Water birth in Michigan? - Mothering Forums

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#1 of 28 Old 01-20-2009, 03:10 AM - Thread Starter
 
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Hi there,

I just joined today as these forums look like they are full of information. I am not pregnant yet but we are trying to be. I wish to learn all I can before we are pregnant, so I am prepared, especially since this will be our first.

Right now I am really interested in water birth. I really don't like the ideal of epidurals, and going through a hospital. Water birth seems more nature to me, I have always loved water, and it's so relaxing.

Anyhow, I was wondering if you could recommend me places to look at for water birth in Michigan? Midwife recommendations, as well as hospitals with links be would great! I live in Dexter, Michigan to be exact, just a few minutes away from Ann Arbor.

Also I would not be able to do water birth at home, as we currently live in a townhouse and I doubt my neighbors would like all the noise hehe.
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#2 of 28 Old 01-20-2009, 10:37 AM
 
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The University of Michigan hospital offers waterbirth through their nurse midwives, but after working there for seven years as a doula I have yet to actually see one. The Greenhouse Birth Center and Mother's Own Birth Center are about an hour away from you and The Birth Place birth center is about 45 minutes. The midwives at these centers are experienced in waterbirth and have tubs in their centers.

We do a lot of births at home in apartments and townhouses. Most women who are planning hospital births labor for quite a while at home -- the difference between the sounds you would make and the sounds they would make would be small -- maybe hollering a bit while pushing. You would be surprised how accommodating neighbors can be and also how little they often hear. For contact info for local midwives see the Michigan Midwives Association website. There are probably a good half-dozen homebirth midwifery practices close enough to serve you.

Good luck! Waterbirth rocks!

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#3 of 28 Old 01-20-2009, 11:47 AM
 
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I've had two water births. One at The Birth Place and one at home with the midwives from the Birth Place. I agree that the noise wasn't much of an issue. However, I know that when I was pregnant with my first, that noise was my biggest concern and the reason I didn't want anyone except my dh at the birth center at all.

The tub at The Birth Place is great.

There was a thread here a while back about waterbirth at Hutzel Hospital (I think). I'll see if I can find it and link to it.

Good luck!

ETA- here it is
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#4 of 28 Old 01-20-2009, 11:51 AM
 
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The Hutzel midwives are totally underrated, IMO. I think they're great. Their offices would be a little over an hour from Dexter, though.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#5 of 28 Old 01-20-2009, 12:17 PM
 
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I had a waterbirth with DD 7 years ago at the Providence Hospital Alternative Birthing Center. It was AWESOME!

http://www.stjohn.org/Women/Pregnancy/

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#6 of 28 Old 01-20-2009, 02:34 PM
 
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Our humble Stacia (Defenestrator, who has posted above)does water birth, and is a GREAT midwife, and is right in your area. If I were able to have more babies, I'd make sure she was at my birth!

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#7 of 28 Old 01-20-2009, 03:13 PM
 
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I had a waterbirth with DD 7 years ago at the Providence Hospital Alternative Birthing Center. It was AWESOME!

http://www.stjohn.org/Women/Pregnancy/
I thought waterbirth wasn't allowed at the ABC? I know you can labor in the tub, but I thought they made you get out to give birth. That's what they did with me in '05. I've heard it's because they can't drain the tubs fast enough in case of an emergency, and don't want to risk having to count on a very pregnant, laboring mother to be able to get out of the tub in such an event.

I vote for a homebirth! I did one with Stacia last May and rented a tub from her (for a ridiculously low price, I might add). HEAVENLY!!!! Way more comfortable than the tub at the ABC . I think she uses Birth Tub in a Box. Correct me if I'm wrong Stacia .

ETA: And Stacia is great too, not just her tubs .

Sending lots of pregnancy vibes your way!

Mama to M (7/05) and S (5/08) my surprise !!!
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#8 of 28 Old 01-20-2009, 03:37 PM - Thread Starter
 
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Stacia: Thanks for all the information, and links. Lots of things for me to research, though it looks like others have a few votes for yourself as well.

Shelleyd: Nice link on the Hutzel Hospital, good read.

Graceoc: I will have to read the information on your link, thanks a lot.

courtenay_e: That makes one vote for stacie.

