Tuesday, August 10, 2010

Home Birth Headaches

I dont know why I have insurance... We end up paying so much out of pocket it's like we are throwing money down the drain for insurance coverage. But then again, I haven't had an emergency room visit in a while, that is when it pays to have insurance.

If you are thinking of doing a home birth be prepared for your providers to not be covered by insurance. I just spent part of my day talking to our insurance company, by the way the reps are great and very easy to talk to, but their answers were disappointing to say the least.

First off, I am attempting to get In Network Exceptions made for my chiropractor and our midwives.

The chiropractor. The chiropractor happens to be out of network, but also happens to be 1 of 2 chiropractors with a Diplomat in Pediatric and Prenatal Chiropractic care in our state... This is a post graduate certification. None of the In Network Chiropractors have this certification, conveniently, the insurance company doesn't believe this differentiates this chiropractor from the 250 other chiropractors that are in network and within a 50 mile radius of me. One thing I do know is seeing this chiropractor has been night and day in comparison to the one I was seeing who was in network. I went from 3 visits a week to just 1 thorough visit a week. The attention she provides is amazing! Her technique so well magical. I don't want to ever see anyone else! It is 35.00 a week, and we are on a tight budget. So my attempt to get an in network exception for her was declined today, but the rep gave me the address if I want to write a letter of appeals regarding the decision. Guess what I will be doing later...

The midwives. The midwives we have chosen are Lay Midwives they are not Nurse Midwives as they offer different services and have different certification. Our insurance doesn't have any In Network Lay Midwives in our area (they do have a category for lay midwives in the "Search for a Provider" link on their website). So I called to see if an In Network exception could be made, the first rep I spoke to did some research on my request, contacted a local branch of our insurance provider who gave her a list... but I verified the list these are nurse midwives. I decided to fight the battle another day. But this first rep called me back because when I asked her if these were lay midwives she said yes, but then found out they weren't. So she called back to clarify which I appreciate! Unfortunately, she said lay midwives have no benefit. Of course, right after I hung up with her, my brain clicked on and questioned whether that meant that lay midwives wouldn't be considered out of network. So, I called and spoke with another rep, who did some research, she said that because of their certification and stature. Lay midwives would have no benefit, which means they would not be covered at all. This includes out of network coverage. She also said that birth center births are allowed, however, there is no mention of home births and if it is not listed in the benefit it is not covered.

And so the battle begins. I want to go ahead and appeal this decision as well, since they have a search function for lay midwives for In Network Providers on there website. I have seen a list of insurance companies that have paid for home birth's and our insurance is listed on it. Plus, insurance companies are known for saying no at first (how many NOs follow through with the appeal process easy cost savings) but if you appeal there decision enough they will usually end up paying for your claim as they should have.

So this was a bit of a boring post. So I will do Seana style take aways.

Take Aways:
1. Research your In Network Providers and insurance coverage before getting attached to a provider.

2. It pays to be polite and well natured when talking with phone representatives, It's not their personal policy they are communicating and angry words in their direction doesn't do anyone any good.

3. Document your calls with a call log, get a name, reference number and time and date of call.

4. Don't give up if you are told NO by your insurance company, that doesn't mean they should NOT be covering your care.

5. Always Appeal, the worst that could happen is you are out a little time, a stamp, and your told NO once more.

6. Keep copies of all documents sent to the insurance company as well as their responses.

1 comment:

  1. I'd encourage you to ask about benefits to pay "Licensed Midwives" or "Certified Professional Midwives" as opposed to lay midwives. As far as the world is concerned, a lay midwife is a barefoot, dreadlocked, stinky woman who carries dead chickens to swirl about the room and strips of towels for moms to clamp their teeth on during contractions. While *some* of us might fit *some* of those descriptions ( ;) ), that isn't what the insurance companies need to think of us.

    Much good luck and do let us know what happens.