Insurance Stress!

[fionar]

Ugh, I sent a letter on Friday to my insurance company asking them, forcefully but politely, to cover my home birth with my in network benefits. I included a letter from my primary care doc indicating she believes it's a safe option for me and I also included information about my midwife's backup doc (who is In-Network with my plan!) and now all I can do is chew my nails and hold my breath and wait for their response.

I'm super super nervous about what they'll say (mostly I'm concerned they'll say "Wait, you're doing what? BANNED FOR LIFE!") because our midwife's fee has gone up pretty substantially since our son was born and I'm very very worried about being able to afford the home birth we want.

...besides which, labor was so blasted fast last time that I'd be terrified of not making it to the hospital in time.

 

[Hangin_On_AGS]

Your very lucky to find a midwife in network! My health insurance does not have any in network midwives nor do they cover any type of home birthing attempt. So we are doing this all on our own out of pocket. Can I ask what midwife you are going with? We are looking at midwives from the cities who are willing to travel our way. I think it's funny your not that far away travel and far along wise Good luck with your homebirth!

 

[fionar]

My midwife isn't in network - that's what I'm fighting for.

We used Amy Johnson-Grass with Health Foundations for #1, before she opened the birth center. In the years since we've had our son, she's opened a birth center in St. Paul, but still serves at home births. We LOVED her.

I've heard good things about Trillium and Morningstar, and Amy's assistant Kate who worked with us at our first birth has her own practice called Twin Cities Midwifery now, and I loved her as well.

Good luck finding someone who can travel for you! In case you were looking at her (I don't know how many births she attends these days owing to doing workshops and teaching and things), I would recommend AGAINST Gail Tulley, who is actually banned from several local hospitals. She's very knowledgeable about a lot of things and is quite skilled, BUT she will keep you away from hospitals and traditional medicine even when they may be what you (or baby) need.

 

[Hangin_On_AGS]

Right now we are looking at Joy parker who is the only mw here in saint cloud. vanessa stephens coldwater (she is our favorite so far) and Sarah B

 

[fionar]

Ugh, just got the "we're denying this, but here's how to file the next level of appeal" phone call, with a letter to follow shortly.

So irritated... this time I'm including studies on the safety AND cost efficacy of home birth, a letter from my midwife and hopefully a letter from an OB who backs her up, all in the interest of getting these *******s to cough up.

SO FRUSTRATED. FRUSTRATED FRUSTRATED FRUSTRATED!!!! ARGH! ::headdesk::

 

[Hangin_On_AGS]

Good Luck with the appeal!

 

[Jtiki]

Focus on the cost issues on your appeal. Do you know your midwife transfer rate to hospital? If it's low, I would include that too. Sure, home birth is cheap. But they may be worried that you will transfer to a hospital and then they have to pay the midwife, AND a hospital bill.

 

[fionar]

The gloves are off - the benefits coordinator here at work is getting involved. Fingers crossed!!

I "came out" at work today so that I could get them involved, since my midwife said that's how some of her other clients have had luck.

We'll just have to wait and see, I suppose..

 

[elohcin]

Good luck! I hope it works out well for you! It's so difficult with the cost of homebirths being a deciding (against) factor for so many people. It was an issue for us the first time, and if we were to go with a midwife this time (or had for our last 2 homebirths) it would have been an issue too. Insurance in our state doesn't cover homebirth unless it's with a CNM, which is stupid because CNM's in-state CAN'T do birth outside of hospitals here.

 

[fionar]

We paid out of pocket initially with our son and then got (out of network) reimbursement from insurance.

Our midwife sounds like she'll work with us if our insurance company decides to be d***s about it, but I'd really rather not have our pregnancy be a financial burden on ANYONE, haha. We'd budgeted initially for what her fees were when we had our son and they have... risen. So we're kind of in a bind. Yikes. Fingers crossed, anyway!

 

[fionar]

Just got copied on our HR person's email to the insurance company.

He included my initial email to him which spelled out how it's safe and yadda yadda as well as explaining the TREMENDOUS cost savings I'm proposing.

He said to our agent that Preferred One's position doesn't make any sense to him and that they want to get me coverage for the care I desire.

FINGERS CROSSED.

