anyone have updated info on homebirth and insurance in massachusetts? - Mothering Forums

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#1 of 14 Old 04-20-2009, 03:36 PM - Thread Starter
 
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i was reading this thread and a couple of other threads (all now closed since they moved into archives) about health insurance, and i had some more specific questions and was wondering if things have changed.

i had posted before asking about HB and options to make it more affordable. we're ttc #2, and we've decided that we definitely want to go the HB route and will make it work some way or another. i've been reading through some posts on getting at least some of your HB paid for by insurance, which is TOTALLY something i'd love to figure out! i'm currently under my husband's employer's health plan, harvard pilgrim healthcare (HMO). it says clearly that it does not cover homebirth.

one idea i had was to get an individual health plan. for example, it's $225/month for a BCBS PPO plan. if it covered HB (prenatal care and birth) in full, having that plan for 10 months would be $2,250. if i used a midwife who charged about $3,600, i sure wouldn't mind saving that $1,350, kwim? what other health insurance companies cover HB? i don't care about prescription coverage or anything, since i'd be keeping my HPHC (we're paying for a family plan either way to cover DD), but a supplemental plan that i could use for HB would be sweet. is this even feasible? any other thoughts?

i have been reading some posts where people got their HB at least partially reimbursed by harvard pilgrim HMO, even though it very clearly lists planned homebirth as an exclusion. if anyone has any info on that, i'd love to hear it!

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#2 of 14 Old 04-21-2009, 12:05 PM
 
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My homebirth was 10 months ago, so pretty recent. Deb Allen said she has had success getting Harvard Pilgrim to cover homebirth. I had Tufts at the time which explicitly does not cover homebirth. Deb used her billing service and billed Tufts.. I don't know the specifics, but I think they used global codes and were otherwise vague on where Fiona was born. They ended up paying about $1500 of Deb's $3500 fee. So, pretty good.

I never called Tufts to inquire about homebirth benefits, I didn't want them to flag my account. I don't know if that helped, but we got back about $1500 more than I was expecting, so..

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#3 of 14 Old 04-22-2009, 03:25 PM - Thread Starter
 
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cool! i'm hoping that if i find a midwife that has a billing service, stuff will just end up in the right hands and we'll get reimbursed for some of it. that would be sweet. $2,000 for an HB is pretty awesome!

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#4 of 14 Old 04-23-2009, 01:05 PM
 
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Have you looked into Aflac disability coverage? Their diosability plan covers birth. You get 6 weeks paid. However, you have to be on it for 10 months before the birth of a child (you cannot get the coverage if you are already pregnant).
I actually purchased it a few months back - my coverage started March 1st. I pay $45.00 bi-weekly, so about $90.00 a month. I will get a check for $3700.00 after the birth of a baby. I will not get cobverage if i ahve a baby before January 1 (10 months). We are ttc this month and if I get pg my due date will be the middle to end of January so I am covered. I did this to cover my homebirth if my insurance does not. I have a BC/BS PPO. If they do pay for it, it will just be extra money to take more time off of work!
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#5 of 14 Old 04-23-2009, 01:58 PM - Thread Starter
 
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Originally Posted by mzmum View Post
Have you looked into Aflac disability coverage? Their diosability plan covers birth. You get 6 weeks paid. However, you have to be on it for 10 months before the birth of a child (you cannot get the coverage if you are already pregnant).
I actually purchased it a few months back - my coverage started March 1st. I pay $45.00 bi-weekly, so about $90.00 a month. I will get a check for $3700.00 after the birth of a baby. I will not get cobverage if i ahve a baby before January 1 (10 months). We are ttc this month and if I get pg my due date will be the middle to end of January so I am covered. I did this to cover my homebirth if my insurance does not. I have a BC/BS PPO. If they do pay for it, it will just be extra money to take more time off of work!
oooh, very interesting! i'm around O time now, so i might wait to sign up during my next cycle if this one's a wash, just in case. but that sounds AWESOME. what do you need to do to qualify for their disability coverage?

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#6 of 14 Old 04-23-2009, 02:00 PM
 
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Blissful Mama to DD-(5), DS-(6) and someone new due in November!
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#7 of 14 Old 04-23-2009, 02:54 PM
 
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has anyone had any luck with Kelley Faulkner and BCBS HMO?
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#8 of 14 Old 04-23-2009, 03:08 PM
 
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Hi!

HMO's generally do not cover because it has to be someone in the managed group providing services, you can try for an exception saying no one in the managed group offers these services...but, to be honest it is a long shot, something you can't count on as it is rare.

PPO's in theory should cover. I have just recently switch billing companies and have gotten some BCBC PPO checks lately, so I have more hope than I did a few months ago. I think the idea of not calling and flagging your account is a good one...I have been discussing this with some other midwives lately and it is the strategy I am going with for now, it is not what my old billing company did.

