Health Insurance Appeal Input
+ Reply to Thread
Results 1 to 3 of 3

Thread: Health Insurance Appeal Input

  1. #1
    Community Host
    Join Date
    Oct 2006
    Location
    Under the big sky
    Posts
    6,535

    Default Health Insurance Appeal Input

    My insurance company (BCBS though a plan through my employer so the employer has to officially approve or deny the appeal) covers midwives as long as I give birth in a birth center, they don't cover them for a home birth. I am planning on a home birth since my labors are very quick so I'm filling out an appeal to see if I can get them to cover the midwife even with a home birth. They want detailed descriptions, expected outcome, and supporting documentation (if any).

    I plan to give them an over view of my prior two births, 1st induced at hospital 6 hour labor from the start of the pitocin 5 pushes and he was out. 2nd no contractions to give a warning, woke in the middle of the night (3:30) with my water breaking (though she blocked it from leaking out so I wasn't sure) progressed very quickly and wound up with an unplanned/unassisted homebirth around 7:30, 3 pushes and she was out.

    I know part of the concern is that something goes wrong and I will need medical assistance. When we called 911 with my daugher we had EMT's at our house in under 5 minutes. A trip to the hospital from where I'm located is a 10-15 min trip, with sirens probably closer to 10 min.

    What else should I cover in my appeal? The typical length of time it takes to prep an OR compared to the length of time it would take us to get to the hospital?

    Any advice/input/help is appreciated.

    Cindy

  2. #2
    Community Host kridda_88's Avatar
    Join Date
    Jan 2008
    Location
    in a house full of boys
    Posts
    4,134

    Default

    I have no advice but I know that my midwife billed the same for a home birth vs a birth center birth so the insurance couldn't tell a difference in the billing. Maybe your midwife could do that. I was going to attempt an appeal but couldn't get any information from the insurance on who to send it to. They just kept telling me that I couldn't do things like that. I gave up very frustrated at the situation and was not in the mood to sit and fight with them anymore. We just paid out of pocket because my midwife wasn't covered at all by our insurance.
    K&S-8/18/07
    DS1-7/18/08, DS2-2/23/10, DS3 1/18/12

    TTC in fall/winter of 2014

  3. #3
    Posting Addict Spacers's Avatar
    Join Date
    Dec 2003
    Location
    My avatar is the tai chi -- a symbol of the eternal cycle of life
    Posts
    16,392

    Default

    Does your state license home birth midwives? If so, then the insurance company should cover their legally-provided services no matter where the service is provided. The insurance company pays for the service, not the location. They would cover your pediatrician if he made a home visit for a newborn, correct? Then they need to apply the same logic to the midwife's services. Anything less should be illegal under your state law. Most states that license midwives have a law that states insurance has to cover them. Call your local elected representatives & see if they can offer some guidance, and if your state doesn't have these laws, suggest they be the one to write it!

    I'd also throw in some statistics about the safety of home birth in general, statistics for this midwife specifically, maybe mention the cost of 911 responders coming to your home a second time for another precipitous birth, and some talk about the dangers of delivering a baby unattended on the side of a road somewhere. Good luck!
    David Letterman is retiring. Such great memories of watching him over the past thirty-two years!

+ Reply to Thread

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
v -->

About Us | Contact Us | Privacy Policy | Sitemap | Terms & Conditions