Sample Appeal Letters for Homebirth Coverage - Page 2 - Mothering Forums

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#31 of 46 Old 05-08-2008, 03:51 AM
 
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Originally Posted by EarthsSpiral View Post
Has anyone had Aetna cover their HB costs?
Hey,
I have no experience with birth, let alone with Aetna, but someone on this thread said that a representative from Aetna said they would pay for it. This is an old thread, but I would hope the information is still a little true.

Nearly crunchy mama to one DS born at home 12/09 and married to my best friend one week later signcirc1.gif

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#32 of 46 Old 06-27-2008, 11:09 PM
 
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Dear Mamma2Molly,

I have BCBS of MN, but live in New York and we are expecting at the moment. I felt very passionate about homebirth, so was going to do it even if I had to pay myself.

Like you, I wanted to get an authorisation beforehand. Initially, BCBS said 'they would not cover for homebirth', but under my policy I have 'home health care' coverage. So, I called my employer (HR dept) and asked them to deal with it and they did! After a week of phone calls and emails, BCBS called me and said that they will cover homebirth and all other midwife services.

They are processing my first claim at the moment...

So, I my advice would be try getting your employer to talk to them and convince them that it's much cheaper for them to pay for homebirth than for hospital birth.

Also, check out the laws in your state. In NY, midwife services 'must be paid' by HMOs. The only way BCBS was arguing for not paying (in my case) was that they wanted me to go to 'in-network'. Of course, there are no midwives who attend homebirths who are in anybody's network.

If all else fails, you can email their press office and tell them you will publicize their refusal...

Anyway, good luck!
anoric
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#33 of 46 Old 07-06-2008, 05:17 AM
 
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#34 of 46 Old 08-07-2008, 01:25 AM
 
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Wow! What an awesome, wonderful, and extremely helpful thread. I bookmarked it and will absolutely be using these suggestions. I have Preferred Care in Upstate NY and we have a PPO which covers 60% out-of-network and 80% in-network. Of course, our homebirth midwife is the only one in the entire area and is out-of-network. FWIW, though, she is IN-network with BCBS (kinda cool). Dh and I have been mulling over how to go about getting the 80% coverage rate, and now we definitely have a starting point.

Thanks so much! I will share how it goes for the benefit of others who may have our same insurance!
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#35 of 46 Old 10-17-2008, 10:52 PM
 
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Anyone have any experience with Blue Care Network?
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#36 of 46 Old 12-15-2008, 09:44 PM
 
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Originally Posted by kitkatsmama View Post
Anyone have any experience with Blue Care Network?
Are you talking about Blue Shield/Blue Cross?

We have Blue Shield and while home birth is a covered benefit it has to be done with a network provider. Surprise, surprise there are no midwives in network. :

My husband and I payed out of pocked for our homebirth, but I'm thinking about writing a letter to the company that manages the network for Blue Shield locally and asking them to credential my midwife as a provider. I know it will probably be a waste of time though so...
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#37 of 46 Old 12-16-2008, 07:14 PM
 
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Quote:
Originally Posted by lwuertz View Post
Are you talking about Blue Shield/Blue Cross?

We have Blue Shield and while home birth is a covered benefit it has to be done with a network provider. Surprise, surprise there are no midwives in network. :

My husband and I payed out of pocked for our homebirth, but I'm thinking about writing a letter to the company that manages the network for Blue Shield locally and asking them to credential my midwife as a provider. I know it will probably be a waste of time though so...
It's worth a shot. I was able to talk my ins co into covering my home birth midwife as in network because there are not in network *home* birth midwives within like 20 miles of my house (really, I doubt there are any...). Either way, I would think they'd cover you as out of network - will the midwife try to bill it and see what happens? You might be surprised.
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#38 of 46 Old 01-22-2009, 04:59 AM
 
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Didn't get to read all the posts yet but want to sub and read them all. Looks like I need one of these appeal letter to send to my insurance co. BCBS FL with HMO plan. One of the poster earlier said in FL, insurance co should cover HB, can anyone tell me more about it or where I can find more info??
We just got denied our Gap Exception, does this mean they will not cover at all? I'll have to call and find out but want to know from you guys' experience what to expect or what I should do next...
TIA

 ~ Have a Blessed Day!
DS 6/2002, DD 5/2006, DS Feb 2009
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#39 of 46 Old 03-19-2009, 05:22 PM
 
