Tips on convincing insurance to cover homebirth? - Mothering Forums

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Old 08-28-2007, 06:52 PM - Thread Starter
 
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I just called outr insurance company, and of course they won't cover home birth at all I was really hoping to have one this time, but paying $1500-2000 out of pocket is way outside our budget...

I heard some mamas have success convincing their insurance companies to offer some benefits for home birth and I was wondering if anyone here had experience with it? I hate talking on the phone, I either shut down and can't say anything that makes sense, or I get really upset and frustrated, which doesn't help the situation

I'd really appreciate any suggestions! I'm only 8 wks pg, so I have plenty of time, but I need to decide which midwife I'm going to go to (my current MW doesn't do HB) If there's a chance that we can convince our insurance company to offer some HB coverage, then I need to switch to CPM right away so I don't pay 'double' for prenatal care... TIA!
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Old 08-28-2007, 08:41 PM
 
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First of all I've never heard of an insurance company paying a facility fees for a home *so* none of them pay for homebirth. Insurance companies will pay various classes of providers for prenatal care and birth attendance. Some, if it's a homebirth will only pay for prenatals. I know some will pay a percent of usual and customary (I think that's the phrase) but since usual and customary is so much higher than what many MWs charge, the insurance companies' prenatal payment can cover prenatals and a good share of the birth fee too.

I suggest posting in your tribal area to find out about state insurance laws as well as others' experiences with your insurance in your state.

~BV
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Old 08-28-2007, 08:44 PM - Thread Starter
 
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Thanks! The amount quoted is for prenatal care and the service provided during home birth, not for home as a 'facility' for birthing... My insurance won't cover any of it...
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Old 08-28-2007, 09:46 PM
 
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Moving to Homebirth.

There's a good sticky (found here) on talking to insurance companies.

I think what BV was talking about is that you can get the midwife to split the bill, break it down (although she usually charges a global fee) - if she can bill the insurance company for 6-12 prenatal appointments, get them to cover those at their "usual and customary" rates, that might go a long way to covering the total fee. Same with postpartum visits, newborn well baby checks, etc. It really helps if your midwife will work with you, knows the right codes to use, etc. It can be done!
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Old 08-28-2007, 11:41 PM
 
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what insurance provider is it and do you have out of network coverage? a lot of companies say they won't cover homebirth at all but like pps said they will cover parts of it. when they bill they just bill as a provider of services, irrespective of where a birth actually takes place.

my coverage has out of network benefits after a deductible and they seem to be covering my cpm at that rate, even tho they said they wouldn't cover her at all.
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Old 08-29-2007, 11:31 AM
 
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What insurance companies cover:
  • Pregnancy care (prenatals & postpartums)
  • Facility fees (like rent on your hospital bed)
  • Birth attendant fees
  • Incidentals (testing, drugs, and such)

If you call asking about homebirth *most* folks answering the phone will equate that with a facility fee like a hospital. As they won't pay you to stay in your own home, they'll often give a flat out 'No'.

Now if you ask if they'll cover a particular provider (shhhh! who *happens* to be a HB MW) you might get a very different answer. The key is in asking the right questions. Often they'll cover a HB MW (just don't describe your attendant as that, they'll fixate on HB and not be able to answer anything helpful) for pregnancy care and birth attendance.

As usual and customary for hospital-based OB practices is more than what most MWs charge, often this will cover the pregnancy care and birth at a rate which cancels out any penalty for going out of network. Speaking of out-of-network, if your insurance company covers MWs in theory but doesn't have any in-network providers in your area, you can often go out-of-network and have them reimburse you at rates as if your provider were in-network. (Replace in-network with preferred provider and out-of-network with non-preferred provider and the sentence is still true.)

I hope that clarifies better.

~BV
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Old 08-29-2007, 05:57 PM
 
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It's true that even though you may hear one thing over the phone, when it comes down to it it's all about the coding! Most of the hb mw's in our area use the same insurance biller, who knows how to "tweak" the codes to get maximum reimbursement (for example, my ins. co. covers 95% of prenatal care BY MIDWIVES so most of my claim will be coded accordingly). They also have a lot of success just using a "global obstetrics code" (which to my understanding doesn't specify where the birth took place, just who attended it).
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Old 08-29-2007, 07:25 PM
 
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Quote:
Originally Posted by mariola View Post
I hate talking on the phone, I either shut down and can't say anything that makes sense, or I get really upset and frustrated, which doesn't help the situation
Talking to insurance people on the phone about HB can be SO frustrating.
On the bright side (possibly if you don't like the phone...) this is something that will probably require a decision in writing. There are some sticky threads at the top of this forum about writing appeal letters for HB coverage.

For example, with my insurance we have to first make a request in writing for "individual consideration." If that request is denied the second (and final) step is an appeal.

The advice above about reading/asking around your tribal area to find out laws in your state is also a good step.

Lastly, this is not meant as discouraging, but it seems like in most cases you won't have an answer about the coverage BEFORE you give birth. At least the way I've heard of is that the midwife requires payment by 36 weeks and then bills for all services using a global fee after delivery.
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