Help with Clinics and Hospitals
My name is Jeannine and I found out just a few weeks ago that I am going to have a baby. I contacted the Morningstar Birth Center in Wisconsin and have chosen to have my baby via a midwife (thank your movie and Pregnancy in America for that). I have done ample research on home birth and I live two blocks from the hospital that would be my back up plan. Everything seems great right? Nope.
I called my regular clinic to see if I could see them for my prenatal exams. They are denying me services based on the fact that I even brought up Morningstar as an option. Apparently, it doesn't matter that my insurance won't cover me at the birthing center. They refuse to take liability for anything. But I don't need them to be liable for much, when the only thing I want is the end result: a baby born at home via a midwife.
The same goes for the other clinic corporation and the city department of health. Apparently, although millions of women around the world give birth each day and aren't in a hospital, it isn't safe for me, a US citizen to choose where I give birth. I am being made to feel like a criminal for even thinking about it.
What can I do? I need to get started on my prenatal exams, but no one who will take insurance wants to see me because I am a liability risk of some sort. The midwife can do my prenatals, but my insurance won't pay much if anything because she is out of network. The insurance company won't even consider letting me do home birth and my midwife won't be considered for in-network status because she doesn't carry malpractice insurance and doesn't work through a doctor.
My midwife has suggested that I lie about her. I am started out my motherhood as a liar. I don't like that. It's not good to tell my child that I had to lie because otherwise she/he couldn't have been born at home. And that lying is okay.
Please help?
I called my regular clinic to see if I could see them for my prenatal exams. They are denying me services based on the fact that I even brought up Morningstar as an option. Apparently, it doesn't matter that my insurance won't cover me at the birthing center. They refuse to take liability for anything. But I don't need them to be liable for much, when the only thing I want is the end result: a baby born at home via a midwife.
The same goes for the other clinic corporation and the city department of health. Apparently, although millions of women around the world give birth each day and aren't in a hospital, it isn't safe for me, a US citizen to choose where I give birth. I am being made to feel like a criminal for even thinking about it.
What can I do? I need to get started on my prenatal exams, but no one who will take insurance wants to see me because I am a liability risk of some sort. The midwife can do my prenatals, but my insurance won't pay much if anything because she is out of network. The insurance company won't even consider letting me do home birth and my midwife won't be considered for in-network status because she doesn't carry malpractice insurance and doesn't work through a doctor.
My midwife has suggested that I lie about her. I am started out my motherhood as a liar. I don't like that. It's not good to tell my child that I had to lie because otherwise she/he couldn't have been born at home. And that lying is okay.
Please help?
Replies to This Discussion
-
Permalink Reply by Sara on
-
I am so sorry to hear about your situ. I totally agree that you should have the freedom to decide where your baby is born and the insurance that you pay for should honor and pay for your choice.
I was in a similar situ, I live in TX. I have an HMO with no out of network benefits. My ins has MW in network, although they all work out of an OB office and only do hosp deliveries. None on the plan near me worked w/ a BC or did HB. I did some research on my state laws and found that since they have MW on my plan and do pay for BC but did not have any on my plan within a reasonable distance and I have no OON benefits they had to allow me to see a MW that practices out of a BC/HB and pay her as in network. That is only b/c they have these available but none in my area. I never told my ins company I wanted a Home birth, i always use the term "out of hospital" they assume BC and I don't correct them--but my MW knows I am planning a HB.
