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Attn Tatgurl and other Ins/HB mommies:

515 Views 9 Replies 7 Participants Last post by  peilover010202
Hey Tatgurl, I was wondering what you included in the letter you composed for your insurance company when you filed a grievance with them about not having any providers available in network.
I AM going to try to get a home birth covered since the more I think about it the more I want that. I just want to make sure I have all the information I need in the letter so I don't take any chances and get denied. Any suggestions/help would be greatly appreciated! :)
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Unfortunatly, I didn't write a letter or I would give it to you. I actually called the grievance department and talked to a "case specialist". I had a page from my insurance plan that stated that if I receive covered services that are not reasonably available from a preferred provider (in-network) that they would cover it. I also said that I had the right to birth at home and that there really is no reason why they should not cover it, considering that there are some CNM in there network who do attend homebirths. There are just non who live by me. I had also had my previous homebirth with a CNM who was in-network, but she is not attending homebirths anymore (not because of safty issues, she just joined a practice with more MW's and now she is only on call one day a week and can not guarantee that she would be able to be at my birth).

I also just found a document ( from the State OF New York
Insurance Department that states that insurance companies must cover homebirths in NYS. Maybe you could see if MA has a similar policy.

PLEASE let me know if you have any questions about this. I would love to help anyone that is trying to get coverage. I guess that I feel it was almost too easy for me. I didn't really have to fight that hard for it.
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Summer Twilight -- I am in the same exact boat right now as you, I actually need to compose my letter today (which is hard without a computer...maybe I should GASP write it by hand?!?!?!?!) because it turns out I was rejected a second time and was not notified -- but the lady at the Birth Cottage gave me some advice about what to write and how to approach me if you want my email (I am only getting on MDC once or twice a day cuz of the dial up issues
) or my phone number.
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We should get together for a New England insurance gripe session! Argh!
: I am thinking that when we get our bill for all the copayments from prenatal visits and the hospital bill we'll have been wishing we had just paid a midwife out of pocket for a homebirth anyway. Ouch!
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Krista -- I am meeting some girlfriends for a picnic at a park in COncord tomorrow if your plans fall thru with the MMDC group - let me know! Your boys could run til they drop
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So far it looks good for tomorrow in Wellsley. Concord is probably the same length drive for me, or not much farther. Another time then!
Just wanted to share my experience with homebirth and insurance. The midwife I used when I was pregnant with DD called my insurance company to check on the coverage and they told her they did not cover homebirth. She was an "in-network" midwife that was covered by my insurance (BlueCross BlueShield). So, basically they would pay her for her services, but not for a stated homebirth. When she filed all the paperwork to get paid, she did not state anywhere that the birth took place at my home, and she got paid the amount she wanted.

I have the same insurance this time around, but a different midwife. I was talking to her about the fact that my insurance did not cover homebirth, and she said it all depended on how they worded their claims. I was also inquiring about how to get my insurance to pay for an ultrasound since last time we paid out of pocket for it and we just can't swing it this time. She told me to let her call the insurance company, because you have to be careful what you say to them and how you ask. If homebirth comes up, they will note your account or whatever and you may have problems later on getting them to pay for things (if homebirth isn't covered). As far as the ultrasound goes, she is going to recommend I have one to an OBGYN that she works with sometimes. That way, I can have an office visit with him for the ultrasound and only pay the copay instead of the entire fee.

It helps to have a midwife that knows how to "work the system". I would suggest talking with your midwife and discussing the insurance stuff with her before trying to tackle on your own. She may have some good suggestions on how to deal with them since she probably has a lot of experience with that kind of stuff.

Good luck homebirth mamas and I hope it all works out for you!
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My midwife said that since she's just a CPM and not in anybody's network, it would be a miracle if any insurance carrier covered my birth. I'm not entirely giving up, but we'll probably just pay for the whole thing out-of-pocket like the last two times.

- Krista
You know, I've read MANY posts on homebirth insurance appeals on the Homebirth forum or in the midwives area. I bet looking it up in the archives could really help you out or just post a new thread about it.

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