Sorry for the incessant updating. Most of our friends don't know about the pregnancy yet, so I have nowhere else to go to be excited and hopeful!!

 

[fionar]

Appeal was officially received in its entirety by the insurance company today.

It includes two studies supportive of midwife-overseen homebirths, showing them to be as safe or safer for mom and baby as ob-overseen hospital births, one study showing the cost efficiency of home birth, medical records from my midwife detailing how fast my labor was, a list of the midwife's criteria for risking out of homebirth (to show she's not some whackjob hellbent on keeping moms at home no matter what), information on transfer rates, information on local OBs they partner with, a letter from my benefits administrator indicating he and the company want the insurance company to pay, and me being only vaguely threatening about them potentially needing to pay for an ambulance to pick me and my newborn up from the side of the road should they demand I deliver in a hospital (I had a VERY quick labor and deliver with my son, hence most of my anxiousness about having to be somewhere other than at home to deliver).

I'll be over here in the corner biting my nails down to teeny nubs until they get back to me.

 

[maidelyn]

Good luck!

 

[fionar]

Shocker. They denied the second appeal and now we're totally on our own for $5,000. They won't cover it in or out of network.

At least my other insurance covered it out of network... I am stressed to the point of screaming and crying right now and I truly feel that a hospital birth isn't a good option for me at all. I am so angry and now have no idea how we're going to pay for this.

This week has been terrible.

 

[sevenofnine]

Shocker. They denied the second appeal and now we're totally on our own for $5,000. They won't cover it in or out of network.

At least my other insurance covered it out of network... I am stressed to the point of screaming and crying right now and I truly feel that a hospital birth isn't a good option for me at all. I am so angry and now have no idea how we're going to pay for this.

This week has been terrible.

That really is terrible. It never makes sense to me that they'll cover a $10,000.00 uncomplicated vaginal delivery at a hospital, but not even a $2500.00 birthing center birth (that's how much the birthing center near me charges). Sure, there is the risk of transfer, but most reputable birthing centers have an excellent transfer rate that should qualm any fears.

I too tried to find alternatives to a hospital birth, but can't afford any of them. Luckily, I was able to find a very natural-based hospital near me, and switched my care there (my first appointment with the midwife was today). I am beyond relieved and although it's still the hospital environment that I really didn't want, I feel much better that they're so much more open to my wants and needs.

I hope you can find what you're looking for!

 

[fionar]

Since insurance won't pay a damn thing, we requested monetary donations "towards the cause" for Christmas. We got basically a month's worth of payments covered, and we also set up a page on GoFundMe so if friends/family want to kick in $5 or $10, they can... and we've gotten $100 there, too. I'm starting to feel a little less despondent about the whole thing, because the prospect of being forced in to a hospital due to finances was seriously depressing.

Things are looking up, even if it's not thanks to the marvelous insurance industry.

 

[fionar]

We submitted an appeal to the state asking that my prenatal care be covered (which is kind of, um, a LAW IN MINNESOTA and my insurance covers midwives and has out of network benefits, so there's NO REASON they shouldn't be covering the prenatal care portion, which is provided in an office), with the promise that we'd have a letter sent by 3/29.

Well, they just cashed the $25 check today (which my lovely employer is letting me *expense* and they're reimbursing me for it!) so I guess we'll be getting that answer soon, too.

I'm not super hopeful, and I'm kind of dreading the letter, because as long as they haven't responded there's still some hope... but when they respond, that's the binding answer and we have no other recourse for getting it covered.

That said, of the $5k bill, we only have something like $1k left to pay. And they're letting us take until 6 weeks postpartum to pay it AND we've been getting reimbursed from my FSA (which is just pre-tax dollars that are still technically MY dollars, but since they're taken out of my paycheck automatically it's like free money, haha).

So... fingers crossed that the letter in the mail from the state is good news. :-/

 

[lynnikins]

fingers crossed you get it sorted hun

 

[fionar]

WE WON!

They have to cover my prenatal care (at 100%) although they don't have to cover the delivery fee. Grand scheme of things, the fee for the delivery itself is next to nothing.

I can't believe we won. It's a legally binding decision for the insurance company, too - they MUST pay. I can't believe it.

 

[Jess137]

That's amazing!!