My insurance won't cover my homebirth and i'm beside myself. Any suggestions? - Mothering Forums

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#1 of 18 Old 11-01-2013, 03:40 PM - Thread Starter
 
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I am very passionate about having a homebirth and at this time, my insurance will not cover it.  I live in NY and am under my husband's health insurance plan that is based out of Utah. They are checking to see what their requirements are to comply with NYS law, but they don't think it looks promising that I will get coverage through them, which is my only option. I am definitely not able to afford paying for it out of pocket. The insurance company also has yet to provide me with any midwives in their network and they don't cover birth centers either. I am not okay with delivering in a hospital with an OB and that is not the experience I wish to have with the birth of my child.  I must find a way to make this work. Does anyone have any ideas? I need help! Thank you.

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#2 of 18 Old 11-02-2013, 03:20 PM
 
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Have you thought about giving birth unassisted? There's a great forum here with lots of info and support!
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#3 of 18 Old 11-02-2013, 05:05 PM
 
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I was faced with this, too. *hugs* I found a practice with OBs and certified nurse-midwives who follow the practice model of the CNMs doing all the "normal" deliveries and only calling the OB when/if things deviate from normal. I love those midwives and I had a beautiful, med-free hospital birth. I personally would not have felt at all comfortable with UC (as a CNM myself, I've seen things go very unexpectedly sideways in the lowest-risk of women) so I found a compromise. I was very disgruntled about it for a while before my son was born but it worked out well!

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#4 of 18 Old 11-02-2013, 05:17 PM
 
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My midwife has apparently had luck billing for prenatal/postnatal/newborn visits to cover a large portion of the fee with insurance companies that don't cover homebirth, bringing the out of pocket cost down to something much more manageable.

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#5 of 18 Old 11-02-2013, 10:27 PM
 
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I lived in Brooklyn and had BCBS of Illinois at the time. My midwife had a billing consultant who coaches me in how to request a waiver. I called and told BCBS that it was my right to have a homebirth with a midwife but since they didn't have any midwives at all in-network, would they pre-approve covering the midwife I was seeing. I received a call about a month later saying it was pre approved. I still owed a bit of money to the midwife after but most of the $10,000 birth was covered. Was very happy with BCBS.
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#6 of 18 Old 11-02-2013, 10:34 PM
 
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Also wanted to applaud you for not giving up. So many mamas get to the point they feel hand-cuffed which is not what you want for birth. Hoping others will chime in with good ideas, loop holes etc. good luck!
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#7 of 18 Old 11-03-2013, 10:12 AM
 
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"Giving up" is a very judgy term. No one posting here has given up, whether or not they gave birth at home, at a hospital, with a midwife, with an OB, whatever. We have all found solutions which worked best under our circumstances.

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#8 of 18 Old 11-03-2013, 11:55 AM
 
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Katie8681, sorry you see it that way. Perhaps, giving up sounds offensive, but that wasn't my intent. It was to encourage OP to keep perusing the kind of birth she'd like to have. But I have seen people feel forced to settle against their wishes.
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#9 of 18 Old 11-03-2013, 11:56 AM
 
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Typo: meant pursue, not peruse!
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#10 of 18 Old 11-03-2013, 12:38 PM
 
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Frankly I'm just hoping OP doesn't decide to give birth at home without an educated attendant because it's the only at-home option she can afford. That's all. There's worse things than giving birth at a hospital.

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#11 of 18 Old 11-03-2013, 09:42 PM
 
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OP, sorry this thread is taking such a detour. As a doula, I think it is very important to birth where you feel most at ease and in company of people you can count on to be there for all of your needs. May you have a satisfying birth experience no matter how your plan unfolds. I hope insurance will grant you a waiver to cover the birth the same as they would a hospital birth. Have you talked to your midwife about a sliding scale?
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#12 of 18 Old 11-03-2013, 11:04 PM
 
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I also hope you get the birth that you desire, Mishashiv. <3

I would like to also say that just because someone chooses to give birth unassisted does not mean they are uneducated. I find that very offensive and judge mental. Most UCers I know are much more educated on pregnancy and birth than the average person. A woman deserves to have whatever kind of birth she desires. Just because you don't feel it's right for you doesn't make it wrong.
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#13 of 18 Old 11-04-2013, 10:08 AM
 
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I had this issue with United Healthcare and eventually got them to reimburse about 1800 of my 4K homebirth fee (I had two CNM's present).

