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Anyone have experience with the midwives and/or hospital?<br><br>
I'm a first-timer who wanted a midwife-assisted pregnancy and delivery at a birthing center, but insurance had me opt for a "nurse midwives" practice.<br><br>
I transferred to them at 24 weeks (30 now), and everything seems all right so far. I've met 3 of the 4, and I love one, while the other two are okay. Nothing rubs me the wrong way yet, but I'm still nervous about delivering at a hospital.
 

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I don't know about those midwives but I wanted to post some info that may be useful.<br><br>
Does your insurance company <i>handbook</i> specifically say that only CNM are covered? If not, and you have a PPO type plan, maternity coverage, and CPMs are legal in your state you can get coverage, but your ins.co. will not make it easy for you. Below is an old post I made for someone in Texas. If you have an HMO, I have a post about appealing them also (somewhere, I'd have to dig on the homebirth board.<br><br>
My midwife is in the SA area if you'd like to find another who will argue with your insurance company for you <a href="http://www.greatbirth.org/index.html" target="_blank">http://www.greatbirth.org/index.html</a>. My ins.co. told me that only CPMs were covered in a hospital and only Drs at home. I had a homebirth with Stacey and she got paid!<br><br>
BCBS<br><a href="http://www.ahealthyme.com/topic/printview" target="_blank">http://www.ahealthyme.com/topic/printview</a><br><br><br><br>
Here's my Texas insurance post:<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><br>
Private health insurance that pays for maternity care has to pay for birth regardless of where it occurs (though it may be at an out of network rate). At the bottom is a link for gentlebirth; there is a lot of information on that site to help with billing. I'm in San Antonio/Converse; CPMs and DEMs are legal to practice in Texas.<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><a href="http://frwebgate.access.gpo.gov/cgi-bin/get-cfr.cgi?TITLE=45&PART=146&SECTION=130&YEAR=1999&TYPE=TEXT" target="_blank">http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT</a><br>
Code of Federal Regulations Title 45, Volume 1:<br><br>
(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.<br><br>
c) Construction. With respect to this section, the following rules of construction apply:<br><br>
(1) Hospital stays not mandatory. This section does not require a mother to--<br><br>
(i) Give birth in a hospital; or<br><br>
(ii) Stay in the hospital for a fixed period of time following the birth of her child.<br><br>
(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.</td>
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<a href="http://www.gentlebirth.org/cgi-bin/q...&maxresults=40" target="_blank">http://www.gentlebirth.org/cgi-bin/q...&maxresults=40</a><br><br><a href="http://www.gentlebirth.org/archives/money.html#HMO" target="_blank">http://www.gentlebirth.org/archives/money.html#HMO</a><br><br><a href="http://www.texasmidwives.com/" target="_blank">http://www.texasmidwives.com/</a><br><br>
From gentle birth:<br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">To get payment from an HMO, I would have the mother call her insurance carrier and request an "in-network midwife." They will<br>
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<br>
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.</td>
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And here is the state board site:<br><a href="http://www.tdi.state.tx.us/consumer/doctors.html" target="_blank">http://www.tdi.state.tx.us/consumer/doctors.html</a><br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Notice to HMO Patients<br>
Texas law protects your access to medical care.<br>
If you are not satisfied that your HMO is providing you with the medical services<br>
you need, you should write or call your HMO to complain. If your complaint is not<br>
resolved to your satisfaction, you have the right to request that your complaint be<br>
reviewed by a panel that is made up of members who have not been previously<br>
involved with your case. THE HMO MUST MAKE THIS PANEL AVAILABLE TO<br>
YOU.<br>
If you want to know if you have other rights, call your HMO.<br>
For more information call:<br>
Texas Department of Insurance<br>
HMO Complaint Helpline<br>
1-800-252-3439<br>
In Austin, Call 463-6515</td>
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For definition of midwfery care and other good info:<br><a href="http://www.cfmidwifery.org/midwifery/faq.aspx#1" target="_blank">http://www.cfmidwifery.org/midwifery/faq.aspx#1</a><br><br>
Definition of OB:<br><br>
"An obstetrician is a physician who has successfully completed specialized education and training in the <b>management</b> of pregnancy, labor, and pueperium (the time-period directly following childbirth)."<br><br>
If you decide to challege your insurance company to pay for your midife, remember to talk to their wallet and not their ear :smile:. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top with hb safety info and check out the WHO because they have a lot of good things to say about midwives.. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top with hb safety info.</td>
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<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Here are some links leading to the parts of Title 45 I quoted:<br><br>
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<br>
Standards relating to benefits for mothers and newborns., Clicked on Subpart C,<br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=%2Findex.tpl" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...l=%2Findex.tpl</a><br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?sid=ca74f84fa665c6b297bc190cf8a5354e&c=ecfr&tpl=/ecfrbrowse/Title45/45tab_02.tpl" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...5/45tab_02.tpl</a><br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?sid=ca74f84fa665c6b297bc190cf8a5354e&c=ecfr&tpl=/ecfrbrowse/Title45/45cfrv1_02.tpl" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...45cfrv1_02.tpl</a><br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=ca74f84fa665c6b297bc190cf8a5354e&tpl=/ecfrbrowse/Title45/45cfr146_main_02.tpl" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...46_main_02.tpl</a><br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=ca74f84fa665c6b297bc190cf8a5354e&rgn=div8&view=text&node=45:1.0.1.2.61.3.33.1&idno=45" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...3.33.1&idno=45</a><br><br><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=ca74f84fa665c6b297bc190cf8a5354e;rgn=div6;view=text;node=45%3A1.0.1.2.61.3;idno=45;cc=ecfr" target="_blank">http://ecfr.gpoaccess.gov/cgi/t/text...dno=45;cc=ecfr</a></td>
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I just wanted to give you a "thumbs-up" for Lone Star. They are totally awesome and I got exactly the birth I wanted. St. Luke's hospital is also really nice and the nurses were great.<br><br>
It is funny that you should say that about liking one midwife over the other ones. I too had my favorites when I went to my prenatal appointments. It is the luck of the draw who you get on the big day, but believe me...they will all do a wonderful job.<br><br>
Jan was my midwife for my delivery and lets just say that she wasn't my first choice initially, but she was AWESOME for the actual delivery. I think whoever you get will do a great job.<br><br>
Hope all goes well on the big day and have you considered a doula. I used Julie Walker and she was great. She is also very familar with working with Lone Star, so that made it very easy in the delivery room.
 

