Murphy101 Posted August 18, 2008 Share Posted August 18, 2008 I've posted before about the difficulties I find myself in for no good reason with this pregnancy. well after a month of hem and hawing, my insurance said they would not cover a planned home delivery via CPM. why? because it's not "medically neccessary" they will not cover this prodecedure unless it is mandated by law. mandated that they cover it or mandated that I have it? the lady couldn't answer that question. I'm so bloomin' furious and frustrated right now.:glare: This is just stupid. A woman with no medical issues who has already had FIVE VBACs without problems shouldn't have to fight this hard to get basic coverage for a pregnancy. Oh and just to be clear, I do NOT have an HMO either. We have the most expensive plan we can get offerred via my dh's company for A***A with a 90% coverage and no deductible. And boy do we pay for it in premiums. So far this year, we'd have been better off keeping the premiums and just paying out of pocket everywhere we go. oh and irony or irony, they are covering my ultrasound tomorrow. yeah ... all of those are medically neccessary aren't they? a friend suggested I call the ACLU about patient medical rights or get an attorney of my own. I have no idea what good that would do. I mean, it's obvious they can stall forever because I NEED to pay for care NOW. She says I should get an attorney even if I deliver without them paying because this is just wrong. Not that any of this matters because it's not like I have money for a lawyer either. anyhoo. needed to vent big time. ETA: for those that don't know. I had an umcomplicated c/s for breech with my 3rd and since had 5 uncomplicated VBACs. My ob, who delivered my last 3, dropped me because I wouldn't and couldn't pay extra beyond her contracted rate with my insurance and I wouldn't consent to an unneccessary c/s so she wouldn't have to monitor a VBAC. Most OBs won't take me at all because they don't do VBACs at all. Of those that do, they are booked or not on my insurance. So I found myself contemplating homebirth for the first time last month. I have found a great midwife, but I'm still stuck trying to afford the unexpected expense. Luckily my midwife said she'll work with me anyway she can if this is what I want and to not worry about the $2000 she normally charges. But of course, I'm going to worry! Quote Link to comment Share on other sites More sharing options...
Mrs Mungo Posted August 18, 2008 Share Posted August 18, 2008 well after a month of hem and hawing, my insurance said they would not cover a planned home delivery via CPM. why? because it's not "medically neccessary" they will not cover this prodecedure unless it is mandated by law. mandated that they cover it or mandated that I have it? the lady couldn't answer that question. They do realize a hospital birth will be much more expensive, do they not? Quote Link to comment Share on other sites More sharing options...
TexasRachel Posted August 18, 2008 Share Posted August 18, 2008 Unless something happens to the baby and then it's millions. So for the insurance, yeah, hospitals are cheaper. I haven't read anything else you've written on this, but is a birth center, or even a hospital, but midwife-assisted birth possible? Quote Link to comment Share on other sites More sharing options...
Murphy101 Posted August 18, 2008 Author Share Posted August 18, 2008 They do realize a hospital birth will be much more expensive, do they not? one would think, but I'm not counting on that much common sense. that and not paying at all is the least expensive thing they can do.:glare: Quote Link to comment Share on other sites More sharing options...
Mrs Mungo Posted August 18, 2008 Share Posted August 18, 2008 Unless something happens to the baby and then it's millions. So for the insurance, yeah, hospitals are cheaper. Statistically, babies are better off with homebirths than hospitals. Quote Link to comment Share on other sites More sharing options...
Murphy101 Posted August 18, 2008 Author Share Posted August 18, 2008 Unless something happens to the baby and then it's millions. So for the insurance, yeah, hospitals are cheaper. I haven't read anything else you've written on this, but is a birth center, or even a hospital, but midwife-assisted birth possible? No because they (the facility if not the provider, but usually the provider too) will not take VBACs. I'd have to drive over 2 hours to get to a birthing center. That is just not an option. Quote Link to comment Share on other sites More sharing options...