Does your ins have any MW on your plan at all? Do they offer BC as an option or exclude them completely? If your ins covers MW in a hosp you may be able to fight to have an OON MW at a BC paid at network rates, depending on your ins coverage and the state insurance laws. This link is to your state's insurance board and has info on insurance regulations and laws http://oci.wi.gov/oci_home.htm
Both CNM and CPM have the legal right to practice in your state. This link can help you find MW in your area, most will help you get coverage from your ins, they usually know which ins groups can be pushed into covering MW care at a BC and getting it covered as in network http://cfmidwifery.org/states/states.aspx?ST=WI
Your state law says that a health care provider cannot be held responsible/liable for any action taken by a MW. It also says that MW do not have to work with a dr so your ins company cannot require it either nor deny you coverage for a MW solely b/c of that. This link is your state laws about MW http://www.legis.state.wi.us/2005/data/acts/05Act292.pdf
You could see an OB w/out telling them you are going to transfer then moving to the MW at the end of your PG and it would save you $$$ (I am guessing thats what she meant by lying) and get your HB. I am not sure I would consider that lying...I think of it as taking drastic measures to obtain the birth you want--shame on the system for putting you in that situ in the first place. Lots of women that are VBAC do it to OB's--agreeing to a c/s so they can get care then refusing to consent at the end even though they know that the OB would not have accepted them as a patient if they had disclosed their plan early in their PG. Is that something you would be uncomfortable doing? Do you consider that lying and out of the question?
Have you calculated what it will cost you w/ins to pay for a dr then also pay the hospital? It may be that the amount you pay the MW w/out ins won't be much different than the amount you pay after all costs are paid to the dr & hosp using your ins.
As far as noone taking you b/c you are a risk is that only b/c you want to transfer to a MW for delivery at the end? It is highly unusual for an OB to refuse a patient for simply being "high-risk"--unless you are a VBAC patient refusing a c-section in an area where VBAC's are banned.
After all is said and done, you may just have to make a hard decision: would you rather use your ins benefits, see a OB, and have a hosp delivery or pay more out of pocket to see a MW and have a HB?
Good Luck. And Congrats!
-
Permalink Reply by Jeannine Fisk on -
Thank you so much for your reply! More and more research is finally helping me to make a better decision about what to do. And calming down helps a lot. No, I haven't been determined as high-risk yet. That would mean I had prenatal testing which I haven't yet. High-irratibility factors yes, but that can be fixed with lots of warm decaf tea and comedy hours with the hubby.
The clinic doesn't want to be liable for communicating test results to the midwife. I think that was the problem. At the same time, if I don't get them done through the clinic it costs me more. According to the administrator I talked to, it will also cost me more in co-pays should I switch at the last moment. Something about lumping services together in a package that the insurance pays all at once. It was hard for me to understand as I was a bit emotional at the time.
Apparently, some insurance companies can be convinced that they can save money with a homebirth and end up paying for all the services either out of network or in-network. I am going to start that process tomorrow. I think I might have my husband deal with the phones as I don't think I can deal with more stress. He's good at controlling his voice, where at the moment, I can't fake happiness. LOL. I've read quite a few websites on how to do it and I'm going to start there. Basically it involves not being able to find in-network providers for out of hospital births. Then, following up all the denials with reasons why it's better.
After thinking hard about it, the city/county health department will often take care of the prenatal testing. My MW suggested this in the first place to save aggrevation and I didn't take her advice. Because they have a bad rap with women who want to homebirth or go with a midwife, I'm just going to tell them that I haven't decided on a provider yet and just want to be sure that me and my baby are okay. Easy way to get tests cheap and accurately :) I do feel that it is being untruthful, but dammit, they forced me into it. Plus, if I qualify for state medicaid, it's covered.
If all else fails, I might have a good job starting on Monday. Maybe I can pay for it. Insurance won't cover much, but maybe I'm wrong. I already sent in a request for benefits relating to pregnancy and birth. Hopefully, I will read something in there that I can give a huge Hooray! over.
-
-
I am glad that you are discovering your options. Maternity benfits are billed as a "global fee" meaning that the dr/MW charges a set amount (usually between $3,000-$4,000) for all prenatal visits (excluding lab work & ultrasounds), a vaginal delivery, & postpartum care. This total fee is billed at once after delivery. If you change providers during your PG the charge is split between the two depending on how many visits each one provides. They are billed as a package i.e 2-4 visits, 5-9 visits, 10-13 visits and so on... So you will not have to pay each one the total fee and when all is said and done the total amount billed for the global fee will be the same when you add the seperate bill from each dr.
