Well. That was a quick end to my dream of a VBA2C.

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AnnaRO's picture
Joined: 07/06/08
Posts: 7033
Well. That was a quick end to my dream of a VBA2C.

I met with one of the midwives yesterday for the local birth center. At first it sounded like they weren't going to even take me on because they normally require a span of 2 years between pregnancies and DS is 17 months. But after consulting with the other midwife they agreed to risk it and take me on. The wait is a requirement by some governing board of theirs. Everything was going great after that. She even suggested I could just as easily do a homebirth since I live just as close to the hospital as the birth center is. Sounds nice. She told me that care starts at 12 weeks, which would put me in November for care to start. Then she asked about insurance and when I told her it was BCBSTX her face fell and she said they don't pay for midwives unless they are PA's too and these are not. They are LM, CPM. So that would make me a cash pay, and the full amount would have to be paid by mid April.

The amount is only a little bit more than what our copay would be for a RCS with insurance, which makes it seem like a simple decision. Unless, I pay the midwives and then end up with a RCS anyway. In that case you are looking at double the amount because we'd have to pay both groups. Its a LOT of money to us. When I told DH about the costs being the same either way, he immediately went to how much it would cost if we had to pay both. And said that its a lot of money to throw at a MAYBE (referring to my VBA2C attempt). So it appears the my DH has no faith that I could even be successful at a VBA2C, and without his full support and backing, I've got nothing. The midwives were my only option for even having a chance at a VBA2C at all. There is no doctor within a 4 hour drive from here that would even allow me to try for a VBA2C. Under the current circumstances I am left with only one option and that is a scheduled RCS.

The only other options are, 1. I could not find an OB and do all my prenatal care on my own. Monitor my BP, the babies hear rate, my blood sugar since I have stuff to do all that with. Then when I go into labor, stay home as long as possible and show up at the hospital only if there is an emergency or when the baby is pretty already coming out so they can't rush me into the OR. (The hospital is listed as allowing VBAC but is not at all VBAC friendly). 2. I could get a teaching job, put my kids in daycare and pay for the midwives out of my own salary. Then if I end up with a RCS anyway I could also pay for that with my salary and DH's salary wouldn't come into play. Then I could well and truly say I did it entirely on my own. I hate this option, because I don't want to put my kids in daycare and I would be miserable working my first year as a teacher while pregnant and trying to prep for a VBA2C. There would pretty much be no time at all to prepare myself for a VBA2C.

I am absolutely gutted over this. I can compare the pain and despair to a death of someone close, it is that painful of a loss. I just wanted on birth on my own terms. Just one time I wanted one chance to truly give birth. Alas, it appears it wasn't meant to be. Anyway, that's my story. I'd like to thank you all for the support and encouragement you've given me even during my very short stay here. I wish you all the best.

Clarkton's picture
Joined: 01/07/08
Posts: 1972

Oh Anna, I'm so sad for you! Sad

Is there really no other way? Does your DH realize how important this is to you? Would he consider something like going ahead with the MW and birth center route and then if you end up needing a RCS you could start teaching after babies arrival and an 8 or 12 week maternity break to pay off the double out of pocket cost? If that were possible and DH would agree with it you could still do the birth center and not have to work before baby comes. I really think you can do it with the right support and if you are a successful VBA2C you won't need to go to work to pay off medical bills. Could you try to do some tutoring to make extra money instead of a full on teaching position?

I have to run now but I really hope you can brainstorm some ideas and come up with another acceptable alternative besides giving up your dream. :bighug:

eliann's picture
Joined: 04/19/11
Posts: 2438

So sorry to hear this. My insurance didn't cover any maternity so it made my decision easy..midwives are cheaper. I wonder if the new healthcare laws will change any of this? I know that individual insurance plans (what I have) will now have to cover maternity care. Gosh, I hope you find a way. I totally understand being heartbroken about this.

Clarkton's picture
Joined: 01/07/08
Posts: 1972

Oh Anna, I'm so sad for you! Sad

Is there really no other way? Does your DH realize how important this is to you? Would he consider something like going ahead with the MW and birth center route and then if you end up needing a RCS you could start teaching after babies arrival and an 8 or 12 week maternity break to pay off the double out of pocket cost? If that were possible and DH would agree with it you could still do the birth center and not have to work before baby comes. I really think you can do it with the right support and if you are a successful VBA2C you won't need to go to work to pay off medical bills. Could you try to do some tutoring to make extra money instead of a full on teaching position?

