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Insurance not wanting to pay for Home Birth?

On Health & Drugs & Medications » Health Care

9,377 words with 12 Comments; publish: Tue, 11 Dec 2007 08:11:00 GMT; (90093.75, « »)

We have Medica for our medical insurance. We were wanting to have a home birth. My husband talked to the guy at his work that is in charge of insurance(his work is self-insured through Medica I guess), this guy said they could make a decision over Medica. My husband explained how much money it would save his work if we had a home birth instead of a hospital(which there's no way I would set foot into a hospital unless it was an absolute emergency!). The guy sounded hopeful that we could get it covered in network and everything, he just wanted numbers from the midwife and how much a hospital birth is. SO my husband gave that info last week. Now today my husband talked to this same guy and he says Medica says they WILL NOT cover a home birth at all, that it's too risky for the patient. :angry So now what!?! Do I write a letter to Medica and try to explain to them the safety of home birth? Anyone know if they have to pay? Even if it's out-of-network? I don't know my rights. We have absolutely NO way of paying $3,500 out of pocket as we are barely making ends meet as it is. We qualify for Medical Assistance, but I doubt they'll pay much. My midwife has another client that has insurance and MA and she said that MA says they will pay $700 and only $700 for prenatal/labor/delivery, etc. even at a hospital(which with the prices of a hospital birth, I can't imagine how they could only pay $700).

HELP!!!!!!!!!!!!! :(

Sara

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  • 12 Comments
    • Sara: I have Medica, too, and just had a homebirth for which I didn't pay a single penny. Credit for that goes mainly to my midwife and her billing service -- but what that also tells me is that maybe you just need to talk to the right person at Medica, and tell them what they want to hear. That "no" probably came from some clueless entry-level customer service rep at Medica. I'd keep trying if I were you. If barking up one tree doesn't give you the results you want, bark up another. Also: Homebirth (as I'm sure you know) is actually SAFER for low-risk pregnant women than hospital birth, and there's plenty of research to back that up. That fact, combined with the cost savings, should be more than enough to convince Medica to cover your homebirth.

      As for what MN law requires... I'm no expert on this b/c I never wound up having to argue with Medica myself...but I think ins. cos. in MN have to cover any caregiver who's licensed to attend births in MN. If your midwife is licensed and provides necessary health services not available from any of your plan's network providers, I think insurance not only has to cover it, but must cover it at the in-network rate.

      I'm sure other local mamas could give you more helpful details about the insurance vs. homebirthers thing, but I just wanted to encourage you to not give up, and let you know that it IS possible to get Medica to cover a homebirth.

      #1; Mon, 10 Dec 2007 11:36:00 GMT
    • Christine, thanks so much for the response. I had to :lol because we actually exchanged some PM's a few weeks ago...you recommended your midwife and so I actually did go see Janet and that's who I'm wanting to go with.

      I had talked to her at the initial meeting, and mentioned about you saying you had Medica and you didn't have to pay anything. She said that yours was a special situation as she was just establishing her clinic and so it sounded like she didn't really get reimbursed for all her fees, but took it as full payment because she was just getting established. But it sounds like Medica must have at least paid something!! SO there's hope!!

      She said we could have a first prenatal and then bill Medica to get an idea how they will cover it for the future bills and that would give us a good idea.

      Thanks for your encouragement. I get so frustrated when the darn insurance companies want to deny the one and only thing I'm trying to use them for. :angry

      I wasn't sure if you subscribed to this thread, so I'm sending you this in a PM too.

      Thanks again, Sara

      #2; Mon, 10 Dec 2007 11:37:00 GMT
    • I would also love any more suggestions or recommendations on getting insurance to help cover the cost of home birth. I have Health Partners through Minnesota Care, and I called them about it this morning. I was told that Minnesota Care will not allow home birth under their coverage. Agh! I will keep working on it, but I would love any other tips or advice anyone has to offer. Thanks!!

      One other thought is that I may be able to switch from Health Partners to either medica or ucare with minnesota care, and if anyone has any experience with either of these covering home birth through the state, that would be great too!

