In-Network Exception for homebirth CNM?

Tash13

Has anybody has any experience getting an in-network exception for a home birth?  The only homebirth midwives in my area are out of network and I just filed my case to try and get it considered as in-network with Oxford Insurance.  Would love to hear any experiences you may have or any other tactics I should use to try and get it approved.

 Thanks!

EBelle80

I was able to get an in-network exception for my prenatal care and delivery. However, the midwives do not bill it as a "homebirth" they will bill it as a "spontaneous vaginal delivery" or something like that. My insurance would not cover a homebirth specifically. My MW said they always bill like this, and no one has ever gotten audited but it is a small risk. If your MWs do homebirths and also have a birth center, that is probably how they will bill it too.

Tash13

The problem for me is that I have CNM's in-network so getting a midwife approved alone is not going to be approved.  I told them that there isn't another CNM within an hour drive that does out of hospital/birthing center births, which will be the reason, but technically we don't have a birthing center nearby either.  I'd love for it to be approved but feel like the system is always against homebirths (despite it being cheaper overall).

haleymay18

Yes we tried. And we appealed three times and used a billing service. No luck. We paid all $4500.00 oop.

mAnYaSha

My case was declined because there is an in-network birth center with midwifes in the area that nobody could find until it got to medical director level. My midwife did peer to peer appeal with no luck even though the other center is further away, especially if I had to come from work going on a freeway with half the # of lanes. They should be paid out of network though. No home birth coverage though.