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Old 03-14-2011, 01:09 PM   #1
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Fighting insurance to cover homebirth?

Have any of you fought your insurance company to cover your homebirth?

Our insurance company denied our claim because our providers were out of network. I called an explained that they didn't have any in network CPM's and that is why we chose the care we did, and they told me they had CNM's and I could have used one of them. Unfortunately, none of the CNM's here do homebirths, so I was faced with the decision to either induce in a hospital with a CNM, or pay out of pocket and labor naturally at home with a CPM, which is what I chose.

What kinds of things should I include in our letter to them?


We have Federal Blue Cross if that matters.

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Old 03-14-2011, 01:30 PM   #2
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Re: Fighting insurance to cover homebirth?

Try getting the cost estimates from the CPM in writing to send to them. Let them know that includes prenatal and post natal care (if it does). Send them something from your OB stating you are a low risk pregnancy. Let them know how close the hospital is. Send them a list of the certifications, etc of the CPM.
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Old 03-14-2011, 02:06 PM   #3
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Re: Fighting insurance to cover homebirth?

We actually already had our homebirth. It cost 1/4 of what my first hospital uncomplicated vaginal delivery cost them.
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Old 03-14-2011, 03:09 PM   #4
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Re: Fighting insurance to cover homebirth?

You should have been fighting that battle before hand. Do they cover ANYTHING for out of network providers normally? Mine covers 50% vs 70% in network. You may at least get them to cover at that rate. Good luck mama. Ins Co's suck when it comes to this.
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Old 03-14-2011, 03:25 PM   #5
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Re: Fighting insurance to cover homebirth?

Can't help you w/this other than to say good luck. We used to have Fed BC/BS and I dropped them like hot potatoes as soon as I could b/c they are awful.
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Old 03-14-2011, 03:35 PM   #6
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Re: Fighting insurance to cover homebirth?

http://www.gentlebirth.org/archives/preApproval.html

http://www.gentlebirth.org/archives/money.html
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Old 03-14-2011, 07:42 PM   #7
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Re: Fighting insurance to cover homebirth?

These sites are great - very useful.

I have BC/BS but not federal. They are just plain awful. Their customer service is atrocious, they are rude and snarky, they have NO CLUE what they are talking about, if you call ten times you'll get ten different people who will tell you ten different answers to the same question. I really REALLY do not like them.

They gave us a big flack about covering our HB as well. What we ended up doing is transferring care to the birth center that our HB MW works for. She will still attend our birth as our HB MW, we will have 2 or 3 prenatal visits at the birth center, and they will bill insurance, since I'm transferring to their care and using our MW through their center.

We have a unique situation though, so that may not be a choice for you.

I agree with the PP that unfortunately, this is a fight that should have been started before the birth, esp b/c it is so involved and so lengthy to go through. I wish I had more advice for you.

The best thing you can do is write up a good long strong letter outlining your choice and why they should cover it. Use statistics that support the safety of homebirth, use laws that support it, explain your MW's experience/schooling, talk about the high c/s rate and how you wanted to avoid the risk of c/s by birthing at home, include a letter from an OB talking about how your were a low risk patient, and maybe outline your medical history to support that, talk about the cost effectiveness of MW care, etc etc etc. Personally, when I was considering doing this, I had my mind set on making my letter to them as convincing and persuasive as possible and strongly worded, no matter how lengthy that meant.

I'm glad I found another way around it, and I'm sorry you are now looking down that same path. It really stinks.
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Old 03-14-2011, 08:58 PM   #8
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Re: Fighting insurance to cover homebirth?

It depends on your plan and how it's set up, all the insurance company does is administer it the way they're paid to. My BCBS coverage includes homebirth and has a list of homebirth midwives. Other companies with the exact same branch of BCBS chose to exclude it from their policy, so anyone working for those companies is SOL-it's an exclusion. Getting an override beforehand is one thing, but after the fact getting it paid is almost** impossible.

My primary insurance has a clause that for medically necessary services that they don't provide or have an in-network practitioner for, they have to provide for an out of network one. Birth is medically necessary, homebirth is allowed under the policy, but they had no midwives that provided the service. So I called and asked how I was to get my allowed homebirth if they had no practitioners. After 2 weeks of calling around to find one, they called me back, said they couldn't provide me one so they would side-contract one of my choosing and put authorizations in place. I'd been planning to drop the policy because they didn't have any network HB MWs, but after they did that I kept it for the double coverage on my HB, and in case I need a hossy transfer.

Anyways, if federal BCBS does cover homebirth but didn't provide a midwife, I would try that route. GL mama!
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Old 03-15-2011, 05:20 AM   #9
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Re: Fighting insurance to cover homebirth?

Our insurance told us ahead of time they wouldn't cover it. We ended up paying out of pocket.
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Old 03-15-2011, 08:47 AM   #10
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Re: Fighting insurance to cover homebirth?

Quote:
Originally Posted by meeshkasheeba View Post
You should have been fighting that battle before hand. Do they cover ANYTHING for out of network providers normally? Mine covers 50% vs 70% in network. You may at least get them to cover at that rate. Good luck mama. Ins Co's suck when it comes to this.
Sometimes you cant really "fight it" until you submit your claim. I know my insurance BCBS PPO does cover out of network providers up to 80% and $300 deductible; however I wont know for sure if they will actually reimburse my claim till after the birth. We have tried to submit claims for a few prenatals and we are still waiting to hear back if those claims have been approved. Im almost 38wks.
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