GHI and Homebirth in NY - Mothering Forums
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#1 of 14 Old 10-05-2010, 02:24 PM - Thread Starter
 
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I have GHI and am planning a Home birth for next year.
I called the health plan and they told me that out of hospital births are not covered by insurance..( they told me that only sterile hospital birth's are covered)
Does anyone know whether this is true or not and has anybody who has GHI had a home birth with a midwife in NY and been reimbursed?
Thank you!

mama to DD 6/05, DS 11/03 and a new dd born 6/11 

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#2 of 14 Old 10-05-2010, 02:56 PM
 
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The person you spoke with on the phone is wrong!!!

NY State has a Homebirth Mandate that requires the insurance to cover HB. That's baloney that they only cover "sterile hospitals"

Talk to some HB MWs who can tell you what their experience with GHI has been. I find that the MWs are very knowledgeable about which insurances are better at reimbursing than others.

Even if you don't have any HBMWs in-network, you will be able to apply for an "out of network exception" (essentially, since they are required by law to cover this service, but have no participating providers who provide this service, they have to cover your MW as if she were in-network).
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#3 of 14 Old 10-05-2010, 04:00 PM
 
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I agree. I would talk to the midwives rather than the insurance co.

Midwife (CPM, LDM) and homeschooling mama to:
13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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#4 of 14 Old 10-05-2010, 07:21 PM
 
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Quote:
Originally Posted by Chavelamomela View Post
The person you spoke with on the phone is wrong!!!

NY State has a Homebirth Mandate that requires the insurance to cover HB. That's baloney that they only cover "sterile hospitals"

Talk to some HB MWs who can tell you what their experience with GHI has been. I find that the MWs are very knowledgeable about which insurances are better at reimbursing than others.

Even if you don't have any HBMWs in-network, you will be able to apply for an "out of network exception" (essentially, since they are required by law to cover this service, but have no participating providers who provide this service, they have to cover your MW as if she were in-network).
NYS requires insurers to cover HB as long as:

1) The insurer is based in NYS
2) The plan is not self insured.

However, if neither of those apply, you should be able to get covered. Speak to your midwife.

DD 01/2007, DS 09/2011

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#5 of 14 Old 10-06-2010, 02:08 PM
 
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Does anyone know if this is true for Pennsylvania as well? I have GHI too and while I'm not currently pregnant I'm curious as to what I can expect later on. I too have called them at the health plan and I was also told that since they have no homebirth midwives in network that they WILL NOT cover a homebirth.
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#6 of 14 Old 10-08-2010, 01:06 AM
 
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We just had a HB in Queens, my midwife said that GHI wouldn't be a problem. She's dealt with them before. I never called to ask if it was covered. She has someone that handles the billing. I just gave her a copy of my insurance card. I don't think she submitted the claim yet, but I'm sure they'll pay. We had no problem with Oxford paying last time either. Neither birth cost me a dime.

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#7 of 14 Old 10-08-2010, 11:11 PM
 
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GHI doesn't cover all the fee, but they do cover. My midwife's billing person told me they'll cover $5000 of her $7500 fee, based on past experience.

Liz, wife to John, mom to Dylan and my giant slug zocha :
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#8 of 14 Old 10-10-2010, 08:02 PM
 
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my son was born at home - Long Island - in August, and GHI covered it. leave the billing questions to your MW - calling ghi is one the most frustrating experiences there is!

Happy at Home Mama to DD 4/95 DS 4/98 and DS#2 8/10  femalesling.GIF        h20homebirth.gif       sewmachine.gif

http://www.etsy.com/shop/motherhendoula
 

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#9 of 14 Old 10-12-2010, 08:31 PM
 
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GHI paid for both of my homebirths. Both in NJ, but still. I was amazed at how much they paid too. They paid roughly 80% of my midwife's fee for my last birth.
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#10 of 14 Old 08-02-2013, 12:46 PM
 
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Hello,

 

I am currently going through the GHI issue with my home birth.  Could you please explain how you got them to cover the full amount/most of the amount?  Thanks!

 

You can email me directly if you like:  yahira57@gmail.com

 

Thanks,

 

Yahira!
 

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#11 of 14 Old 08-02-2013, 12:47 PM
 
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Hello,

 

I am currently going through the GHI issue with my home birth.  Could you please explain how you got them to cover the full amount/most of the amount?  Thanks!

 

You can email me directly if you like:  yahira57@gmail.com

 

Thanks,

 

Yahira!
 

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#12 of 14 Old 08-16-2013, 01:36 PM
 
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There was no home birth midwives in our network, so our midwife filed for an exemption on our behalf. Covered everything but the $500 deposit we had already put down. We're in NYC.
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#13 of 14 Old 08-26-2013, 07:21 PM
 
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Hi there,

 

Im due in 3 weeks.  My midwife has a biller who deals with patient's insurance details.

She thought that coverage would not be a hassle, but alas it has not been without headaches.  I have GHI, and they have agreed to an exception (after originally attempting to decline coverage), but they are only offering to cover $4,000 of the $7,000 fee.

My midwife's billing office has suggested that I accept this $4,000 letter of agreement, but I'm wondering if I should continue to argue for GHI to cover the entire fee?

 

I'm fearful that continuing to pursue further coverage could jeopardize the $4,000 offer already on the table, but I also feel that since I've met my deductible for the year, it's not fair to have to pay another $3,000 in fees.

 

Any thoughts, guidance or experiences are greatly appreciated!!

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#14 of 14 Old 08-27-2013, 03:25 PM
 
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@AlyNYC
I would probably try again, either over the phone or in a letter. Maybe write down the cost of a hospital birth, with all the interventions those often include, vs a natural home birth and show them they're still saving money.
Good luck!
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