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I don't think it's legal for your insurance to insist you have a CNM. Since midwives can be licensed in TX, my understanding is that insurance must cover them.<br><br>
good luck!<br><br>
-Angela
 

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<div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>alegna</strong> <a href="/community/forum/post/9446408"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I don't think it's legal for your insurance to insist you have a CNM. Since midwives can be licensed in TX, my understanding is that insurance must cover them.<br><br>
good luck!<br><br>
-Angela</div>
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I don't know if that is totally true. Your insurance company can state they will only pay for a birth in a hospital (I totally don't agree with this practice though).<br><br>
If you have the time though, it might not hurt to "educate" your insurance company and try to find a hole in the ruling for only CNMs in hospitals.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
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<div>Originally Posted by <strong>sbroglie</strong> <a href="/community/forum/post/9446478"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I don't know if that is totally true. Your insurance company can state they will only pay for a birth in a hospital (I totally don't agree with this practice though).<br><br>
If you have the time though, it might not hurt to "educate" your insurance company and try to find a hole in the ruling for only CNMs in hospitals.</div>
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I'm pretty sure they can NOT legally dictate where a licensed practitioner practices.<br>
(doesn't mean they won't TRY, but I'm pretty sure it wouldn't be legally upheld if protested)<br><br>
-Angela
 
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