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So I'm late on this post but I'd like to share my experience. I wrote an appeal letter which was abruptly denied because they claim that homebirth simply isn't covered. They said it says it in THEIR manual but cannot locate it in mine (which in itself is a crock). Anyway, They are now paying for most of it after lots of work because I argued if they won't pay for the "birth" they need to at least cover the prenatal visits. I am getting a huge portion of it paid for because they pay for the prenatal visits at 100% and they just won't pay for the vaginal birth. Oh, and my midwife is also billing them separately for the well-baby exams. Hope that helps!
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#40 of 46 Old 03-19-2009, 05:24 PM
 
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Oh and if you want it, this is my appeal letter:

February 13, 2009

xxx including
xxx
P.O. Box xxx
Redmond, OR 97756

Dear Sir or Madam:
This letter is in response to the denial of coverage for the prenatal care, labor and delivery, and post partum care surrounding the birth of my daughter, Holly Pittman, on 12/23/08.
After having our first daughter in the hospital in February 2007, we were not satisfied with the care we received and were astounded by the cost of having a simple, non-complicated pregnancy and birth. When I became pregnant with Holly in March 2008, we searched for a better, less costly alternative. Due to the horrifying statistics of unnecessary interventions such as vacuum and forcep delivery, episiotomies, pitocin inductions, and especially that 1 in 4 women are given c-sections, we determined that the healthiest and most cost effective birth option was a homebirth with an attendant midwife.
During our midwife’s first visits, we were insured through xxx's Regence BlueCross Blue Shield plan. Knowing that she had been paid many times through BlueCross, we had little to worry about. Unbeknown to us, our provider would be changing half way through the pregnancy to a new provider. Our new in-house health insurance was supposed to be better and cheaper for everyone. Obviously that is not the case for us, with your recent denial to cover the cost of the birth of my daughter.
I am including a breakdown of the cost to deliver my first daughter in a hospital setting:
$3,515.78 Prenatal/Post partum care and delivery charges paid to midwife, xxx
$6,519.95 Bill from the hospital for Angela
$910.00 Paid to xxx, the anesthesiologist that performed the epidural
$3,100.35 Bill from the hospital for Lexus (new baby)
$1,187.94 Charges incurred for Dr. visits and shots for baby's first 6 weeks
_______________
$15,234.02 TOTAL

Clearly it is in the best interest of the company to keep costs low for health insurance. The cost for an OB/GYN to do the prenatal care, a hospital birth with attending physicians, and the following stay in the hospital, would have cost nearly five times the $4,100 that my midwife Marcene charged for the ENTIRE course of maternal care. I had complete prenatal care, labor and delivery support, post partum care for six weeks, as well as checkups for baby for six weeks.
Aside from the obvious point that it saves thousands of dollars, I'd also like to comment on the quality of service I received from my midwife. From my first appointment to my last at 6 weeks post partum, I felt a strong and loving connection with Marcene. She always made me feel completely comfortable and that she deeply cared for my baby and me. I never felt that with the quick 10 minute checkups at the clinic that I had with my first baby. Marcene was wonderfully knowledgeable and gave me a sense of empowerment throughout my labor, making me realize I am a woman and was made to do this. When baby was born, she was healthy, alert, and ready to nurse. I was able to hold baby for as long as I wanted and wasn't forced into doing anything I didn't want to do. There were no nightime blood draws for myself or my newborn, no IVs, no pills, etc.
I feel like I healed more quickly, bled less, and enjoyed my experience more because I chose to have a homebirth. I also believe the continued support, as well as the more enjoyable birthing experience has helped stave off post partum depression, which in itself can be another long-term costly medical liability.
The representative on the phone told me that home births are not covered. I urge you to ask why that is and to reconsider, for the numerous reasons stated above, as well as countless other benefits to having your baby at home.
Thank you for reconsidering coverage of the birth of my daughter.
Sincerely,
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#41 of 46 Old 04-07-2009, 05:31 AM
 