Shanana: Correction that makes two votes for stacie...or is it one vote for her tubs hehe.

Thanks everyone for all the great information. I have plenty of time before I officially have to decide on anything, so it's nice to just be able to research it right now. I do have a couple more questions to ask.

First off Shanana mentioned how great stacie's tubs are, so what makes a tub great? I assume being comfy would be one, anything else?

As usual money is a big factor too. I've heard that alternative births a lot of times don't take insurance, is it usually the same for water births?

thanks for answering!
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#9 of 28 Old 01-20-2009, 06:02 PM
 
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As far as tubs go, I used the nice jacuzzi tub at the Birth Place for dd1. It was great and really comfy. Then for dd2, I used a blow up fishie pool and it was also great. I honestly didn't notice any difference in terms of comfort or anything. I was able to lean on the sides of the fishie pool for support and everything and of course I could at the Birth Place tub.

My insurance reimbursed me for dd1's birth. For dd2, our insurance switched midpregnancy and we're still waiting on reimbursments from both companies.
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#10 of 28 Old 01-20-2009, 06:06 PM
 
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It's not that out of hospital midwives don't take insurance. It is that insurance companies don't often reimburse for out of hospital births. Now, actually, many WILL reimburse for out of hospital birth, as long as it's not Blue Cross (though I just heard of one woman, an MDC Mama, actually, who DID talk BCBS into reimbursing at 90% for a homebirth!!), or an HMO, you might actually have a good chance at getting reimbursement. And, it doesn't matter how the baby was born (ie: land or water), if they cover homebirth, they cover homebirth, though some will only cover CPM or CNM, not DEM, so that they can be sure that they aren't paying your sister, friend, or cousin to randomly attend.

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#11 of 28 Old 01-20-2009, 06:19 PM
 
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FWIW, we have BCBS and they wouldn't cover homebirth at all, but they did cover midwife care/birth by a CNM at the hospital. Water birth didn't matter to BCBS, although I didn't end up having a water birth.
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#12 of 28 Old 01-20-2009, 07:29 PM
 
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FWIW, we have BCBS and they wouldn't cover homebirth at all, but they did cover midwife care/birth by a CNM at the hospital. Water birth didn't matter to BCBS, although I didn't end up having a water birth.
It depends on your specific plan within BCBS. Even if you have a non-Michigan plan, the type of midwife you are using has to be listed as payable. The claim goes first to MI BCBS. If you have a Michigan plan they make the first determination. If you have an out of state BCBS plan, the determination for reimbursement may be passed on to the out of state office, or paid depending on the agreement between the two state BCBS offices.

In Michigan, BCBS only consistently reimburses midwives who are CNMs and are registered or participating with BCBS. For the handful of CNMs doing home birth here, waterbirth included, BCBS has been reimbursing for home birth and covering all but a small portion of the global fee for several years.
The reason they will pay only CNMs is MI is that they are the only type of midwife currently licensed in the state. Has to do with paperwork they have to file with the Office of Financial and Insurance Services at the state level.
They will not pay the facility fee if you use a birth center unless the birth center is licensed (not available in Michigan), or is affiliated (owned) by a hospital.

You can PM me with any other questions about midwives and reimbursement in MI.

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#13 of 28 Old 01-20-2009, 10:02 PM
 
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Shanana - Well, I guess they techinally don't 'allow' waterbirths at the ABC, but when I had DD#1 there my mw pretty much knew that was my plan. Once I hit transition she asked me if I wanted to get out and when I said no they just went with it. I heard later I was the talk of the place for a bit LOL!.

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#14 of 28 Old 01-21-2009, 12:47 AM
 
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mothercat, though I know you used the word "consistently" it surprised me greatly when the homebirth I just found out was covered was through a CPM! I have heard from time to time that if it falls across the right desk, a persistent client has gotten coverage for a birth with a CPM. However, I also know that most CPMs in the area suggest that though they can try, there is often little hope that a non CNM attended birth will be covered.