I have to run now but I really hope you can brainstorm some ideas and come up with another acceptable alternative besides giving up your dream. :bighug:

Spacers's picture
Joined: 12/29/03
Posts: 4097

No, no, no, no, nooooooo! Take a deep breath and don't start jumping to conclusions. First thing is to check your policy, not the summary, the actual provisions of coverage; if you don't have it, ask your HR department for a copy or a link to the actual coverage online, again not a summary. Unless your specific policy specifically excludes CPMs or birth centers, then you can almost certainly get at least some of it covered. Insurance pays for the service and for the provider, not the place. If your midwives are legal to provide this service (birth) in your state, then your insurance company can not refuse to pay for their services that the iinsurance company would otherwise cover in another place, i.e. in a hospital. Does that make sense? You would have to pay the full fee in cash and then submit for reimbursement after the birth and it would be out-of-network, so only covered 50% or 70% or whatever your coverage is. Quite frankly, I'm kind of surprised that a birth center wouldn't already know this. If they use a billing service, the billing service probably knows more than they do, so ask to get in touch with the billing service; it might be a matter of finding the right code to bill, or billing under a supervising doctor rather than the midwife, etc. And also call your HR department and ask them to lobby for you, that's their job! Sometimes just having an HR person say, "Hey, this is supposed to be covered!" can open doors you thought were closed. The insurance company knows that losing one business means losing dozens or hundreds of customers.

OK, so whether it's covered or not, now how do you pay for whatever you need to pay? Does your husband have a flex account or medical reimbursement account? If so, then start putting pre-tax money into it next year for this, which is going to save you tax money in the end. Show him what you've posted here (copy & paste to a document if you want to edit a bit) and tell him how important this is to you. He really should have your back on this. I don't know your financial situation & I don't expect you to disclose it, but here are some things to think about. What would the expense of a RCS on top of VBAC really do to you? Would you lose your house? Could you dip into savings & still be OK? Do your parents have money they could/would lend if it came to it? Is your DH up for a raise? If so, live on what he makes now & put the raise toward birth expenses. Or does your DH own his own business? If so, he should discuss with his tax expert how to deduct family medical expenses which will lower his business taxes.

You *can* make this happen, and your husband should help you. He should have faith in you. We have faith in you & we don't even know you! Blum 3 You were robbed of your last birth experience and you have the right to at least try to make this one a good experience. Print out some of the things you've written here, print out the last bit of your last birth story, make him sit down & read those things. If he knows how much this means to you, he'll do it. If he doesn't, then I say get the teaching job and pay for your VBAC first and then for a marriage counselor because that's not how husbands support their wives, or their children's mother.

:bighug:

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

"Spacers" wrote:

Unless your specific policy specifically excludes CPMs or birth centers, then you can almost certainly get at least some of it covered. Insurance pays for the service and for the provider, not the place. If your midwives are legal to provide this service (birth) in your state, then your insurance company can not refuse to pay for their services that the iinsurance company would otherwise cover in another place, i.e. in a hospital.

I called the insurance company myself to double check and they said the same thing, unless its a PA they will not cover it.

"Spacers" wrote:

What would the expense of a RCS on top of VBAC really do to you?

It would put us in a real financial bind if we had the expense of both.

"Spacers" wrote:

Would you lose your house?

Not likely

"Spacers" wrote:

Could you dip into savings & still be OK? Do your parents have money they could/would lend if it came to it?

We don't have any savings. We used all of our savings while DH was unemployed for about 8 months before and after Kole's birth. And no our parents are most definitely not an option as a money source at all.

"Spacers" wrote:

Is your DH up for a raise?

No.

I don't think out discussions on the matter are settled yet, but I already feel exhausted just thinking about having to fight so hard for this already. It shouldn't have to be so damn hard just to give birth on your own terms! I hate that there are seriously no other options besides going rogue.

Spacers's picture
Joined: 12/29/03
Posts: 4097

"AnnaRO" wrote:

I called the insurance company myself to double check and they said the same thing, unless its a PA they will not cover it.

Check your policy. They generally can not deny coverage for a provider that is legal to provide that service in your state. Also ask the birth center if they have a supervising OB that they can bill under. Keep pestering everyone. Call your local & state representatives and ask them why Texas doesn't mandate coverage of CPMs for out-of-hospital birth, and ask them to lobby the insurance company for you, they work for you!