 

I had to jump through a lot of hoops to get it done though.  First of all, my understanding (just from talking with my midwife) is that if homebirth is legal in NY they have to at least offer coverage in some form.  

 

Secondly, 99% of the issue is billing codes.  I had to get a list of billing codes from my CNM's billing service to send to my insurance company for their review.  THEN I also had to get my in-network primary care provider to write a letter to United stating that there were no in-network homebirth providers to her knowledge.  THEN I had to hassle the insurance company for several months to send me something in writing approving the billing codes.  THEN I had to battle with them for over a year after my son was born to even get the 1800 reimbursement.  They kept denying the claim as no being medically necessary LOL.  

 

Call and pester them to find out how to get the in-network exception.  You'll probably have to talk to about fifty people before you find someone that wants to help you.  I honestly think if I hadn't have been such a persistent pain in the butt I would have never even gotten the small reimbursement I got.  They love to tell you "no" and hope you go away.  Good luck.

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#14 of 18 Old 11-04-2013, 10:17 AM
 
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Quote:
Originally Posted by rlschrader View Post

I would like to also say that just because someone chooses to give birth unassisted does not mean they are uneducated. 

I didn't say or mean to imply that someone choosing to give birth unassisted means they're uneducated; but they are choosing to give birth without an educated, trained attendant, or maybe I should say "assistant". I didn't mean it was wrong, either. Is it more likely to end tragically, yes. It can also end perfectly. 

 

ITA that insurance companies say flatout "no" to everything first in hopes you'll go away. That's true of homebirth and a crap ton of other things as well. It's not necessarily their final answer, but you have to be prepared to annoy the hell out of them.

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#15 of 18 Old 12-26-2013, 02:26 PM
 
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Quote:
Originally Posted by whiskeyandwater View Post
 

I had this issue with United Healthcare and eventually got them to reimburse about 1800 of my 4K homebirth fee (I had two CNM's present).

 

I had to jump through a lot of hoops to get it done though.  First of all, my understanding (just from talking with my midwife) is that if homebirth is legal in NY they have to at least offer coverage in some form.  

 

 

The law is only applicable to plans that are written in NYS. The rules are based on where the policy is written, not the location of the subscriber. OP's insurance is out of Utah; NYS' law doesn't apply. I am from NYS originally and know people whose insurers successfully refused to pay because they were not covered by the law, either due to being based out of state or being self insured. 

 

There seems to be some confusion here over what the problem is. Network exception only comes into play if it is a covered service but there is no provider in network. If the insurer has a blanket policy against the service then it doesn't matter--the issue isn't the provider but the service itself. (Classic example: Aetna will only pay for home birth when covered by law. If you live in NYS but your employer has Aetna and is based in NJ, they won't pay.)

 

if home birth is not explicitly excluded then you can try to get it covered in some way. if it is not, your best bet is the strategy mentioned upthread: have her split the billing and bill for the prenatal care and not delivery since prenatal care is a covered service and CNMs are usually covered providers. The problem with this strategy is that you won't know in advance and expose yourself to the risk of a bill. 

 

I am not saying you won't get it covered--I'm saying you need to know what the basis of the refusal is if you want to work around it. You might also want to ask people who have used your insurer specifically. 


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#16 of 18 Old 12-28-2013, 06:53 AM
 
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Our insurance never covered our homebirths/MW. I just pay OOP, it's not worth the headache for me to fight with them honestly. I hate insurance companies and how healthcare works :(


Kailey 8.1.06 Midwife - Hospital

Nola 3.20.09  Midwife - Homebirth

EDD 7.12.14 New Midwives -  Outdoor Homebirth w/ a Team Green baby!

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#17 of 18 Old 12-28-2013, 07:08 AM
 
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It is completely 100% possible to have a natural, safe, and happy birth in the hospital with an OB.  It happens every day!

 

If things don't work out with your insurance company, it may be worthwhile to meet with a few OBs in your area and see if you can find one that you feel comfortable with.

 

Good luck!

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#18 of 18 Old 01-12-2014, 10:56 PM
 
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Many times when insurance companies tell moms that they don't cover home birth, they will pay a midwife who calls and asks about the out of network maternity coverage benefits, which is what the service is .


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13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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