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#15 of 28 Old 01-21-2009, 01:03 AM
 
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We do have an out of state plan, and the state where the BCBS is listed allows for midwife births of any variety, but MI doesn't with BCBS because of the liscensing thing, which isn't available here. It was so circular and ridiculous, since our insurnace would have covered the birth if we were in their home state.
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#16 of 28 Old 01-21-2009, 02:40 AM - Thread Starter
 
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First off, I was right when I said these forums looked like they great amount of information. I really appreciate everyone taking the time to answer me.

Shelleyd: Thanks for further explaining the tubs. The more I think about it though during the actual time of labor, I probably won't be thinking to much about the actual tub. Still it's good to know!

courtenay_e: That makes more sense, then saying midwives wouldn't accept the insurance. May I ask what HMO stands for ?

mothercat: You just typed a mouthful on insurance, whew. In particuliar I took note of this quote:

Quote:
"They will not pay the facility fee if you use a birth center unless the birth center is licensed (not available in Michigan), or is affiliated (owned) by a hospital."
I'm assuming you are talking specifically about Blue Cross, if I was following the conversation right. Is this typical with insurance, or a minority?
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#17 of 28 Old 01-21-2009, 10:16 AM
 
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First off Shanana mentioned how great stacie's tubs are, so what makes a tub great? I assume being comfy would be one, anything else?
With my first daughter, I labored at home for over 24 hours, and then went to the ABC. We have a hot tub at home (not a bath tub, an actual hot tub), so I thought I was all set. Turns out it was awful for laboring in. I had a posterior baby, so needed to be leaning forward. The seats in the tub made it impossible to lean on the sides of the tub, and it was too deep for me to kneel on the bottom. And even if I could have knelt, it would have been on a hard surface. I ended up draping myself over a small raft, but it was unstable and uncomfortable. When I got pg again, I didn't want to have anything to do with that tub!

Then when I moved to the ABC, I spent my time lying on my side in their tub, which I also found uncomfortable. I rested my head on a folded up towel, but again it was basically just a big bathtub so it was very hard and I found it to be uncomfortable.

The tub I used with Stacia is specifically designed for birth. It's inflatable, and even the bottom inflates so it's nice and cushy for kneeling. I was worried it wouldn't be big enough (I'm 5'9" and weighed around 225 lb at 9 mo pg), but it was plenty large. It's oval shaped, so long enough for a tall person without requiring hundreds of gallons to fill. It had a comfy seat I could sit on, but there was lots of unobstructed access to the walls for leaning. The walls were extremely strong once the tub was filled, so I could lean or even sit on them. And they were tall, so it was plenty deep. I couldn't believe how much more comfortable I was.

edited to add: oh yeah, and it has handles! those were great! here's a link: http://www.waterbirth.org/mc/page.do?sitePageId=45085

And I don't know if this is related, but I did not find the water gave me any relief with my first daughter, and it provided wonderful relief with my second .

As for your questions on insurance, I agree with Courtenay - it all depends on whose desk it falls. Your best bet is to talk to individual mws and find out how successful they are in billing. Even then they can't guarantee anything, but they can tell you which insurance cos they've dealt with and how it went. But if you have an HMO (health maintenance organization, like HAP), they absolutely will not pay, as they only pay if you see a participating provider and no homebirth mws can participate in an HMO.

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#18 of 28 Old 01-21-2009, 11:08 AM
 
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mothercat, though I know you used the word "consistently" it surprised me greatly when the homebirth I just found out was covered was through a CPM! I have heard from time to time that if it falls across the right desk, a persistent client has gotten coverage for a birth with a CPM. However, I also know that most CPMs in the area suggest that though they can try, there is often little hope that a non CNM attended birth will be covered.
Yes, that's why I said "consistently". I had heard that 2 CPMs in MI had been granted BCBS provider#s~ Mickey Sperlich (now retired) and Charlotte Sanchez (moved). Neither one could remember applying for the number, but it showed up in the mail anyway and allowed them to get paid by BCBS.

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I'm assuming you are talking specifically about Blue Cross, if I was following the conversation right. Is this typical with insurance, or a minority?
Yes, that is one of BCBS's rules. Other insurance companies don't seem to have as much of an issue.

