WWYD? Advice Please?

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krazykat's picture
Last seen: 2 years 9 months ago
Joined: 08/11/07
Posts: 1143
WWYD? Advice Please?

When I planned for my HBAC, even though I transferred to her at 38.5 weeks, I agreed to pay my MW $3500 ($500 deposit and then $250 every 2 weeks until the balance was paid). That was on her promise that she would bill my insurance, and she said she had received reimbursement for other clients who were on Tricare insurance. I asked her if I would be reimbursed by Tricare or if she would get paid. She said sometimes the client gets reimbursed and sometimes it comes straight to her, but that if she got anything she would let me know and would expect me to let her know. I agreed.

DS was born September 17th after a planned home birth turned hospital transfer and c/s. I got a paper in the mail in November that one claim had been submitted for prenatal care and that Tricare had covered like $200 or something like that.

All the while I am paying my payments. Well in January I called the office to see where I stood, how much I owed, and how much had been paid by Tricare. My MW responded to a totally unrelated post of mine on Facebook and said she had gotten my message and they were looking into it.

No call until today and it was from one her apprentices. She says that Tricare is refusing to cover anything, even the prenatals, but they are going to keep working on it for me. My problem is, I have checked the claims status online and the ONLY claims that are showing are two on August 28th (which were prenatal). I always get a paper from Tricare when any claims are submitted and they also tell what they approved and what they didn't. I have one paper showing that they paid my MW the $200-something in November. I think they are telling me that they have submitted claims, but I don't think they have. Or at the very least, wires are getting seriously crossed between me, them, and Tricare. I have paid $2500 of the $3500, but I don't want to pay any more until I get an accurate summary of where my account is.

I don't want this to turn nasty, but I feel a little jipped. I must admit that it bothers me a little too that I only spent 3-4 weeks of prenatal care with her since I went post-dates, and then I didn't even end up birthing with her anyways. I feel like they totally ditched me since I was a transfer and a repeat c/s Sad

That got longer than I had planned, so thanks for reading. What would you do? Or say?

Mom2ThreeKiddos's picture
Last seen: 4 years 7 months ago
Joined: 09/15/09
Posts: 1380

Have you called tricare? I would get a bill from her and submit the claim myself. The midwife I am looking at doesn't prorate either so I would be full fee too. If you have proof they have paid them $200, I would call them back and talk about it. At this point give them the benefit of the doubt, but that stinks for you.

mandora's picture
Last seen: 4 years 2 months ago
Joined: 07/16/07
Posts: 262

I don't think it's unreasonable to ask for a summary of everything before you continue paying. That's just good business. I would just ask your m/w if she could provide you with a summary of her bill/invoice, what has been paid, and what is outstanding, as well as a copy of anything she's submitted. Then I'd call your insurance and request the same. I don't think you need to be grumpy about it, since it's seriously a very reasonable request and if either party has an issue providing you with receipts and a statement of where your account stands, that's some shady business.

Once you have those papers you can assess where you stand. Maybe it is just a mix-up, or everyone is confused about where money is going to/coming from.

Good luck!!

MrsHooah2U's picture
Last seen: 5 years 3 weeks ago
Joined: 01/07/08
Posts: 946

I agree with PP. Knowing how big of a PITA tricare could be you need to make sure you get papers from both sides so you can compare. If nothing else tell your midwife you just want the records for your own personal files. I would be VERY surprised if she said no. If she still expects the $1000 from you then she should be MORE than willing to fork out any paperwork you want!

Good luck with it all, hopefully tricare would also be helpful and give you the information you need! Smile

jolly11sd's picture
Last seen: 3 years 10 months ago
Joined: 02/02/05
Posts: 3327

I would totally talk with both of them to see what has gotten paid and what has not so that you are not over paying. Totally ask for copies of things for your records, nothing odd about that. I've had to talk with our claims rep. a lot to help them understand that the HBMW did the prenatal care and part of the birth even though we transferred to the hospital. It seems like more got paid out that way since I was able to clarify and my MW was also able to work around some of her fees and codes to get us the most back possible. They really didn't want to pay out anything since it was out of their 'comfort zone' but the more info I got for them the more they worked with me.

I feel your frustration though since I too paid the $4500 cash for my HBAC and basically had to eat the cost of a lot of it with the transferr we did. Plus some hospital bills on top of that since the birth ended there. We just got a little check back last week for some of the MW costs and that was from an Oct. birth.

Last seen: 2 years 10 months ago
Joined: 11/23/07
Posts: 870

get the paperwork from both, just as PP said.

and if you really find it important, tell them that you'd be more comfortable paying say.. $100 every 2 weeks until you get insurance sorted out.

krazykat's picture
Last seen: 2 years 9 months ago
Joined: 08/11/07
Posts: 1143

Thanks ladies!! I talked to Tricare. Four claims had been submitted and they were all dated prior to his birth. But there were errors in the way they were submitted, so they told me what to tell my MW so she can re-submit them. Then I talked to her apprentice who said I am paid in full. WTH? But ok... lol. So she said she will re-submit the claims and let me know what happens.

I think a lot of my frustration was that I answered her call at about 6 pm last night which is always a crazy time in the house with both babies wanting dinner, needing baths, and close to bedtime. I apologized if I was b*tchy, and it seemed like by the end of the convo it was all good.

Some of it is my own negative feelings about transferring. Why couldn't I just push him out?! Ahhhhhh oh well. Thanks for listening and advising Wink