized CPMs) could bill certain insurance and not others and some CNMs could bill Medicaid but not some private insurance. It is certainly something that seems unique to HB but, I am fortunate to not have had to deal with insurance much outside of birth. 

 

Quote:
Originally Posted by talldarkeyes View Post

That seems quite reasonable to me, so I knew we might have to pay out of pocket to meet her entire fee but my letter did not indicate any of that wording. It is extremely frustrating and confusing! Now we are left to wonder not only IF our insurance with cover any of the costs but if they will even cover the costs in the even of a transfer for something like a 4th degree tear!

Because you have already told them your plans for birth...(and because you are saving them THOUSANDS of dollars by choosing HB!)...AND because it's in the best interest of safety for you to be open about your HB plans (IMO), I think I would follow up with the insurance company directly. As them if their letter intends to mean that they do not cover transfers of any kind. And if it's just complications as the result of a transfer, ask them how they plan on establishing where the complication occurred.  Talk about a can of worms!  

 

Quote:
Originally Posted by Alenushka View Post                                                                                                                                                                 
Most of the time insurance will use Federal guidelines such as Medicare or Medicaid standards.

Except not in the case of this family's insurance. In her case the MW she has chosen is covered by some Medicaid providers and other insurance providers in the area but not by her insurance plan. It was not my experience here in MD either. Using you special knowledge of insurance, can you provide some back-up for this statement specifically in terms of HB? 


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#12 of 12 Old 06-26-2013, 09:33 AM
 
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Appeals often work. And if they do not, at least you know what is coming.

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