The funny thing about BCBS is that their plans exclude CNMs and other midwives unless the company purchasing the plan ask for the midwives to be included. Almost all the other insurance companies include midwife coverage automatically unless the purchasing company ask them not to.
Whether they include all midwives is another story and may depend on licensing.
The insurance companies feel a bit safer about including licensed midwives because it gives them a layer of protection (the licensing agency) if there should be a problem. What I have been told is that if an insurance company allows participation by a provider who is unlicensed, and then there is a problem (malpractice), the insurance company can also be included in a resulting lawsuit for giving "legitimacy" to the unlicensed provider by having allowed them to be a participating provider.
IMHO, it sounds like the myth of vicarious liability that the OBs use as a reason not to work with CNMs and other midwives. The myth is that because the doc holds a higher degree, he/she will be held responsible for all the midwife's mistakes even if he/she had no input on those decisions.
It's never happened.

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#19 of 28 Old 01-21-2009, 11:18 AM
 
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Thanks mothercat for trying to clear up something that is sooo confusing for most people! Also, I don't know what most birth center facility fees are, but I would guess that they make up a much smaller part of the bill than the hospital. Maybe addressing that will help ease some people's minds about birth center costs.

Here is my weird anecdotal experience. I trained in a practice that asked for payment up front always and then submitted bills for insurance. When I took it over, I thought I might try billing just for the copay, submitting insurance, and then asking for the balance later if the company didn't pay. After doing that, I went from nearly 100% payment rate from blue cross to nearly 0. They came up with all kinds of reasons to deny my claims, including unlicensed provider, non-participating provider, etc. A couple of times recently, though, I have gone back to billing them after payment and they paid again. It could be a fluke or it could actually be a different standard for reimbursing the family vs. paying the provider directly. I'm voting for fluke for now, but my strategy for them in the future will probably involve client reimbursement instead of direct billing. How frustrating!

I have found that the smaller the insurance company, the better. It is hard to make the money-saving argument to a company as big as blue cross or Aetna. Even though we are hugely cheaper than hospital birth, they don't seem to care and think that *not* paying us would be even cheaper!

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#20 of 28 Old 01-21-2009, 06:50 PM
 
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Here is my weird anecdotal experience. I trained in a practice that asked for payment up front always and then submitted bills for insurance. When I took it over, I thought I might try billing just for the copay, submitting insurance, and then asking for the balance later if the company didn't pay. After doing that, I went from nearly 100% payment rate from blue cross to nearly 0. They came up with all kinds of reasons to deny my claims, including unlicensed provider, non-participating provider, etc. A couple of times recently, though, I have gone back to billing them after payment and they paid again. It could be a fluke or it could actually be a different standard for reimbursing the family vs. paying the provider directly. I'm voting for fluke for now, but my strategy for them in the future will probably involve client reimbursement instead of direct billing. How frustrating!
For us, BCBS over the last 2 years has been routinely reimbursing the family rather than us. This applies whether the family paid us in advance or not. And it seems that they pay the family at a higher rate than they do the midwife anyway. I just tell our families that this is what will happen and they are expected to deposit the checks and once it clears, write us a check for the amount they received. They also need to be aware that, if for some reason, the insurance pays at a rate that more than covers what we charge they have to send us the extra as they are not legally allowed to profit for insurance reimbursement. Hasn't been a problem, but they need to know.
I know of one midwife who would way overbill and if the client didn't have a problem with it (as in they all kept quiet), she would split the profit with the family. Serious repercussions when she got busted. Had to repay the overage plus penalties. I think the families had to repay the insurance also. I think her actions were also communicated to other insurance companies as fraud and she lost her ability to bill any insurance. Cautionary tale, but OT. Sorry.

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#21 of 28 Old 01-21-2009, 09:51 PM
 
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Good advice!

One other scrap of info that I thought of that is a little bit more on topic: UofM has only 3 tubs for 30 rooms and that is one of the reasons why there aren't a lot of waterbirths there. But, the last director of the nurse midwives service and the current director both are fans of waterbirth and they have made a policy that you can bring your own tub, something that is not widely publicized. I had a mom who was risked out of my homebirth practice because her babe needed immediate surgery upon birth and the director of the CNM practice took the time to walk me through the l&d and make sure that I could hook my hoses up to the sink (standard kitchen faucet adapter works on the handwash sink, who knew?). I thought it was a nice gesture and was a generous effort to try and preserve some of a mom's birth experience in the face of an unwanted transfer of care and change of birthplace.

