Texas CPM vs. CNM - Mothering Forums

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#1 of 20 Old 11-01-2008, 09:38 PM - Thread Starter
 
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I understand that a CNM is a Certified Nurse Midwife and that a CPM is a Certified Professional Midwife, but beyond that, I'm not sure...

What are the differences with regard to training (hours, classes, births), apprenticeships, equipment/medicines on hand for emergency situations, insurance coverage, general feelings/policies/philosophy on pregnancy, labor, and birthing, etc? Is one preferable to the other or does it even matter?

What good "interview" questions might I ask a potential midwife? Thanks!
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#2 of 20 Old 11-01-2008, 11:00 PM
 
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this chart should answer some of your questions about differences in training/education and other things (like carrying oxygen, or using eye ointment).

There is a list of questions to ask midwives in the homebirth forum

In TX if you have a PPO they are required to cover LMs (Licensed midwives) but only at out of network rates.
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#3 of 20 Old 11-02-2008, 12:26 AM
 
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CPM- 3ish year apprenticeship and completetion of midwifery course (taught by other midwives), must pass the NARM exam and apply for licensure

CNM- are registered nurses that go to a midwifery school (usually associated with a nursing or med school), CNMs have the option of working in a hospital, CPMs do not, I believe law requires that CNMs have a collaboration agreement with a physician.


As far is which is preferable, that is really up to you. There are some CNMs that are fairly medically minded and use interventions frequenstly. However there are many homebirth/birth center CNMs that operate like CPMs. Both carry oxygen to homebirths and pitocin.

I would recommend finding a midwife based on who you click with rather than CNM vs CPM, unless you are looking for a midwife in a hospital. There are wonderful midwives with both credentials.

As for what to ask here are few questions to get you started: (excerpted from a Midwifery Today article)
How did she become a midwife and what training has she had?
Is she certified or licensed with any organizations?
Does she belong to any midwifery organizations, attend conferences and workshops, subscribe to professional journals?
What is her basic philosophy of childbirth?
How many births has she attended as the primary midwife?
Does she handle higher risk situations, such as twins or breeches?
What is the fee for her services, how must it be paid, what does it include?
What kinds of services are included in prenatal care? (May include early detection of problem areas for the mother and baby; nutrition information; exercise recommendations; in-home care; recommendations for parent education via books, videos or classes.)
Does she work with another midwife or assistant at births?
What does she do if two of her clients are in labor or birth at the same time?
How do clients reach the midwife? Does she have a pager or cell phone allowing 24-hour access?
How does she handle problems or complications that develop during labor?
What standard and emergency equipment does she carry? What herbs or medicine does she use? Which ones does she not carry and why?
Does she have any affiliation with a physician who can answer questions about unusual developments either during the pregnancy or in an emergency?
What is her policy for transporting to a hospital?
What medical facility would she use? Has she developed a good working rapport with them?
What kind of postpartum care does she provide? (Ask about frequency of baby checkups, assistance with breastfeeding.)

Maria :, mom to 4 cuties with 1 sweet hubby
doula, childbirth educator and midwife wanne-be!
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#4 of 20 Old 11-02-2008, 12:30 AM
 
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This is a little OT, but I'm having trouble getting my insurance to pay for my last homebirth.

Peach - Where can I get that
Quote:
In TX if you have a PPO they are required to cover LMs (Licensed midwives) . . .
in writing?

My insurance company is trying to say that they only cover CNMs, not CPMs . . .

Thanks!
--LEE
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#5 of 20 Old 11-02-2008, 12:46 AM
 
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Originally Posted by leewd View Post
This is a little OT, but I'm having trouble getting my insurance to pay for my last homebirth.

Peach - Where can I get that

in writing?

My insurance company is trying to say that they only cover CNMs, not CPMs . . .

Thanks!
--LEE
I've always heard that since they're legal in the state they have to cover them... but would also love the law to quote.

What insurance do you have if you don't mind?