      #3; Mon, 10 Dec 2007 11:38:00 GMT
    • I had a homebirth 16 months ago and we have United Health Care. It took me four months of submissions and escalations, and in the end they covered 80%. I didn't think they'd cover anything, so I was pleased with the 80%.
      #4; Mon, 10 Dec 2007 11:39:00 GMT
    • I live in Milwaukee and was insured by Humana when I had a home birth about two years ago. my midwife had a standard letter that she sent to insurance companies explaining that she cared for me for prenatal and delivery and post partem care; that it would be in their interest to pay for the costs of my care under her considering the cost savings to them versus a hospital birth. then she sent them a detailed billing summary. they paid out close to the total bill.

      I had called Humana at the start of the pregnancy and their customer service people read me a screen off their computer that said that they would not cover because the provider was not in the plan, but I figured why not try. it is a special situation (in our country) and it is not even usually addressed in your policy. In fact, whoever your husband talked to that said they would not cover because it was too much risk for you........sounds like they made that line up themselves. Hate to say it, but since when did insurance companies care if what they are paying for is safer for you or not......they don't care....their only goal is not to spend money on you. At least with a homebirth you can convince them that they are spending FAR less money than if you had delivered at a hospital.

      my advice would be don't spend too much of your time or energy ahead of time because you will have a giant headache. have your midwife spell out her credentials and that you saved them a load of money, send them the bill and see what happens. since you said there is no way you would deliver at a hospital anyway, why suffer the frustration of even talking on a tele with the insurance company.

      I could probably get you a copy of the letter if you wanted to give to your midwife......

      best of luck!

      #5; Mon, 10 Dec 2007 11:40:00 GMT
    • I think it's useful to site a study that supports the claim that homebirth is safer, not just cheaper.

      Here's a link to the most recent, biggest study to date: CPM2000

      http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

      If you write a letter to them include a copy (I bet you could find a better copy than the one I linked you to though)

      #6; Mon, 10 Dec 2007 11:41:00 GMT
    • Thanks everyone for all your responses!! I've since talked with my midwife and we've got something worked out! :thumb SO yeah!!

      Good luck to all you mamas having to deal with insurance companies being a pain in the rear! :p

      Sara

      #7; Mon, 10 Dec 2007 11:42:00 GMT
    • Hi. I have Group Health through Wisconsin State insurance. Anyone out there with experience with this? I read the person from Milwaukee with Humana.

      Any help would be appreciated....:love

      Heather

      #8; Mon, 10 Dec 2007 11:43:00 GMT
    • I'm so glad that you got it worked out with your midwife :thumb

      I have a close relative who works for Medica, and I can tell you that they do not normally cover home births. Believe me, there are people who write wonderful letters, but they have yet to change their stance. I agree that it's a ridiculus stance, but I don't think they're going to change it anytime soon.

      #9; Mon, 10 Dec 2007 11:44:00 GMT
    • I need to subscribe, as I have been a Doula for teen moms, and most of them want a homebirth but end with UC's.

      Everyone I have talked to keep saying Midwivery is illegal in MN and I have met two Midwives and three Doctor's who have had charges pressed against them.

      I would LOVE to get on a campaign that would bring back homebirthing and Midwives!

      #10; Mon, 10 Dec 2007 11:45:00 GMT
    • I just paid 3,000 out of pocket for my homebirth - no help from insurance company. In fact, the only "good" thing about the fact that I transported to the hospital after 3.5 days at home with a broken water and no birth was the fact that the insurance company got socked with a hospital bill.:mischief

      Sorry you are learning this cold hard fact. :(

      ~Tracy

      #11; Mon, 10 Dec 2007 11:46:00 GMT
    • Everyone I have talked to keep saying Midwivery is illegal in MN and I have met two Midwives and three Doctor's who have had charges pressed against them.

      I assume you're talking about DEMs? Midwives are not illegal in MN. Licensure is available for DEMs.

      Midwives of North America DEM State-by-State Legal Status Chart:

      http://www.mana.org/statechart.html

      The actual MN statutes:

      http://www.revisor.leg.state.mn.us/stats/147D/11.html

      Minnesota Midwives Guild:

      http://www.minnesotamidwivesguild.com/

      #12; Mon, 10 Dec 2007 11:48:00 GMT