If your coverage works on a deductible plus a percentage then the amount you pay won't be different at all even if you switch dr. If you coverage works on a co-pay (as mine does) you will have to pay the copay again at your first visit to the MW after you switch. This is what I did. I had already paid my copay to my MW then when I was 3 mos I switched to HB MW and had to pay the copay to her at my first visit. Since my copay is only $40 thats what my extra cost was for changing providers. I don't know what your copay is but chances are it will be cheaper than paying hospital charges and/or out of network costs for seeing the MW for all prenatal care.
My stand against my ins co was based on exactly what you mentioned. I wanted an Out of Hospital Birth and they did not have an in-network provider (in my area) that would provide that service to me. I did have to call every MW on my network within 50 miles of my house to confirm the only do hosp births and stress that to my ins company. I also emphasizes to them, as you said, that it would be much cheaper for them to avoid the costs associated with a hospital delivery. But I never used the word Home Birth--per my MW advice. They tend to shut down at that. As I said they assume it will be in a BC. It took many, many phone calls from me and the MW/BC to obtain the authorization. But it finally worked and they relented. So don't give up. Call your State ins department to find out what your rights are.
It is an uphill battle and can be very stressful and frustrating, but in the end it is well worth it. Fight the good fight! Much luck.
-
Permalink Reply by Jeannine Fisk on
-
Thank you so much for your input on this! I'm going to show this to my husband too so he can help us both get the in-network coverage we want to work for. It's nice to hear that even though it's a tough battle, that it's winnable. Thank you!
-
Permalink Reply by Cindy Lerner on -
One thing that always concerns me with these insurance questions is that people are letting insuarnce companies decide what is best them. I know that insurance can be a great help in emergency situations where the out of pocket costs would be outrageous. But, with our total midwife cost for prenantal and homebirth paying cash it was similar to what out our portion would have been had we done all hospital prenantal and birth. After everything was said and done I've told friends who asked about the cost that I would have been willing take out a $10,000 loan if that's how
much it cost to have my homebirth. I think that as a society we have gotten too wrapped up in insurance and stopped focusing on what is really important. And the health and well-being of mother and child is NOT a concern for the insurance company, it is our duty to make our own decisions and sometimes that might mean having to pay a little more for what is better. Heck, I pay twice as much to buy organic food in the store, but is it worth it? YES. Just something to think about.
-
Permalink Reply by Cindy Lerner on
-
One thing that always concerns me with these insurance questions is that people are letting insuarnce companies decide what is best them. I know that insurance can be a great help in emergency situations where the out of pocket costs would be outrageous. But, with our total midwife cost for prenantal and homebirth paying cash it was similar to what out our portion would have been had we done all hospital prenantal and birth. After everything was said and done I've told friends who asked about the cost that I would have been willing take out a $10,000 loan if that's how
much it cost to have my homebirth. I think that as a society we have gotten too wrapped up in insurance and stopped focusing on what is really important. And the health and well-being of mother and child is NOT a concern for the insurance company, it is our duty to make our own decisions and sometimes that might mean having to pay a little more for what is better. Heck, I pay twice as much to buy organic food in the store, but is it worth it? YES. Just something to think about.
-
-
I agree w/you--to a point. The bigger issue is that a comglomerate of power between the ACOG and the Ins lobbyists have control over our Maternity Care System here in America. When a woman fights the ins co for coverage for a MW and a BC/HB (like I did) it takes away some of the power and moves us closer towards regaining control over our Healthcare choices. A national effort by all women to demand the coverage we pay for is what it will take to allow us to get away from OB's & hosp births and give us back power over how and where are children will be born. But since most women are OK with the system as it is, we are a long way from that. For now, we each fight the fight individually, like I did. Luckily, I live in a state with laws that protect my right to chose.
