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#1 of 16 Old 07-20-2013, 09:35 PM - Thread Starter
 
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Does anyone have any advice? Or anyone successfully done this? We have met our in-network deductible. And insurance pays 80% now. However, my MW is considered out-of-network. That is a whole separate deductible that we have not met. I talked to my insurance, they have midwives, however they are only hospital related midwives. I've done some research and have found that some have asked that their MW be considered a gap exception and pay her as in-network. Since none of the providers they have, offer the service they need (home birth). I also have plans to prove I'm low risk, have home birthed previously and how it will save them quite a bit of money. Oh and I have BCBS of TX.

 

I was mostly curious if anyone has done this and if so, advice.


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#2 of 16 Old 07-21-2013, 06:03 AM
 
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Sure!  I would say it's not a "give-in" that insurance will pay but certainly lots of them do. Have you talked to your MW about her experience with your provider?  Also, do a search here...this topic comes up all the time and reading some of those old threads should help you get a picture of what it's been like for other HB mamas (the good, the bad, and the ugly).  ;-)  Good luck! 


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#3 of 16 Old 07-21-2013, 05:49 PM - Thread Starter
 
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Thank you! I haven't talked to my MW yet. I meet with her on Wednesday and plan to discuss what I want to do.


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#4 of 16 Old 07-21-2013, 08:12 PM
 
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I applied for an in network gap exception fully anticipating having to appeal. I even had letters ready for my midwife's biller and others online. Fortunately United Healthcare approved my in network gap exception on the first try!!
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#5 of 16 Old 07-22-2013, 08:33 AM
 
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Quote:
Originally Posted by LittleBlackBug View Post

I applied for an in network gap exception fully anticipating having to appeal. I even had letters ready for my midwife's biller and others online. Fortunately United Healthcare approved my in network gap exception on the first try!!

 

If you don't mind sharing, what state are you in?  I've been told here in Wisconsin that UHC is very clearly telling people that in-network gap exceptions are not going to happen and any employee caught giving one will be fired.  I've also heard of one couple who got approved but when the time came to pay the bill, they totally backed out on it.  I tried five years ago with my son and got nowhere, so I didn't even try this time.  It seems to vary by region of the country from the anecdotes I've been reading about.


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#6 of 16 Old 07-22-2013, 07:32 PM
 
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I am in Colorado. My midwife was already in their system from previous births that we covered, I don't know if that helped. I am waiting for the final submitted to my insurance, so hopefully they don't change their mind. If they do, I'll appeal as the company I work for is self insured and would save a lot by covering the home birth.
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#7 of 16 Old 07-25-2013, 12:24 PM - Thread Starter
 
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Just a little update. I called today, and they tried to tell me home birth is not a necessity and that they provide MWs that do hospital births, in-network. So I got the appeals address and am now writing up my letter to send them tomorrow.


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#8 of 16 Old 07-25-2013, 12:58 PM
 
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I don't think mentioning that homebirth is cheaper will help your case. If they think you'll get a homebirth no matter what they say, their choices are 1) pay for your homebirth 2) pay nothing for your birth. It's the same reason that it actually makes sense not to cover birth control: women will pay for contraception out of pocket if they have to. 

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#9 of 16 Old 07-30-2013, 08:34 PM
 
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Here's a sample form from Larsen Billing:

 

http://www.midwiferyservices.org/In_Network_exception_form.pdf


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#10 of 16 Old 11-06-2013, 05:29 PM
 
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Did you end up getting help from your insurance?
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#11 of 16 Old 12-26-2013, 03:15 PM
 
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I was able to get my insurance to cover my first homebirth 100% when I got an out-of-network exception. I'm really hoping I can do that again this time :)


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#12 of 16 Old 01-14-2014, 11:16 AM
 
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Were you able to get this handled? I'm in a similar situation, but haven't yet had my first prenatal because of this issue.


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#13 of 16 Old 01-14-2014, 07:17 PM
 
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I know this is old now but I am in the same boat. My midwife charges $7500 (nj)!! And it is out of network. When I asked my midwife she said it would definitely be out of network so I don't think she will be any help. I have BCBS Illinois and I just filed a gap exception. I fully expect it to be turned down and that I will have to appeal but I will keep trying. Good luck to everyone.
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#14 of 16 Old 01-20-2014, 12:49 PM
 
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I am in a similar boat.  I'm in CA, though.  I called our insurance company today and it seems as though they will only cover a birth if it happens inside of a hospital (Doctor, midwife, ob/gyn - doesn't matter what type of professional does it as long as it's in a hospital).  Ugh.  I thought our society (laws in CA) had gone further than this by now.  Birth is birth and they should have to cover it however the patient and their provider has chosen as is safe and healthy (and in my low-risk pregnancy I believe a home birth is actually the safest and healthiest option).  At least it's legal to HAVE a home-birth here still (for now), I guess.  A friend of mine has the same insurance company and got them to cover her entire mw's fee but her plan is a PPO and ours is an HMO so I'm guessing that means we're stuck with in-hospital type care for now.  I guess they covered my friend's full mw's fee because there was not another mw on their provider list for a certain amount of miles from her home (which is close to my home so I'd be going into the same category there, but I don't know that they'll budge because of me not being in a PPO plan).  


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#15 of 16 Old 01-20-2014, 01:38 PM - Thread Starter
 
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I did not have the chance to follow through with it. I had my appeal all typed and ready to send and that next week, I went into the hospital with an extensive DVT in my leg. So I lost any chance of a home birth this time :-/ 


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#16 of 16 Old 01-20-2014, 02:06 PM
 
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I'm sorry, Cassandra.  


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