Homebirthers - insurance question

~adamwife~

How did you begin the process of asking insurance what they will and won't cover?  Excuse my ignorance, but I don't even know where to begin, because I've never had to do anything like this - normally my healthcare providers do all of the work.

flyer23

I called my insurance company's customer support number and asked. I asked very specific questions, e.g. whether CPMs were covered or only CNMs.

My midwife's insurance billing service was also a big help.

At least for me, it was a bit of a crapshoot as to what would get covered, because my midwife is out-of-network for my insurance company. (There are no in-network midwives in my area.) So even though they said it would be fully covered, almost everything ended up getting declined initially because it exceeded the "allowable" charges. Determining the "allowable" charges is not at all straightforward, so it was a difficult thing for me to figure out prior to the birth...

Anyway, we're working through it and have gotten about half of it covered now, and I anticipate that the rest will be covered within the next month or so, but it's taken a LOT of legwork on my part.

jasonsgirly

My husband did the work (since it's his insurance)...he works for a large company so they're self-insured.  Before he met with the benefits' lady, he reviewed the insurance policy.  Our midwife recommended that we go through the policy and see if it specifically says "no homebirth coverage"...so that he could say, it's not excluded.  Which makes it harder for them to say no.  So, that would be my advice, to look through your policy and look for exclusions. Then call them up and see what they say, all along, knowing it's not specifically excluded. 

Good luck!

pepomntpat

DH called and asked them.

jteneback

I called and the lady had some document she referenced.  It said specifically that home birth was covered.  However, it will be out of network so we likely won't get anything back.

MrsTiara

We can't get a straight answer.  We paid 100% of the midwife fee last time and insurance covered the birth center (makes NO sense).  This time we're planning on just paying, and if insurance covers any of it, bonus for us. 

Brandy1229

You can get out your policy (the big book) and check. Be thoughtful of your state's laws too.  Aetna doesn't cover home birth across the line but in FL, it is state law that a company that provides maternity coverage MUST cover home birth.  So state law trumps Aetna's policy.  I don't have maternity coverage (I'm self employed with an individual policy, it is nearly impossible to get and awful coverage if you do) so I am not anticipating the home birth being covered but hopefully I can get reimbursed some of my prenatal care.  My midwife is looking into how I can file the claim with the best results.

ScottiesLilHottie

My midwife works with a company that calls the insurance company and asks all of the tough questions for me. I had to pay $15 for them to do it, but I don't care. I hate arguing with insurance companies. lol.

 Turns out that my CPM-attended homebirth will be covered. However, she is being covered as an out-of-network provider. So -- where I don't usually have a deductible, I now have a $500 deductible. And where-as my care is usually covered at 90%, the remaining balance after deductible for my homebirth will be covered at 50%.

ErinMSB

ScottiesLilHottie:

My midwife works with a company that calls the insurance company and asks all of the tough questions for me. I had to pay $15 for them to do it, but I don't care. I hate arguing with insurance companies. lol.

 Turns out that my CPM-attended homebirth will be covered. However, she is being covered as an out-of-network provider. So -- where I don't usually have a deductible, I now have a $500 deductible. And where-as my care is usually covered at 90%, the remaining balance after deductible for my homebirth will be covered at 50%.

This is almost exactly our situation too.  We pay a $20 fee for a service to make those calls and talk to our insurance company for us.  WELL worth it to me! 

And my CPM is also covered as out-of-network.

If I remember right, you're just getting started with the homebirth thing, right?  Have you interviewed any MWs yet?  I would ask them about insurance coverage.  Some will tell you about a company they use (like the one I and PPer mentioned), some will tell you that they can help you with it, and others just don't deal with it at all.  And there's a good chance that the MWs will have had experience with your particular insurance company already and can give you some idea of how the company's handled it in the past.

Also, I found that in my area, many MWs will have one price if you have (or are using) insurance and another if you don't (or won't be using it).  And the way we went into it was to figure the average price of a homebirth for our area, and assume we'd have to pay that.  (For us, it's almost the same or a little less than what we ended up paying for DD's hospital birth with the deductible and copay when that was all said and done.)  Then if our insurance did cover part of it, even better for us!