[xochimama]

WHAT are they so f*&#ing afraid of?? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/splat.gif" style="border:0px solid;" title="splat"><br><br>
We had our first "talk about homebirth" visit with the mw, which was great. She wants to be paid her full fee ($2800) in cash by the 36 week, and then WE are responsible for trying to get reimbursed.<br><br>
Our mw will no longer deal with the insurance company herself: she said that she's had too many problems in the past, and is still dealing with a claim from last April, and she just didn't want to do it anymore.<br><br>
So today I call my insurance company. They do cover homebirths--in fact, 100% coverage, but ONLY if it's done by an "in-network" provider and only if SHE does the billing. (Because then, they control her fee, too-- since to be a provider, she has to agree to take whatever they decide to pay) Well, my m/w is in-network, but doesn't want to do the billing, and wants—and deserves—her full fee.<br><br>
I'm just FLOORED by how insane and stupid our health care system has become. I can't believe that my insurance company will pay for everything if I go see the same m/w in her office and deliver in the hospital, as opposed to home. It would cost them a helluva lot LESS if they just paid for the homebirth! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/Cuss.gif" style="border:0px solid;" title="cuss"><br><br>
Arrrrrrrrrrrrrgh!!

 

[erin_brycesmom]

It doesn't sound like your insurance company is afraid of homebirth at all so I'm a bit confused. Maybe they are afraid of fradulent billing which I can't say I blame them. Your insurance actually pays 100% for homebirth...wow that is awesome. I am so jealous. I have government healthcare so I'm not as lucky. Don't give up yet. Usually if you talk to the right people you can get someone who is reasonable who can help you out. Whether it is your MW (if you can get her to bill) or a manager at the insurance company who can work a deal with verifying everything through the provider while you do the acutal billing. A lot of times a "no" can be turned in to a yes. Keep trying mama! I am starting the good fight just to get a partial reimbursement that I don't even know if I can get at all. Believe me, I am going to hear a whole lot of "NOs"...I've already gotten a few. I'm not going to stop until someone gives me a yes...if that is possible, lol. I already know i have my work cut out for me with that.

 

[ccasanova]

sorry your having to deal with that. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/eyesroll.gif" style="border:0px solid;" title="roll"> Thats part of the reason I still haven't called my insurance company. I don't want to get mad if I don't like what I hear from them. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/eyesroll.gif" style="border:0px solid;" title="roll">

 

[alyssatuininga]

We are feeling similar frustration. We REALLY want a home birth again but looks like we will be traveling over an hour to use our mw's birth center this time because our insurance will pay 100% of the birth center birth and absolutely nada for a homebirth. It sucks I hate traveling in labor but being a penny pinching SAHM I just can't justify the $3000.

 

[xochimama]

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<div>Originally Posted by <strong>erin_brycesmom</strong> <a href="/community/forum/post/10301894"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">It doesn't sound like your insurance company is afraid of homebirth at all so I'm a bit confused. Maybe they are afraid of fradulent billing which I can't say I blame them. Your insurance actually pays 100% for homebirth...wow that is awesome.</div>
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Ok, your point is well-taken. Actually, I don't know if they pay 100% homebirth. They just have a "zero" co-pay on a homebirth, versus a $300 co-pay on a hospital birth. I thought that sounded great, too! But then I started asking more questions, and it's just the typical run-around.<br><br>
They will NOT confirm that they will reimburse me—at all—even though my m/w is one of their providers, because it would fall outside of their "normal" procedures...<br><br>
I guess what irks me is that the insurance companies have so much say over HOW healthcare is managed and provided in this country. It just doesn't make sense to me.<br><br>
But yea, I am following up with all the paperwork and forms and questions, and I will try my hardest to get a pre-authorization for this...

 

[MamaTessa]

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<div>Originally Posted by <strong>xochimama</strong> <a href="/community/forum/post/10302558"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">But yea, I am following up with all the paperwork and forms and questions, and I will try my hardest to get a pre-authorization for this...</div>
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Are you filing for an exception? Your insurance company should have a procedure to follow to get something outside their "norm" covered.

 

[erin_brycesmom]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>xochimama</strong> <a href="/community/forum/post/10302558"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Ok, your point is well-taken. Actually, I don't know if they pay 100% homebirth. They just have a "zero" co-pay on a homebirth, versus a $300 co-pay on a hospital birth. I thought that sounded great, too! But then I started asking more questions, and it's just the typical run-around.<br><br>
They will NOT confirm that they will reimburse me—at all—even though my m/w is one of their providers, because it would fall outside of their "normal" procedures...<br><br>
I guess what irks me is that the insurance companies have so much say over HOW healthcare is managed and provided in this country. It just doesn't make sense to me.<br><br>
But yea, I am following up with all the paperwork and forms and questions, and I will try my hardest to get a pre-authorization for this...</div>
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That is crappy, I'm so sorry mama. I see what you mean and I totally agree with you!!!! That really irks me about insurance companies as well. *We* should be the ones that say HOW *our* care is managed in an agreement with our providers. Nothing else should get in the way of that <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/angry.gif" style="border:0px solid;" title="angry">.<br>
I hope you can get something worked out so that you can have the care that you want without paying out the bleep for it <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">!

