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fighting with insurance

569 Views 5 Replies 5 Participants Last post by  patricegonzales
Our insurance plan with United Healthcare includes homebirth as a covered benefit, but does not have any in-network homebirth providers.

I requested an in-network exemption for our MW, but that was denied. They will pay her at out of network rates.

I appealed that decision and it was again denied, saying that homebirth is a "choice."

This just seems so unfair that they would cover homebirth but not have any providers.

Any tips on how to proceed? The letter says that if I feel the plan provisions have been misapplied, I can write yet ANOTHER appeal letter within 60 days. Should I be calling my husband's HR people?
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Oh, I am watching this thread because I have them too.

My understanding is that if they do not have a provider for the service, they are required to pay for an out of network provider at in network prices. But that could be a CA thing? Not sure though.

Fight them. And go to your state insurance commissioner. I know a lady that got her homebirth covered at 100% because she did that.....
Our plan is not subject to state insurance laws because it is a self-funded group plan.

Originally Posted by deymm View Post
Our plan is not subject to state insurance laws because it is a self-funded group plan.
Yikes, ugh. DH's employer is like this too, EXCEPT that they happen to have a birth center in network which does homebirth. Can you look into that option?

Otherwise, definitely contact the HR person. A friend of mine did exactly that for a self funded plan, they did some calling and the got a pre approval letter. Most likely if you appeal to them based on the cost savings of homebirth v hospital birth and the evidence of that they will be receptive!
Because in that case it is the employer directly saving money, they're only paying an administrative fee to UHC.
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We had United Healthcare and they paid a majority of our midwives fee after the fact even though they said upfront that they would only pay 60%.

Our midwives also did some creative billing by billing for newborn exams and home visits that insurance paid with no questions asked. Our midwives said they generally got paid very well from UHC. The midwives total fee was $2900 and I think once we were reimbursed for everything we paid about $300 out of pocket.
I also have UHC and was worried about this.
I was told different things on the phone. I asked for all of the info in writing so that I could see for myself (it is on line and easy to access). Have you looked your plan over yourself? I wouldnt take their word for it! After looking myself, I found that my plan covers 100% of physicians fees in or out of network but only 60% of the room and board out of network. I dont think I am going to have to pay anything for staying at my own home!
Also, from dealing with them in the past, I know they like to deny everything at least 3 times. Keep trying! I sent the same info in 4 times (trying to get my breast pump paid for) they denied it 3x and sent it through on the 4th.
I have not yet had my homebirth (due early May), but I think it will all work out. I dont take no for an answer until I have hit everything possible.
A coworker just had a homebirth and they covered 100% of it. She got a case worker before the birth and filed for a gap exception or something like that.
Good luck! I hope it works out for you. I can let you know how mine goes if you like.
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