INSURANCE!
I am pregnant with my third child and I am determined to have a birthcenter or homebirth this time around. My last two were pain med free, but induced, and I don't want to have any part of that again. So here's the problem, my husband's work just switched our insurance over, and we are stuck between a rock and a hard place when it comes to delivering at all. It's going to be 2500.00 regardless of whether I deliver in/out of a hospital, but it could end up costing us huge amounts of money if we do have an emergency. I'm not anticipating this, and neither is my midwife, but the fear of being in such debt is just wearing me down. Does anyone have any experience skirting around the insurance companies policies and making the system work for you? I now have a Blue Shield PPO, apparently there is a list of approved providers and to step outside of that means you are responsible for 100% of costs. Any help would be great. I'm going to meet with my midwife today to get her input as well.
Thanks! Kate
Thanks! Kate
Replies to This Discussion
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Permalink Reply by KM on -
Yes my midwife has a payment plan. The problem is not so much covering the cost of the midwife, it's covering what we could be charged if there was an emergency. I'm just not getting alot of clear info on this new policy and I really need someone who is well versed in insurance jargon to tell me specifically what questions to ask and how to word them so that I get definite answers and not wishy washy ones. I've heard so many horror stories of people trying finding out after the fact that they owe a lot more than they had anticipated because they didn't get clear info. I just want all my bases covered.
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Permalink Reply by Sarah Atondo on -
I'm so glad you posted this.
I also have BCBS PPO, and because of it, I am staying in the hospital. They told be they only cover 75% of your care if you go with a CNM, which here ends up being about $1500. If I deliver in the hospital it will cost us the exact same thing.
Having said this, if I go for a home birth, and then have to be transferred to the hospital, we will be screwed and have to pay both amounts to both providers. We are buying a new house and moving and that would really suck to have to owe money to one or the other.
I totally feel you on this matter. My last birth was pain med free in the hospital, but I had to have a whiff of pitocin when I was ruptured for 12 hours and still not in labor. Not everything went as I wanted and I am still bitter about a lot of it, but I WILL stand up for myself and my baby this time and not let them push me around. Here's the real kicker. I WORK here in L&D, so that makes it even more difficult to have a home birth. If something went wrong I wouldn't want to be made the example of why homebirth is bad. Here everyone is pro induction, csection, and epidural, so they all think I am a crazy idiot. UGH, homebirth can be a lot more complicated than one would think!
I wish you the best of luck and hope that this all works out for you! It is the best and safest place for you to be!
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Permalink Reply by Jennifer C on -
How can they make you pay if you have an emergency?
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Permalink Reply by Marisa Christiano on -
Does the midwife accept insurance? My understanding, at least here in NY is that they have to cover out of network what they don't provide in network. The insurance company can not dictate where you give birth and must provide a HB midwife if you want to have a HB. There was only 1 licensed HB MW practicing in my area 5 months ago when we gave birth so we ended up using someone who was not yet licensed, while they were very qualified... we had to private pay $2000.00
GL with your situation!
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Permalink Reply by Corie Feiner on -
Where are you located?
We were able to work with our insurance company and our midwife to have the insurance company COVER THE ENTIRE BIRTH and BIRTH EDUCATION CLASSES!
We are in NYC, NY.
We also have an insurance plan for lower incomes from the state and a small insurance company with a bad reputation. By the end of a very rigorous process, the staff at the insurance company were rooting for us.
We had to interview about four midwives to meet their requirements. When we met Sakina, not only was she perfect for us, but she had everything the insurance company asked for.
Attached is the NYS Law. Get the law from your state regarding birth and read between the lines to see if it holds up to support homebirth. Then send it to your insurance company. Ask for their requirements. Then go from there.
I am working on a book about it, but in the meantime, you can e-mail me with questions at info@coriefeiner.com
You can do it!
Corie - Attachments:
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Permalink Reply by KM on
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Corie,
This is very interesting. I'm in CA, where can I access this information to see I can get more coverage under state law?
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Permalink Reply by Alice Brown on
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Hey Kate,
I have dealt with so many issues with my insurance company since I got pregnant. Because we were paying over $900.00/month through the BCBS plan we had through my husband's work, we dropped them and went with one of the new Individual Blue plans with BCBS. There was no lapse in coverage and we have had BCBS for years. We have now had this plan for almost months. At 7 weeks, when I called to talk about coverage they told me that my pregnancy was considered a "PRE-EXISTING CONDITION" and that the pregnancy would not be covered AT ALL until February of 2010. I am due March 7th.
I was concerned with the debt and the possibility of something going wrong. Where would we get the money or how would we handle the debt? Then my husband and I decided to try for Medicaid. In Alabama, in order to have Medicaid cover any of your bills you HAVE TO be part of the Best Start Program, well in order to be part of the Best Start Program you have to pick from a VERY small list of about 13 doctors that will actually take Medicaid. Well the doctor I had (who totally supported a natural birth, his wife's birth were all natural) did not accept Medicaid, nor did his partner. I had to decide before my Best Start Appointment. I talked with someone in the program) and told them I was considering going with a Midwife in Tennessee (because Midwifery is ILLEGAL in Alabama) and they told me that I could just apply for Medicaid, get approved, and then wait on the Best Start Program for IF something went wrong. That is what I have decided to do.
So to recap, I have been approved for Medicaid BUT nothing will be covered until I make that phone call to Best Start. So I keep those number close by and the Medicaid cards in my purse in case of an emergency. Then I let all the fear go. I have decided that I cannot dwell on this. I cannot change this but I can try my best to out smart those who have completely ripped us off!
I am sorry to ramble on about it. And I AM SO SORRY you are having to deal with this. To deal with these things during pregnancy is the worst. Let me just encourage you to focus on the positive and to know that there are risks but to also know the more stress we put on our body and the baby then the more problems we can cause for ourselves. No one understands you frustration more than I and again, I am so sorry. You can do this though. You are a strong woman!
I wish you the best!
Alice
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Permalink Reply by KM on
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Wow, thanks for all the replies!
Sarah, that is EXACTLY the conclusion we came to after talking to the midwife. If it's going to cost me the same, I'm staying home. My midwife has a plan where you pay monthly until you reach 2500 and then after the birth she bills insurance. Then what was not covered is taken out of the 2500, and IF any is left, you get it back. I'm a lot less stressed now.
Jennifer C, I had a miss understanding about how the out of pocket max works and was under the impression that I could be charged twice. Looking back on it I'm not sure why I felt that way. Blame it on mommy brain. :)
Thanks to everyone else for the support and encouragement! We have to be their for eachother!
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Permalink Reply by Adrienne H on -
I am not well-versed in insurance jargon either... but I'll just share our recent experience briefly. We have 'ok' insurance, not that great. Basically they'll cover a maximum of $5000 for a vaginal birth, and $7500 for a c/s, including prenatal, post natal, doctor bills, hospital, everything. Not a lot, right!?! Well we ended up with a c/s in the hospital - from which the bill was over $19,000, not including the doctor bills. Long story short, a lot of bills got written off and reduced very easily. It just took persistent calling and explaining our situation. In a couple cases I just wrote a letter requesting a reduction and attached a copy of last years taxes so they could prove our income wasn't too high. Like I said, it took a lot of persistent calling, but I want to say almost all of the remaining bills were reduced or written off. We did still pay out of pocket, but a lot less than we expected. My point is that you may be surprised at how quickly people will help you out in this area if you just ask.
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