Last resort, Kickstarter campaign? :biglaugh: I'd donate $20 to help you, maybe another 249 others would, too?

Spacers's picture
Joined: 12/29/03
Posts: 4097

Write a letter to the insurance company demanding to know why a CPM, whom your state recognizes as a legal provider of birthing services, would not be covered by insurance in your state. Write to your state department of insurance asking the same question. Include copies of your policy and ask for responses in writing. Does Texas have a Board of Midwifery? I think have to since the state licenses CPMs. Call them & ask about this.

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

So I would have to wait until after the birth and then try to get insurance to reimburse me? But I would run the risk that they would refuse to pay and I would still be out the money right? Its a matter of talking my DH into agreeing to pay for the midwives while running the risk that I might end up in the hospital anyway. He hasn't done any of the research and thinks its fine to just show up at the hospital and they'd let me labor at my leisure there. I've tried to tell him that they would cart directly into the OR if I showed up there and the baby wasn't already half hanging out of me. Not to mention there isn't a doctor within 200 miles that would ever agree to take me on as a VBA2C.

They already told me there is no supervising OB they could bill under.

I've never heard of Kickstarter.

eliann's picture
Joined: 04/19/11
Posts: 2438

I'm in Texas too, and I my friend has insurance and had a birth center birth with her first and is now preparing for home birth. Both of those are out of network she says. I googled it and bcbs-tx says your birth center has to be within 30 minutes of a hospital and the CNM must have a practice agreement with an OBGYN.

Texas sucks. But its better than Illinois, which doesn't allow birth centers and Mississippi where its illegal if you plan a home birth.

One thing that Spacers (sorry don't know your real name) mentioned that might be worth considering....how much is your deductible? Does your plan have co-insurance? If you have a high deductible and/or co-insurance, you might want to call your hospital and get a quote and run some numbers. Birth centers usually have a low transfer rate. And you could end up saving money than if you went to a hospital and they put you through the rigamaroll and you end up with a c-section. C-sections are pricey. I too went the hospital route for the same reason. I didn't have maternity coverage either way and I didn't want to pay double if I were transferred. But a big part of me wishes I had stuck with the birth center. Also my friend says that if the midwife sees that you are at risk for a c-section (high blood pressure, breech, etc) before a certain time they let you opt out with only partial payment. She didn't have to pay in full until 37 weeks. So maybe ask them about that.

I'm going to tell you something that no one else here has said...if you HAVE to go the hospital route....prepare like crazy during pregnancy, arrive at the hospital as late as possible, get a doula or a best friend in that birthing room with you, and tell your OB that you have to have a natural birth, advocate for yourself and believe in yourself. You can do this girl!

AnnaRO's picture
Joined: 07/06/08
Posts: 7033


Found it. I will call them tomorrow, or should I write to them?

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

But I do know that most other insurance does cover the midwives, just not BCBS.

Spacers's picture
Joined: 12/29/03
Posts: 4097

I would call the Board of Midwifery tomorrow. Don't tell them you've had two c-sections, though, just say you want to VBAC. You don't want to give them anything to have a problem with that they might not want to help. The fact is that the number shouldn't matter, because the issue is insurance coverage for state-licensed midwives, but no need to risk it, kwim? Good luck!!!

Any chance of switching insurance companies? You're probably in or close to an open enrollment period if it's through your DH's work.

Is your family deductible more than $2,500 for your family, or your out-of-pocket family limit around $12,000? If so, then it's probably considered a high-deductible health plan (HDHP) and you can run $6,550 through a health savings account, which is going to spread the deductions from your paycheck out over all of next year (roughly $250 per paycheck) even though the bill for the midwives will be paid in April. And if your DH's employer offers a flex plan or medical reimbursement account, you can also contribute $2500 (maybe more in 2014) pretax dollars & spread those deductions through the year, about $100 per paycheck. And this is all pre-tax money which lowers your taxable income. Money in an HDHP-HSA can roll over from year to year but money in a flex plan or MRA is "use it or lose it," although there was talk that that might change in 2014, but IDK for sure either way.

