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Discussion Starter · #1 ·
It's that wonderful time of year again - benefits selection.

When I was pregnant the first time, I had a PPO with Cigna and it was iffy whether they'd cover the homebirth or not. I ended up in the hospital, so I will never know. Now I have an EPO with United Healthcare and they wont cover ANYONE out of network (Midwife, naturopath, etc). I'm' trying to decide if it's worth $600 a month to use the PPO family coverage through my employer.

I have been looking at health quotes, but without actually speaking to someone, I can't even find if maternity care is covered by most policies.

Who has had a homebirth (or midwife prenatal care followed by a UC) successfully covered by insurance? Would you mind sharing the company and policy type so I can start from there?

TIA!
:
 

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I'm interested too! I currently have Network/HMO through Cigna and they don't cover anything out of network. We get to switch at the beginning of the year, but don't know to what.
 

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I have BCBS of Illinois, PPO plan; CPMs are legal in Texas. My mw has a biller and of the $2700 I paid $1400. Sometimes it is better not to mention hb at all and just have your mw (try not to specify what kind if you don't have a CNM) bill for pre and post natal care. Gentlebirth has a lot of advise on billing.

Quote:
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.
http://www.gentlebirth.org/cgi-bin/q...&maxresults=40

http://www.gentlebirth.org/archives/money.html#HMO

For definition of midwfery care and other good info:
http://www.cfmidwifery.org/midwifery/faq.aspx#1

Definition of OB:

"An obstetrician is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth)."

From gentle birth:

Quote:
To get payment from an HMO, I would have the mother call her insurance carrier and request an "in-network midwife." They will
probably tell her that there is none in network, but they have plenty of other options. She will have to stipulate to them that she has researched
the treatment plan and decided that the midwifery model is her preferred treatment plan. Then she will need to say since there are no "in-network," providers I want a "transfer of care (TOC) exception number, or waiver for the services." (different terms for the same thing.) Many company insurance specialists will have the form. If they refuse to consider a TOC you can file for a review for the denial at that point, then appeal, and finally arbitration or State Insurance Board.

Quote:
Here are some links leading to the parts of Title 45 I quoted:

Googled "Code of Federal Regulations", clicked on it, picked Title 45 from the drop down menu, picked Volume 1 - subtitle A - 1to199, clicked 146 Requirements for the Group Health Insurance Market, clicked 146.130
Standards relating to benefits for mothers and newborns., Clicked on Subpart C,

http://ecfr.gpoaccess.gov/cgi/t/text...l=%2Findex.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...5/45tab_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...45cfrv1_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...46_main_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...3.33.1&idno=45

http://ecfr.gpoaccess.gov/cgi/t/text...dno=45;cc=ecfr
[/QUOTE]
 

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I live in Texas also & plan on filing after the birth. I better get something back-I don't even care if it is the whole amount, which would be wonderful though.
 

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Discussion Starter · #6 ·
Okay, so in the Program Summary Description for the PPO plan it specifically states that midwives and doulas are not covered. It doesn't say anything about homebirth. I'm not sure if it would be safe to assume it could be covered, even partially. WDYT?
 

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move to VT-- the state program for all children in the state and pregnant women covers homebirths. and i know women who have private insurances who can still be covered through the "dr dynasaur" program for their homebirths.
 

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Quote:

Originally Posted by ~MoonGypsy~ View Post
It's that wonderful time of year again - benefits selection.

When I was pregnant the first time, I had a PPO with Cigna and it was iffy whether they'd cover the homebirth or not. I ended up in the hospital, so I will never know. Now I have an EPO with United Healthcare and they wont cover ANYONE out of network (Midwife, naturopath, etc). I'm' trying to decide if it's worth $600 a month to use the PPO family coverage through my employer.
One thing to keep in mind is comparing the price of the health coverage versus the price of just paying for the homebirth out-of-pocket.

In our situation, my wife could choose between an HMO which almost definitely won't cover a homebirth (though we're sill going to try, hehe) and a PPO which would cover a portion of it. However, the PPO plan was so much more expensive than the HMO that it would actually have ended up costing us more to go with the PPO than it would to go HMO and just pay for the midiwfe ourselves (plus she's been on this HMO for awhile now and has plan providers that she really likes, which helped the decision).

I don't know what the pricing of your options are, but don't forget to take that into consideration. $600/month is fairly pricey, if there's an option that's $300/month cheaper (and would still give you coverage that you want in areas other than prenatal/birthing), that price difference alone is probably enough to cover the homebirth.

I know this seems fairly obvious, but in our initial searching for options and crusade to find some coverage that would cover a midwife/homebirth, we were forgetting about this until we stopped and did a reality check when comparing prices of different plans.
 

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I have a consumer health driven plan called Lumenos through my company and they reimbursed us at the out-of-network rate. They don't cover homebirth but my midwife submitted a global charge for prenatal and postpartum care.