They do ask that the tub have its own support person so that the nurses don't have to deal with it -- a tub doula!

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#22 of 28 Old 01-22-2009, 05:54 PM - Thread Starter
 
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Shanna: Great link on the tubs. It sounds like your first experience was very uncomfortable, I'm glad the second one was so great.

mothercat: Thanks for explaining further with Blue Cross. I really wish insurance didn't have to so complicated. I will probably have to have a look see at our insurance, and visit individual places...once I'm pregnant that is. I tend to way over-plan things before I really need to.

Stacie: That's really interesting the University of Michigan would let one bring their own tub. I kind of like that word, "tub doula!"
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#23 of 28 Old 01-22-2009, 07:53 PM
 
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mothercat, though I know you used the word "consistently" it surprised me greatly when the homebirth I just found out was covered was through a CPM!
I thought it was the prenatals and postpartums that were being covered, not the actual birth. Maybe I'm wrong though.


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#24 of 28 Old 01-23-2009, 12:58 AM
 
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I may have misunderstood, but it was my understanding that they are not only paying for the birth, but also paying it at 90% as an IN network provider. *shrug* Crazy.

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#25 of 28 Old 01-23-2009, 02:12 AM
 
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Well either way, it's still amazing. Hopefully this will pave the way for other midwives!!



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#26 of 28 Old 01-23-2009, 10:41 AM
 
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Courtenay, I may ask you to put me in touch with this mom. We had HAP PPO with Eleanor and they paid 80%. We still had HAP PPO this time and then my dh's union switched us to Blue Cross on Oct 1st with no warning. SO most of my pregnancy I was covered through HAP and then the last trimester and birth was Blue Cross. I'm not sure what's going on with billing. Bridgett is working on it for me. But if (or should I say when) Blue Cross denies payment, I may ask for your help.
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#27 of 28 Old 07-12-2009, 02:16 AM
 
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Hello all.. I know this topic hasn't had a post in months but I came across it while trying to find information on water birthing in Michigan. I am a expecting my first after a loss and I am already starting to think about pain management... it's pretty much the thing I am worried most about.
I have been reading up a ton on having a water birth and I was excited to learn that U of M offers it. I am using a Mid Wife at PPH in Ann Arbor and so far it has been the best experience I have ever had! I highly recommend using a Mid Wife over a Dr.
I am just wondering if my Mid Wife would be able to offer this service to me.. I feel kinda silly asking her because I still have a ways to go... I guess time will tell.
Thank you all for such great input on this topic.
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#28 of 28 Old 07-13-2009, 11:53 AM
 
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Originally Posted by Defenestrator View Post
Thanks mothercat for trying to clear up something that is sooo confusing for most people! Also, I don't know what most birth center facility fees are, but I would guess that they make up a much smaller part of the bill than the hospital. Maybe addressing that will help ease some people's minds about birth center costs.

Here is my weird anecdotal experience. I trained in a practice that asked for payment up front always and then submitted bills for insurance. When I took it over, I thought I might try billing just for the copay, submitting insurance, and then asking for the balance later if the company didn't pay. After doing that, I went from nearly 100% payment rate from blue cross to nearly 0. They came up with all kinds of reasons to deny my claims, including unlicensed provider, non-participating provider, etc. A couple of times recently, though, I have gone back to billing them after payment and they paid again. It could be a fluke or it could actually be a different standard for reimbursing the family vs. paying the provider directly. I'm voting for fluke for now, but my strategy for them in the future will probably involve client reimbursement instead of direct billing. How frustrating!

I have found that the smaller the insurance company, the better. It is hard to make the money-saving argument to a company as big as blue cross or Aetna. Even though we are hugely cheaper than hospital birth, they don't seem to care and think that *not* paying us would be even cheaper!
Yep, I had SelectCare (I don't think they are in business anymore) and they paid more than we billed! And it was reimbursement I think. That was with Charlotte, and she's not local anymore, but I agree about the smaller companies and just being persistent until you get the right person. Also, Charlotte seemed to have a lot of luck sticking with saying Midwife vs. spelling out what kind. She was very happy to actually get paid what her services are worth!

Heather, mama to Harriet, Crispin, in with Tom and 2
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