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Overview - Basic Principle: Maternity Care is Expensive. Homebirth is Less Expensive, has Better Outcomes and more Satisfied Customers
Here's one midwife's explanation of maternity care economics, which will help you to lobby better for yourself!
This graph shows 2003 facility charges for labor & birth. Facility charges are JUST for the facility itself, i.e. either hospital or birth center. The facility charges do not include:

additional anesthesia services charge for an epidural - around $2000-$3000.
additional newborn care charge - up to $5000 [Numerous charges, including nursery fees, pediatrician fees, medications]
additional maternity provider charge for all births - around $3000-$5000 for the average four hours a doctor spends with you during prenatal care, the birth, and quick postpartum checks during hospitalization. [Procedure code 59400]
To get the current bare-bones Medi-Care reimbursement rates for your area, go to the Medicare Physician Fee Schedule Look-Up, selecting the default "Single HCPC Code", "Pricing Information", and then changing the "Carrier Option" to "Specific Locality", and keeping the default "Default Fields (Pricing Information Only)". Copy the Procedure code from each of the procedures above into the HCPC field, select the "Global" option for the Modifier field, and then select the Carrier Locality that applies to your area. Remember, the prices shown on this web site are the bare-bones prices paid by the biggest, cheapest plans, such as Blue Cross and Blue Shield. Higher-end insurance plans usually pay about twice the Medi-Care rate.
(In case you're unable to download this .pdf file, here are the Facility Labor & Birth Charges, U.S. 2003 By Site and Method of Delivery: NOTE - These prices are nationwide averages. The cost in the San Francsico Bay Area is about 3-4 times that of the least expensive areas.)
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#42 of 46 Old 04-20-2009, 04:18 AM
 
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Overview - Basic Principle: Maternity Care is Expensive. Homebirth is Less Expensive, has Better Outcomes and more Satisfied Customers
Here's one midwife's explanation of maternity care economics, which will help you to lobby better for yourself!
This graph shows 2003 facility charges for labor & birth. Facility charges are JUST for the facility itself, i.e. either hospital or birth center. The facility charges do not include:
additional anesthesia services charge for an epidural - around $2000-$3000.
additional newborn care charge - up to $5000 [Numerous charges, including nursery fees, pediatrician fees, medications]
additional maternity provider charge for all births - around $3000-$5000 for the average four hours a doctor spends with you during prenatal care, the birth, and quick postpartum checks during hospitalization. [Procedure code 59400]
To get the current bare-bones Medi-Care reimbursement rates for your area, go to the Medicare Physician Fee Schedule Look-Up, selecting the default "Single HCPC Code", "Pricing Information", and then changing the "Carrier Option" to "Specific Locality", and keeping the default "Default Fields (Pricing Information Only)". Copy the Procedure code from each of the procedures above into the HCPC field, select the "Global" option for the Modifier field, and then select the Carrier Locality that applies to your area. Remember, the prices shown on this web site are the bare-bones prices paid by the biggest, cheapest plans, such as Blue Cross and Blue Shield. Higher-end insurance plans usually pay about twice the Medi-Care rate.
(In case you're unable to download this .pdf file, here are the Facility Labor & Birth Charges, U.S. 2003 By Site and Method of Delivery: NOTE - These prices are nationwide averages. The cost in the San Francsico Bay Area is about 3-4 times that of the least expensive areas.)
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#43 of 46 Old 06-25-2009, 10:50 AM
 
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I'm going through an interesting version of this. In January, my attempted homebirth turned into an emergency cesarean due to cord prolapse. I'm currently trying to get United to cover at least my prenatal care, since we pre-paid our midwives. Has anyone ever dealt with this specificity? Obviously the whole argument about saving money by covering homebirths doesn't apply to us in the least.
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#44 of 46 Old 09-29-2009, 01:18 AM
 
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I've heard that it's next to impossible to get them to pay for the prenatal care if you transfer. But that doesn't mean it can't be done.

Jen 47 DS C 2/03  angel.gif04/29/08/ DD S 10/28/09 DH Bill '97.

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#45 of 46 Old 09-30-2009, 01:49 PM
 
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I get news that my insurance is asking my midwife to pay back the money they paid for my homebirth.. stating that they do not cover homebirths. (even though she has had 5-6 births through them and they paid for each of them) My daughter is now 6 months old and we are just receiving notice on this!
I don't understand how the insurance company can PAY for services, then come back and say "Oh sorry we did an audit and you need to pay us back!" They said something about not covering newborns that were born at home. Can they do that? Is that legal? Is there anyone I can call?
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#46 of 46 Old 11-14-2010, 01:39 PM
 
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Wow.  I hope your midwife didn't pay them back!!

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