And one final thought, which I heard someone did when she moved to Alaska which bans home birth VBAC, and that's to lie. When she filled out new forms for her new OB, she put down that her first birth was vaginal, so he didn't even bother requesting her records from her old OB. She told her midwife the same thing and the midwife never asked for proof or documentation, and she had a home birth VBAC! I'm not sure what kind of trouble you could get into for lying on hospital paperwork, but pre-registering is mostly to verify insurance coverage and to know which OB to call when you get there, so you might be able to get away with it. This is probably easier to manage if your scar is low enough and/or your bushiness is quite bushy. :bigwink:

OK, one more that just occured to me as I was writing that last bit. This comes from ICAN, which you should also contact if you haven't already. On your registration paperwork, if it says anything like you will consent to a c-section upon the advice of your doctor or in the event of a life-threatening emergency, cross that part out, write that you will provide your consent for a c-section at the time if it becomes medically necessary, initial it, and ask for a copy right then & there. I did this with both births & no one ever questioned it. This will protect you in the event that you are forced into an unwanted c-section. Performing surgery on someone without express consent is assault, and if they strap you down, that's imprisonment, and the entire medical staff in the OR could lose their licenses, and face fines and jail time, not to mention how much you'd get from a civil suit. It's extreme, but if they are going to play hard ball, you can be just as good at the game. It might be good to have a few phone numbers of family law attorneys in your phone. I've never heard of anyone saying during labor, "I'm going to talk this over with my attorney," and I hope you won't be the first, but it's an option. In a true life-or-death emergency, your verbal consent in front of witnesses *is* enough. I know that for a fact.

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

No chance of switching insurance companies. They do offer a HDHP, but we are not on that. BCBSTX is the only company available to us, and DH's job covers the health insurance premium for the entire family 100%. I don't think I'd be comfortable with lying and I know DH wouldn't be. I feel so intensely discouraged with this right now. I know I should step back for a while and come back to it but I can't stop thinking about this and worrying about it. I asked on a local group for input tonight on the possibility of finding a VBAC friendly OB.
Here are some examples of what I got:
This link: Get Babied Doula Collective Austin Texas DoulasTexas + VBAC = sucks. ? Get Babied Doula Collective Austin Texas Doulas

And this is just part of the conversation before I abandoned it:

Spacers's picture
Joined: 12/29/03
Posts: 4097

You're in Austin? I thought you were somewhere else. I remember someone else here years ago who was in Austin & hoping to VBAC and she hired a midwife who does "monitrice" service to accompany her to the hospital. That is kind of a hybrid of a midwife at home during labor, then a doula when you go to the hospital to give birth. It's a good option for moms who risk out of home birth, or whose insurance won't cover it, who don't want to spend their entire labor at the hospital but who need or want attentive monitoring before heading to the hospital. The rates for a monitrice are far less than for a midwife, and usually include accompanying you to a doctor's appointment and a couple of home visits after birth, so maybe that could be a good middle ground for you? Since you have a good rapport with the birth center, ask if they would provide this service for you. If not, then I think the midwife's name that the Pg.org mom used was something like Brianne or Brielle.

ETA: Found her! Brielle Epstein.
https://www.facebook.com/pages/Brielle-Epstein-Midwife/437925672937926

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

No. Not in Austin, I'm in Midland, Texas. That article was posted on the local group by a local mom to demonstrate to me how unlikely I am to get a VBA2C in the state of Texas.

AnnaRO's picture
Joined: 07/06/08
Posts: 7033

I've called the local hospital and the one that is 30 minutes away. At the local hospital, I couldn't get anyone on the phone but left a message for a childbirth educator and also emailed her. At the other hospital I spoke with a L&D nurse who told me she didn't have the numbers, but they do see VBAC patients. She has never had anyone VBA2C or even attempt it because the OB's won't touch it, but advised me to check with OB's for their VBAC info because they call the shots. I imagine the info for the local hospital will be the same or worse.

Neither of these hospitals are listed on the cesarean rates website.

pico83's picture
Joined: 09/06/06
Posts: 3008

:bighug: I hope you find some way to work it out.

cactuswren's picture
Joined: 10/19/09
Posts: 4658

I haven't said anything here because we've been talking about this elsewhere, but yes, hugs and I am not giving up on you yet!

Joined: 12/01/05
Posts: 1000

If you are willing to take on debt, I would go with the midwife. If for some reason you need to go ahead with a hospital birth, you can take your time to pay it off. Even if you only pay back $20 a month, they can't do anything to you. You would still be on the hook for it, though. This is a tough situation. I wish there was more we could do.

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