Getting Insurance to Pay for Homebirth
I am trying to get my insurance to count our home birth fees as in-network, applying it to our deductible and then paying what will go over our deductible. My understanding is that, since they do not have a home birth practitioner listed as in-network, then we should be able to negotiate with them to get my midwife covered as if she were in-network. I am insured through United Health Care (Ohio).
Does anyone have any advice for how they pursued this, recommendations, what to say (or not-to-say), and so forth?
Thanks for any feedback!
Rachel
Does anyone have any advice for how they pursued this, recommendations, what to say (or not-to-say), and so forth?
Thanks for any feedback!
Rachel
Replies to This Discussion
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Permalink Reply by Levonne Pettway on -
My midwife uses a billing service that specializes in serving home birth midwives (it was started by a midwife). From what I can tell, the key is to bill for services rendered and not to mention the location. They use all the standard billing codes that a midwife in a birth center might use, and the site of your birth isn't really the information that they are looking for. Of course, if you tell them "home birth" right off the bat, they they will most likely freak out and you'll be red flagged in one way or another. Ask about midwifery care etc, but leave the home part out of it.
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Permalink Reply by Rachel Hiser on
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That would work fine if I wanted to pay out-of-network fees. But, I'm trying to get them to count her as in-network since they don't have an in-network provider for home birth. My out-of-network deductible is $3000. My in-network is $1500. My midwife fees are $1750. So, it would really be nice to get them to count the charges for in-network so, if I have any other medical care this year, I wouldn't have to cover two separate deductibles (in and out-of-network). Plus, I'm concerned that the OB office I was seeing before finding my home birth midwife is going to send a bill to my insurance and the insurance company will count those charges against my in-network benefits. I really don't want to pay for both the OB visits AND the home birth out of pocket!
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Permalink Reply by Amanda Whitmire on -
This page seems to have some useful links: http://www.homebirth-usa.org/choosing/insurance.html
In my case, licensed midwives are covered as out-of-network providers is the same way as acupuncturists and chiropractors (70%). Good luck!
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Permalink Reply by Rachel Hiser on
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Thanks Amanda! That is an excellent link and exactly what I was looking for. One of the links on the page included step-by-step instructions for how to approach the insurance company - this is VERY helpful!
Fortunately, my insurance covers CNMs and chiropractic services (no acupuncturists or massage therapists though - which is a shame!). I have so many chiropractic visits allowed per year @ 100% with a co-pay. And I have full maternity coverage, less my deductible. Fortunately, our plan covers 100% after the deductible, so I know exactly what I'll be paying out of pocket. I just need to get this covered as in-network! lol.
Thanks again!
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Permalink Reply by Jessica Fox on -
I was recently able to get United Health Care in Florida to approve my midwife at in network rate.
Depending on how your plan is structured you would make the call yourself or an in-network doctor such as a Primary Care Physician would have to make the request on your behalf.
In my case my PCP's office called and asked for a "gap exception" for not having a midwife in-network within 30 miles. It took a couple of days to get a verbal approval and less than a week to get the official letter for it.
Now we just get to cross our fingers that when the time comes they'll reimburse at the correct rate.
Good luck!
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Permalink Reply by Maria Radonicich on -
I am trying to figure out how to have my midwife covered in-network with United Healthcare in NC. How do you know what way your plan is structured and whether you call yourself or have your primary care physician call?
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Permalink Reply by Rachel Hiser on
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My guess would be whether or not you normally have to have your primary care physician refer you to specialists. My plan does not. I can "self-refer" to anyone I want and don't need prior authorization to do so. So, I can go online, search for a provider who is in-network, and then schedule an appointment all without having to go through my primary care physician.
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Permalink Reply by Bethann on -
the structure of your health insurance is based on whether it is an HMO or a PPO. HMO's have referrals and are very difficult to deal with as far as getting services approved and so on. PPO tend to be the most flexible plans which allow you to go in and out of network with not many problems. United Health I believe is either an HMO or an in between of the two. If you are able to go online to your health care provider you should be able to look at your plan and what it dictates. It should tell you in the title whether it is an HMO. If you need pre-approval for a service like an MRI or such then I would suggest having your dr's office try to get the midwife approved for you. If you do not need pre-approvals or referrals then you might be able to fight it on your own. I worked in a dr's office so I know insurance... hence my information above.
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Permalink Reply by Jessica Fox on
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My plan is a PPO but the way my employer set up the contract required an in-network doctor to make an exception.
I found this out by calling United's member services phone number and requesting to be transferred to the "Care Coordination" department.
Open with a statement such as "since you do not have a midwife in my area that can provide the birth of my choice in your network, could you please provide a network gap for my midwife?".
If they let you do it yourself they'll take all of the information down on that phone call and give you a reference # for follow up, if not they'll let you know to have a doctor do it for you.
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Permalink Reply by Rachel Hiser on
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Very good info Jessica and Bethann!
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Permalink Reply by janackeh klein on
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Permalink Reply by Kaitlin Rose on -
I was just about to share that link! Thanks for posting it. I'm so glad Jeremy wrote that article (and so glad to host it on my site!).
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