Dh's company just switched to aetna... not looking forward to dealing with that next time around... :

-Angela
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#6 of 20 Old 11-02-2008, 01:03 AM
 
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My understanding which could be wrong is that in TX if you have a privately funded insurance (which most companies do) they do not have to follow state insurance law.
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#7 of 20 Old 11-02-2008, 01:14 AM
 
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In Texas, the insurance companies are supposed to cover homebirths but they often use a loophole. The loophole is that a lot of places are self insured but use the insurance company to "manage" the benefits. Because companies are self insured, they don't have to follow the "regular" guidelines.
Here is a link to a list of mandated health coverage in Texas:
http://www.tdi.state.tx.us/reports/benefita.html

When I took my insurance company to task, I was able to find the law that said that they had to cover maternity services. The insurance company gave me the excuse that they didn't because the employer was operating under the guise of self-insurance and they were just the administrators. My midwife was able to get them to cover the homebirth and she isn't a CNM or a CPM. She is a Licensed Midwife. In Texas, direct entry midwives are another option to consider.
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#8 of 20 Old 11-02-2008, 01:40 AM
 
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Quote:
Originally Posted by library lady View Post
In Texas, the insurance companies are supposed to cover homebirths but they often use a loophole. The loophole is that a lot of places are self insured but use the insurance company to "manage" the benefits. Because companies are self insured, they don't have to follow the "regular" guidelines.
Here is a link to a list of mandated health coverage in Texas:
http://www.tdi.state.tx.us/reports/benefita.html
Okay.... so if it really is using the insurance company (dh's company is I'm 90% sure...) then aetna's anti-homebirth policy is not legal, is that correct?

I've always heard it's not legal... but I'd like to catch them on it...

-Angela
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#9 of 20 Old 11-02-2008, 01:55 AM
 
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#10 of 20 Old 11-02-2008, 02:02 AM
 
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Quote:
Originally Posted by alegna View Post
Okay.... so if it really is using the insurance company (dh's company is I'm 90% sure...) then aetna's anti-homebirth policy is not legal, is that correct?

I've always heard it's not legal... but I'd like to catch them on it...

-Angela
Technically, it isn't legal in Texas. Aetna will give you the run around on the phone and give you a bunch of excuses.

If you continue to use your regular midwife, I know she can get Aetna to pay. :-) The baby was born in April of 07 and Aetna paid the following Dec./Jan.


I found this other link with a summary of some of the insurance changes: http://www.texasbar.com/Template.cfm...&ContentID=972 (Make sure that you are not on an HMO.)
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#11 of 20 Old 11-02-2008, 03:39 AM
 
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library lady : you rock!
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#12 of 20 Old 11-02-2008, 11:40 AM
 
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Quote:
Originally Posted by library lady View Post
Technically, it isn't legal in Texas. Aetna will give you the run around on the phone and give you a bunch of excuses.

If you continue to use your regular midwife, I know she can get Aetna to pay. :-) The baby was born in April of 07 and Aetna paid the following Dec./Jan.


I found this other link with a summary of some of the insurance changes: http://www.texasbar.com/Template.cfm...&ContentID=972 (Make sure that you are not on an HMO.)
No plans to change midwives... but hey, no new baby planned yet either... just planning insanely ahead

Aetna just pisses me off that they can have right there in black and white an illegal clause.

-Angela
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#13 of 20 Old 11-02-2008, 03:19 PM
 
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I've been paid by Aetna policies.

Some policies don't cover "homebirth", but do cover "Licensed midwifery services, regardless of place of birth". They don't cover "CPMs" (an academic/professional title, but not one that denotes any legality of practice), but do cover "LMs" in Texas. (Any CPM must be Licensed in the state of Texas (ie have her LM) to practice legally... and insurance is required in Texas to recognize and cover licensed care providers, UNLESS: a) they have a specific exclusion -- for example a lot of the BCBS of Texas policies have specific exclusions-- or b) are a private insurance.