I pay over $500 a month for ins coverage for my family. I owe over $20K in student loans that I took out to put myself through college. I carry the weight of a home mortage. I have 2 children I am supporting. I live frugally. I cut coupons and hit the sales. I have trimmed my budget down so that there is no give left anywhere. I would not qualify for another loan to pay for anything, I couldn't afford the pmnt. As you said, I would be willing to pay any amount for a the well-being and health of my child & myself. But as they say "you can't squeeze blood from a turnip." To be blunt the only way I could pay the total out of pocket cost for the delivery of my baby w/ A MW at a BC is to stand on the street corner and beg for it.
Being willing to pay for something and being able to are not the same thing. For some of us there is no choice. Just something to think about.
-
Permalink Reply by Cindy Lerner on
-
If you took the money you had to pay to have maternity coverage on you insuarnce and put it in a savings account it would be more than enough for a midwife birth or een a hospital birth for that matter. I did not have maternity insurance for that reason, and had I been transferred to the hospital for an emergency my insurance treats that as an emergency and still covers as much as it does for ER visits. I do think we should fight for our right to choose and still have insuarnce coverage, but right now the system is so messed up that my priority is just getting the birth I want without an insurance company telling me what to do. By not even getting maternity coverage I took the power that they had to tell me what to do. Even with maternity coverage that my sister was paying $200 a month for she still had to pay over $2000 out of pocket for a completely normal vaginal hospital birth. If she would have saved the $200 for a year that $2400 plus the $2000 for her portion out of pocket she could have paid for most midwives prenantal and birth costs plus had some left over for birth classes. And her regular health insurance would have covered had an emergency occurred. I think we just have to take a second look at where our money is actually going when we buy maternity insurance. I also know that my midwife will work with anyone to do payment plans especially if they do not have insurance. I think it is really great that you fought to be able to use your benefits. I was actually advised not to getthe maternity insurance since I wanted a homebirth and again all the money I saved monthly by not having it went to my midwife and it all worked out perfectly. Still have health insurance for emergencies, but I have not had to use it thank God.
-
-
My ins is covered through a group plan. Its a all or nothing thing. Denying the maternity coverage is not an option. I have looked into independent ins co that would have allowed me to choose different types of coverage but due to the medical needs and "preexisting conditions" of my family (we have recurring medical needs that make emergency only coverage unsuitable) it was not the best option. However, my maternity coverage is excellent. I paid $40 for my first visit to confirm PG and all other costs are covered at 100%. Since I switched to a HB MW I had to pay the co-pay of $40 again but still my total cost for the entire PG is $80. Hard to beat that. So far this year, even paying monthly for coverage, we have saved thoudsands of dollars in medical bills
Ins coverage and availability depend greatly on the family and what their specific needs are and the area that you live in. So while that has worked out for you, and I think its great it has, consider yourself lucky, that would not be a option or a reasonable solution for many people, including me.
And while MW do work with a pmnt plan that won't help come up with the money to actually pay it. And most want to be paid in full by 36 weeks. Take me for example. My MW charges $3500. To pay it by 36 weeks it would be almost $100 a week to get it paid in time. Not in my budget. Not doable. Plus her assisstant fee is $250 due at time of birth. Plus she requires me to purchase a kit she needs for the delivery--my ins covers all of this.
If I were to cancel my ins to save the $ it would take over 7 months worth of saving the $ from my premiums to cover that fee, and that would leave all other medical costs unpaid. For all of my family. Not a reasonable solution. I am sure other women face the same issue. It is simply not a choice or an option.
I think we are in agreement that the situation is sad. I just don't agree that paying out of pocket, with or without ins, is an option for many people. Granted for women that may have no or very little maternity coverage a MW is absolutely cheaper. But for me its the diff between $40 copay and close to $5000 worth of $$$ that I simply don't have and can't get. Not legally anyway ;)
© 2013 Created by MyBestBirth Admin.