Anyway, I wish there was a better answer...it is so wrong for them to not cover our services...even from a financial standpoint it is crazy!

Re Kelly, again HMO doesn't cover in general, and you may want to make sure she is going to be around as she does travel a lot between here and Africa. I have heard she has been here lately so you can give her a call.

If you wanted to talk to any of us about this subject or others all our info is on www.massmidwives.org...feel free to call.

All the best!
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#9 of 14 Old 04-23-2009, 03:50 PM - Thread Starter
 
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thanks paige! i just PM'd you about it but then saw your response here. heh.

thanks everyone! i really appreciate all this info. because of everything i've been reading here lately, i went from "i'd love a homebirth but i don't think it's financially feasible" to "i am definitely gonna homebirth next time!" i'm super excited!

now all i need to do is GET PREGNANT!

fuzmalesling.giffemalesling2.GIF mama to my spunky little girl, m, born 12/10/07 blahblah.gif, and my sweet little guy, k, born 10/27/10 babyf.gif
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#10 of 14 Old 04-23-2009, 04:22 PM
 
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As far as the Aflac disability coverage you just need to be in good general health I think. The representative just sat down with me and asked me a bunch of questions about my health. (I don't even remember what they were as I am in good general health so just said no to everything, LOL)

The amount they will pay out per month depends on how much money you make at work - legally you cannot make more than 80% of what you bring home from work. I don't know what they do with SAHM's. How much you pay per month will depend on how long you want coverage if you become disabled (3 months is the least) and how long you want your wait period to be before they send out payment (the shortest amount of time is 0 days for accidents and 7 days for a disability). I took the 3 months because I only plan on using it for the maternity coverage for wich they pay 6 weeks for a vaginal birth regardless. I also took the shortest time 0/7. They consider birth a disability so I will have to wait 7 days from birth before they will send out a check. I also think I got some kind of group discount because of my job signing up with them and offering coverage to all employees. But even aside from the discount I think it's a good plan. A few of my friends have had it for maternity coverage and love it. And if there is any kind of complication during pregnancy and I am required to bedrest, I will get coverage for three months.
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#11 of 14 Old 04-23-2009, 04:28 PM
 
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Oh, one more thing. I signed up for coverage active as of March 1, and I could not ttc and get covered until this cycle (O'ing end of April). So if it's something your really interested in, I would look into it and sign up ASAP if you are actively ttc. I signed up and ttc regardless. If I had gotten pg I would have just cancelled it as I *think* my insurance will pick up most of a homebirth and I really want to be pg!

Good luck to us both!
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#12 of 14 Old 04-23-2009, 08:03 PM
 
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We are currently applying to BCBS PPO. We are using the midwife billing service and applying for reimbursement after our baby has been born. We know some who have been covered by BCBS PPO, but it seems inconsistent - some are approved, some not. (BTW, I would love to hear others experiences about BCBS PPO and what you or you PCP wrote in your appeals/letters.) The billing service told me this, which I thought might be helpful to others:

Also if your PCP is kind enough you can ask them to write an additional letter to the form. On the letter they can say how you are a Low Risk Pregnancy, and how it is your want/need to have a homebirth.

Also if you have other children-born at home or hospital- and they were fast, easy births it can aid in the approval for the homebirth. You would just need to explain those births and included the Medical Records.

As an example: One patient received a referral due to this. She has 2 children already, both born at the hospital/birth center in a hospital. Her first child was born 1:30 after she arrived at the hospital. Her second child she had was born 30min after she arrived. She also had a 1:15 min drive. Due to her speedy births and the area she was in they allowed the homebirth of her third child.
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#13 of 14 Old 04-26-2009, 01:35 AM
 
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Fairly recently, a midwife in MA told me she'd had great success billing HMO plans for prenatal visits. She can typically bill most of her entire fee through the prenatal visits, and then you would make up the remainder in the 3rd trimester.

See, the way the insurance sees it, they're not paying for a homebirth, they're only paying for the checkups before that. It's all about finding a loophole, and a midwife with a clever billing service.

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#14 of 14 Old 04-26-2009, 01:42 PM - Thread Starter
 
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eeeeeenteresting. maybe they aren't as picky about covering prenatals for CPMs vs. CNMs?

maybe the midwifery bill will go through before baby #2 arrives and the insurance companies will stop being jerks and this will all be moot. wouldn't THAT be something?

fuzmalesling.giffemalesling2.GIF mama to my spunky little girl, m, born 12/10/07 blahblah.gif, and my sweet little guy, k, born 10/27/10 babyf.gif
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