And in certain circumstances, you can even petition for an in-network exemption, even if the midwife would normally be covered at the out-of-network rate.

So, it's essential to have someone verify coverage that knows the ins-and-outs and what questions to ask. I my billing company that handles all this for me and my clients.
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#14 of 20 Old 11-02-2008, 03:28 PM
 
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My insurance company is trying to say that they only cover CNMs, not CPMs . . .
If they have a specific exclusion in the written policy, then they can get out of paying LMs.

For example, some of the BCBS of Texas policies state that they DO cover midwifery care for out-of-hospital birth, excluding midwives who are not also registered as advanced practice nurses. So, CNMs are covered, but LMs (CPMs) are not.

But, it depends on your policy. I've been paid 100% by BCBS, 80%, 60% and nothing, depending on the particular policy, and what year it was billed (as they are constantly adjusting policies).

Tricare (military) also does not cover LMs/CPMs, but only CNMs currently.

Your midwife (or her billing company if she employs one) may be able to give you more guidance on your specific situation.
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#15 of 20 Old 11-02-2008, 03:57 PM
 
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My aetna policy SPECIFICALLY excludes homebirth. How is that legal? Given that they must cover LMs and LMs can't attend hospital births... etc. Also isn't there a clause that insurance companies can't dictate where a practitioner practices?

-Angela
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#16 of 20 Old 11-03-2008, 11:16 AM
 
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It boils down to, if they don't have to follow the law, it's not technically illegal. That doesn't mean they won't pay eventually. You can also (sometimes) speak to the people in HR who write the policy for your dh's company. They can force the insurance company to pay. Whether they will or not is a different question.
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#17 of 20 Old 11-03-2008, 11:40 AM
 
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Originally Posted by mamaverdi View Post
It boils down to, if they don't have to follow the law, it's not technically illegal. That doesn't mean they won't pay eventually. You can also (sometimes) speak to the people in HR who write the policy for your dh's company. They can force the insurance company to pay. Whether they will or not is a different question.
Good to know. They would probably back us. It's complicated- he works for a tiny company that does payroll and insurance through a larger staffing agency. But the staffing agency is also their client just to confuse things But at any rate they're a good company and would probably go to bat for us...

-Angela
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#18 of 20 Old 11-03-2008, 05:22 PM
 
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I can't make heads or tails of the links y'all have posted . . .

I'm hoping the HR lady can kick their butts.

Someone asked which insurance company I was with: The Insurance compnay was called "Fiserv" last year, but now they are "UMR."

My CPM does not do the billing. Her clients pay her and then we do our own insurance ppwk. She will help if/when she can, but she's too busy with her actual job to do much about what our insurance companies are saying to us.

Anyway, thanks for the input!
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#19 of 20 Old 11-03-2008, 05:26 PM
 
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Originally Posted by leewd View Post
My CPM does not do the billing. Her clients pay her and then we do our own insurance ppwk. She will help if/when she can, but she's too busy with her actual job to do much about what our insurance companies are saying to us.

Anyway, thanks for the input!
But she'll write up your bills - right? That's half the battle. Having the right codes and such on there.

-Angela
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#20 of 20 Old 11-03-2008, 08:05 PM
 
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This is not to do with insurance - which is the least of it if you have a bad experience with the birth. I am about to venture out and interview midwives again - specifically, I will ask them:
How were their birth experiences (and if they were good, what made them special - sort of give you a glimpse into the real person instead of reading something off a website), if they ever think it is okay - even in an emergency situation - to do procedures against the will of the client or without explaining and getting permission from the client (example: pulling on the cord, then going after the placenta), who do they usually bring to births - students? assistants? and how many? and what are the names (sometimes it may be someone that you interviewed with that you didn't like or in my case, someone you had that you would never want at your birth again), do they give you a choice whether or not to labor alone or do they have to be present - think of everything. Birth should be the best day of your life - topping the wedding by far- and how much time did most of us spend on the details of that big day? You need to find someone that respects that - I hope I do this time. Good luck hunting!!!
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