 

[KBinSATX]

I filed with my insurance myself the last time and had no problems getting reimbursed. It just is a bit of a hassle but it's all doable.<br>
My midwife would charge $4000 if we wanted her to bill insurance and $2500 if we pay her cash. I know the allowable by the insurance is only $2800 so if we had her bill insurance we'd already owe $1200 ourselves. So it's better for us to do the calling and filling out forms and save a bunch of money.<br><br>
I am sure you'll get it all worked out. I too would be happy to be covered at 100%. There are no in-network midwives where I am so it's only 75% for us. I think I will try harder to get an in-network exception.

 

[Sarah8Jane]

I'm lurking and saw this post.<br><br>
You will probably get everything resolved through the insurance company, but if you have problems getting your covered homebirth reimbursed, I would let the company know that you will be contacting your state insurance department to file a complaint. It sounds like you've probably talked to someone who doesn't really know how to handle exceptions, but if they have a policy of not reimbursing for in-network providers who don't bill insurance, you potentially could argue unfair trade practices and fraud. Your state insurance department would definitely want to know about it.

 

[xochimama]

Thanks for the ideas and encouragement.<br><br>
BTW, KBinSATX, I did ask what the allowable was for homebirths, so that I could plan on paying the difference if they only paid for part of the $2800 fee, and the woman I spoke with wouldn't give me an answer!! She said that until they received a claim, they couldn't tell me what they will pay.<br><br>
Does that sound weird to you all? I asked her point blank: "So I have to go through the whole nine months, and only at the end will I find out if you will pay anything?" And she said YES.<br><br>
I just wanted to scream! Do they realize that I am also super hormonal right now??? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">

 

[KBinSATX]

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<div>Originally Posted by <strong>xochimama</strong> <a href="/community/forum/post/10310476"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Thanks for the ideas and encouragement.<br><br>
BTW, KBinSATX, I did ask what the allowable was for homebirths, so that I could plan on paying the difference if they only paid for part of the $2800 fee, and the woman I spoke with wouldn't give me an answer!! She said that until they received a claim, they couldn't tell me what they will pay.<br><br>
Does that sound weird to you all? I asked her point blank: "So I have to go through the whole nine months, and only at the end will I find out if you will pay anything?" And she said YES.<br><br>
I just wanted to scream! Do they realize that I am also super hormonal right now??? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"></div>
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What she means is that she needs to have a procedure code to tell you what the allowable is. There is no big book that goes by words and she looks up 'homebirth' or anything. They pay based on procedure code.<br>
My midwives billed the whole thing (including all care) under the procedure code for vaginal delivery <a href="http://www.dhmc.org/webpage.cfm?site_id=2&org_id=564&morg_id=0&sec_id=0&gsec_id=29702&item_id=30711" target="_blank">59400</a>.<br><br>
Check with your midwives and see what code they are using. Call back and ask for the allowable for that code.

 

[xochimama]

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>KBinSATX</strong> <a href="/community/forum/post/10310707"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">What she means is that she needs to have a procedure code to tell you what the allowable is. There is no big book that goes by words and she looks up 'homebirth' or anything. They pay based on procedure code.<br>
My midwives billed the whole thing (including all care) under the procedure code for vaginal delivery <a href="http://www.dhmc.org/webpage.cfm?site_id=2&org_id=564&morg_id=0&sec_id=0&gsec_id=29702&item_id=30711" target="_blank">59400</a>.<br><br>
Check with your midwives and see what code they are using. Call back and ask for the allowable for that code.</div>
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YOU ROCK!!! THANK YOU for the info!! I'm so glad I posted my vent--I never would've known to ask in this way...!

 

[waterjen]

you're giving me the courage to call my insurance company and find out what they say. I've been putting it off because I know how difficult it it...<br>
so thank you...

 

[ccasanova]

does anyone know if an insurance co. would ever make an exception for someone that is out of network and make them in network? There is only one midwife innetwork, and she does not do VBAC's or Hb's. So there is no one else. I have a midwife in mind, but I would like my insurance to cover her as in network. Does anyone know how to go about doing that?

 

[KBinSATX]

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<div>Originally Posted by <strong>ccasanova</strong> <a href="/community/forum/post/10310926"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">does anyone know if an insurance co. would ever make an exception for someone that is out of network and make them in network? There is only one midwife innetwork, and she does not do VBAC's or Hb's. So there is no one else. I have a midwife in mind, but I would like my insurance to cover her as in network. Does anyone know how to go about doing that?</div>
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Yes, I am trying to do it that way this time around. I found a really good excemption form on a local midwife's site: <a href="http://midwiferyservices.org/In_Network_exception_form.pdf" target="_blank">http://midwiferyservices.org/In_Netw...ption_form.pdf</a><br><br>
I'll be using that wording and see if I can't get an excemption.<br>
Good Luck to all of us. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">

 

[xochimama]

Hey everyone, also check this <a href="http://www.mothering.com/discussions/showthread.php?t=560454" target="_blank">sticky</a> in the Homebirth Forum. There are a bunch of links and information about how to go about getting it pre-authorized and covered.<br><br>
ccasanova, apparently, some states have a law that REQUIRES the insurance company to cover the out-of-network provider, when they do not have an in-network provider who provides the service you need. But you might have to get it pre-approved/pre-authorized. Check the link above.

 

[waterjen]

Our midwife told us to call and ask if our coverage included "out of hospital birth" and then "midwife". It does but there are no midwives in an 80 mile radius at least that are "in-network." Originally our midwife would be "out-of-network" but because of the "network insufficiency" we are asking that she be covered at in network rates. It is yet to be ruled on...<br>
Thanks..hope this helps somebody...

 

[happylemon]

Blah, that sucks. Our insurance wont pay a penny, we are paying out of pocket for our home birth.