A midwife isn't covered?

leighzlou

I had my first appointment with my midwife this week and they ran a verification of benefits for my insurance. It came back saying that my insurance will not cover any midwife care. I knew it was going to be out of network, but no coverage at all?? It is a legitimate degreed and licensed medical profession! Its not like I'm going to a witch doctor. I am just super ticked right now. They said they have never had an insurance refuse to cover anything before, so they are going to run a test claim and see if they pay anyways. It just sucks because we can't afford to go this route without any coverage so I may end up with an Ob/Gyn in a hospital. Has this situation happened to anyone else?

 On the plus side though, I got to see my little speck of a baby and see the heatbeat! 

shannonalise

Who's your provider?

MissAmber23

Our was covered as a "specialist" which meant we had to pay a larger portion of the cost out of pocket. Ironically, an OBGYN is not considered a specialist, and therefore would have been a lower cost to us. Maybe you could ask if there is that sort of provision in your insurance?

leighzlou

shannonalise:

Who's your provider?

 

Blue Cross Blue Shield of Texas  

iris427

Call your insurance.  A lot of insurance companies will automatically refuse to cover things but will change their position if you are willing to call and fight with them.  Sometimes if the insurance doesn't cover any midwives in-network, you can get them to cover yours since they don't offer any alternatives.

ncbelle

That sucks :-(  I'd definitely call and fight it.  FWIW I have BCBS (although NC) and both my hospital based midwife and my birth center based one were in network and fully covered.

mishu917

My insurance is only covering hospital births but as long as your provider is in network, you are good. Of course, I can always do out of network.

I should add that I asked BC/BS why it was so crappy, and they said it's based on what my workplace selected... so basically, my workplace set those limits...it's kind of stupid because using a midwife is supposed to be cheaper, plus with less interventions, it means less money for them to pay. Oh well...

MrsJuicy2B

Is it an HMO? If it is, you'll be required to use their in-network providers, often in a traditional hospital setting. Your insurance company should have a list of in-network providers on their website. If your midwife isn't in-network it doesn't mean that other midwives aren't. PPO plans have more flexibility but cost the patient more each month, in general. It usually says which type of plan you have right on your insurance card.

LittleEgypt

iris427:

Call your insurance.  A lot of insurance companies will automatically refuse to cover things but will change their position if you are willing to call and fight with them.  Sometimes if the insurance doesn't cover any midwives in-network, you can get them to cover yours since they don't offer any alternatives.

 You should also check your state's laws on midwives and health insurance. In WA, there is a law that is supposed to protect my right to choose from different types of providers for the same services.

Tash13

I had blue cross blue shield of Rhode Island when I had DS.  I found an in-network MWs office (multiple MWs) that were completely covered because they were with an OB's office.  Have you done a search for MWs on your insurance website? That's where I found mine.  My insurance didn't necessarily know I was using a MW, just that I was using that particular practice.

jteneback

leighzlou:

shannonalise:

Who's your provider?

 

Blue Cross Blue Shield of Texas  

My husband has them.  They suck.  It might be worth a call to see if there is a workaround, though. 

shannonalise

iris427:

Call your insurance.  A lot of insurance companies will automatically refuse to cover things but will change their position if you are willing to call and fight with them.  Sometimes if the insurance doesn't cover any midwives in-network, you can get them to cover yours since they don't offer any alternatives.

This. This is exactly what we had to do to get ours covered. And we got it covered in-network as well because it was the only birthing center in our town. They wanted to tell us that they cover "midwives" at hospitals, but we argued that and we got them to cover it "in-network" since we wanted to birth at the birthing center. 

This was Blue Cross Blue Shield of Florida. 

flyer23

jteneback:

leighzlou:

shannonalise:

Who's your provider?

Blue Cross Blue Shield of Texas  

My husband has them.  They suck.  It might be worth a call to see if there is a workaround, though. 

Ditto this. I have another BCBS plan, but because I live in Texas, all of my claims actually go to BCBS of Texas, and then they forward them on to my BCBS plan. Even though MY plan clearly covers homebirth, it's been a huge struggle getting the claims covered, because BCBS of TX has their own ideas as to what the allowed amounts should be. I'm STILL working on getting some of the claims covered -- 10 months later! My midwife's insurance billing service says this is par for the course for claims that have to go through BCBS of TX.

bea0422

Have you tried looking into a Nurse-Midwife? We couldn't afford a regular Midwife. Thankfully our insurance was willing to cover a nurse-midwife because they deliver in a hospital with back up available immediatly if necessary... I have several friends who have run into the same probalem. I was a little nervous at first but could not be happier with her. A hospital birth isn't the ideal location, but with a supportive staff I believe it can still be a beautiful experience. Good Luck!

amanicen

Thanks for posting this, I ran into the same problem last month. I'd switched practices in order to have a midwife... only to be told BCBS changed their policy and would only cover OBs in their practice.

I gave up but thanks to this post I'll be calling the insurance on Monday. (Now if I can only get through to anyone in less than 40 minutes holding...)

E&RMommy

I would check out The Women's Specialists of Houston.  They are a group of ob/gyns and midwives.  The midwives deliver at St Luke's.  One of the midwives (Deborah Rigby) was instrumental in me changing from pediatrics to ob/gyn as my specialty when I was in medical school and still deciding.  I delivered my first few babies with her, and I will never forget that as long as i live.  I've worked with all of their doctors and they're fantastic.  It might be a great middle ground for you and your insurance.  (And no I do not work for their practice or have any involvement with them in any way.....I'm a resident.  Of any practice here in town that I've worked with they seem to be the most intervention-free friendly that might be covered by your insurance).    

oliverncherie

I have BCBSTX as well, and they do cover my midwife as Out of Network. The irony is that with my $1500 deductible, plus the OON percentages, I'd end up having to pay more than if I don't use my insurance and pay the midwife out of pocket. BCBSTX should cover ultrasounds and other testing...even if performed at the midwifes office...