I'm just wondering though - if it will cost $600 a month to upgrade your insurance - wouldn't it just be cheaper to pay for the homebirth out of pocket? How much does your midwife charge?
 

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Quote:

Originally Posted by alegna View Post
Huh. It says midwives are NOT covered? My policy said they were. What's the legal status of midwives in AZ?

-Angela
In Arizona - there are - by law (statute) - Licensed Midwives and Certified Nurse Midwives.
 

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Quote:

Originally Posted by ~MoonGypsy~ View Post
It's that wonderful time of year again - benefits selection.

When I was pregnant the first time, I had a PPO with Cigna and it was iffy whether they'd cover the homebirth or not. I ended up in the hospital, so I will never know. Now I have an EPO with United Healthcare and they wont cover ANYONE out of network (Midwife, naturopath, etc).

TIA!
:
That sounds like almost EXACTLY my story. I had Cigna PPO, and they paid for EVERYTHING without any trouble. They since switched us to Aetna, who won't pay squat out of network.
My midwife gave me a reduced rate when I told her that I was considering either using a doctor or going unassisted because of the insurance issue. If you have an established relationship with yours, maybe she's willing to do the same rather than lose you!
 

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Quote:

Originally Posted by ~MoonGypsy~ View Post
Okay, so in the Program Summary Description for the PPO plan it specifically states that midwives and doulas are not covered. It doesn't say anything about homebirth. I'm not sure if it would be safe to assume it could be covered, even partially. WDYT?
By Federal Regulation (title 45) if your midwife is licensed by the state to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child, then they have to pay even at OON rates. They cannot not pay a licensed provider if you are using the OON option, just because. Doulas, on the other hand seem to rarely be covered. What I would do here would be to file a claim for the Doula as pain relief; I was going to do thisfor the tub if I rented one for my water birth.

(forgot to include the provider info earlier)

Quote:
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.
 

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Quote:

Originally Posted by i'mmykid'$mom View Post
By Federal Regulation (title 45) if your midwife is licensed by the state to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child, then they have to pay even at OON rates. They cannot not pay a licensed provider if you are using the OON option, just because.

(forgot to include the provider info earlier)
I'm not sure I understand - what makes an insurance company HAVE TO PAY if you have an HMO and use a licensed midwife who happens to be out of network ??? This is the situation I'm in at the moment (see my thread on Pacificare HMO coverage)???? Any suggestions?
 

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Discussion Starter · #15 ·
I think that JCFelt is right.

I currently pay about $75 a month for just myself for all benefits. DBF has coverage for himself and DS, which is roughly double that. (It worked out cheaper to do it that way, even though we work for the same department in the same company)

The PPO Health insurance would be about $550, plus extras like dental, life, etc. The only major things that (knock on wood) we would need to worry about would be pregnancy. And at the rate I'm going, I don't even know if I will deliver in 2007. My Midwife charges $2000, and the insurance would cost $7200/yr so the difference is just not worth it. We would need to go see the naturopath, acupuncturist and osteopath once a week to even break even on that deal. On top of that I have lay midwives which might be fighting an uphill battle with the insurance companies.

Does anyone have experience with the Flex Spending accounts? Again, I'm worried that I would not deliver in 2007 and I thought I was told that if you don't use the money in the account by the end of the year, you will lose it. Is that true?
 

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FYI - this doesn't apply to this post per se, but it is good info. I have Aetna, and the MW I am using bills for HB's by saying I 'birthed WITH the birth center', since all the equipment that comes to the HB is the same thing that is already in the BC, and Aetna will cover the BC birth.
 

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Quote:

Originally Posted by twogreencars View Post
I'm not sure I understand - what makes an insurance company HAVE TO PAY if you have an HMO and use a licensed midwife who happens to be out of network ??? This is the situation I'm in at the moment (see my thread on Pacificare HMO coverage)???? Any suggestions?
I actually got the reg off my mw's website and she has never not gotten money out of an insurance company; though they put up a fight. After reading Title 45 a dozen times I think the way it works is that by federal reg (which has the force of law) you are not required to give birth in a hospital but (with group health w/mat coverage) you are still entitled to an "attending provider" who is entitled to be paid.
 

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I did exactly what the PP says to do (thought I didn't kow it at the time, I'm jusy argumentative by nature) Told them that since they have no in-network mws and that that was the care I needed (I stipulated that an OBGYN is a specialized surgeon in complicated pregnancies, and I was low risk and had already had 2 HB with this particular mw who was also being referred to them by my in-network GP). It worked but took 6 months of phone calls. still worth it.
 

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How did you manage that? I am in a fight right now with UHC to get them to pay--my husband has a meeting with the broker this morning to discuss it--they have midwives in network, but because I am a VBAC they won't take me. It chaps my hide that they are willing to pay for a totally unnecessary surgery that could cost 10x what the midwife charges but can't/won't cough up the measley few grand so that I can have the best birth for my baby
 
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