Jennifer in MI Posted August 18, 2008 Share Posted August 18, 2008 I've posted before about the difficulties I find myself in for no good reason with this pregnancy. well after a month of hem and hawing, my insurance said they would not cover a planned home delivery via CPM. why? because it's not "medically neccessary" they will not cover this prodecedure unless it is mandated by law. mandated that they cover it or mandated that I have it? the lady couldn't answer that question. I'm so bloomin' furious and frustrated right now.:glare: This is just stupid. A woman with no medical issues who has already had FIVE VBACs without problems shouldn't have to fight this hard to get basic coverage for a pregnancy. Oh and just to be clear, I do NOT have an HMO either. We have the most expensive plan we can get offerred via my dh's company for A***A with a 90% coverage and no deductible. And boy do we pay for it in premiums. So far this year, we'd have been better off keeping the premiums and just paying out of pocket everywhere we go. oh and irony or irony, they are covering my ultrasound tomorrow. yeah ... all of those are medically neccessary aren't they? a friend suggested I call the ACLU about patient medical rights or get an attorney of my own. I have no idea what good that would do. I mean, it's obvious they can stall forever because I NEED to pay for care NOW. She says I should get an attorney even if I deliver without them paying because this is just wrong. Not that any of this matters because it's not like I have money for a lawyer either. anyhoo. needed to vent big time. ETA: for those that don't know. I had an umcomplicated c/s for breech with my 3rd and since had 5 uncomplicated VBACs. My ob, who delivered my last 3, dropped me because I wouldn't and couldn't pay extra beyond her contracted rate with my insurance and I wouldn't consent to an unneccessary c/s so she wouldn't have to monitor a VBAC. Most OBs won't take me at all because they don't do VBACs at all. Of those that do, they are booked or not on my insurance. So I found myself contemplating homebirth for the first time last month. I have found a great midwife, but I'm still stuck trying to afford the unexpected expense. Luckily my midwife said she'll work with me anyway she can if this is what I want and to not worry about the $2000 she normally charges. But of course, I'm going to worry! Is that $2000 just for the birth? I paid $2000 for my entire pregnancy/delivery with my homebirth midwife. I'd think that she could bill the insurance company for your prenatal visits and then work out a rate with you for the birth - worst case scenario. I'd also keep fighting the insurance company on this. Keep going up the ladder. I also met with a homebirth midwife who was able somehow to bill the ins. company for a homebirth under "facility" fee. She just never mentioned what the facility was. I didn't go with her, so I don't know exactly how that worked. But, maybe you can work something out with your midwife too. Unless something happens to the baby and then it's millions. So for the insurance, yeah, hospitals are cheaper.? This would be true in the hospital as well! Most homebirths turn out absolutely fine. Those that result in a transfer are usually done in plenty of time to have a safe, healthy outcome for both mom and babe. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted August 18, 2008 Share Posted August 18, 2008 You wouldn't happen to be stuck with Aetna, would you? Link: http://www.aetna.com/cpb/medical/data/300_399/0329.html We just switched to this mess in July and it really p*sses me off. We are paying the $2500 out of pocket to have our homebirth. Midwives make squat, so we are paying her first, then fighting the insurance company. If we get anything at all she will refund us. I'm not holding my breath. Barb Quote Link to comment Share on other sites More sharing options...
Barb_ Posted August 18, 2008 Share Posted August 18, 2008 Nope, sorry. Read this link: http://www.bmj.com/cgi/content/abstract/330/7505/1416 Unless something happens to the baby and then it's millions. So for the insurance, yeah, hospitals are cheaper. I haven't read anything else you've written on this, but is a birth center, or even a hospital, but midwife-assisted birth possible? Quote Link to comment Share on other sites More sharing options...
Quiver0f10 Posted August 18, 2008 Share Posted August 18, 2008 We had to pay out of pocket for our homebirth too and I know it stinks, but it's money well spent. Quote Link to comment Share on other sites More sharing options...
lighthouseacademy Posted August 18, 2008 Share Posted August 18, 2008 A few thoughts come to mind: Number one is that your old ob, if she was contracted and "referred" CAN NOT ask for more money than insurance pays or that is FRAUD. Next onto the homebirth coverage. Unless your policy SPECIFICALLY states that they won't cover out of hospital birth, then they have to cover it. You may not get the highest rate, but they do have to cover it. Actually, I got them to pay 100% of my daughter's birth because they tried to pay 60% (non-preferred rate) but because they did not provide a preferred provider who provides the service of homebirth within a 50 mile radius, they were required to pay at the preferred rate (PPO insurance). They tried to tell me that if I wanted the birth paid for at the preferred rate I should have had my baby in the hospital. The fact that they told me where I should have delivered was enough grounds to take it to the insurance board of CA. I had asked the insurance company to pay 80% of usual and customary and the insurance board required 100% of the bill. It required legwork on my part, but it was doable and done. BTW if you have Aetna, I think that they have a specific clause that they won't cover out of hospital births, but check your policy. Quote Link to comment Share on other sites More sharing options...
Murphy101 Posted August 19, 2008 Author Share Posted August 19, 2008 You wouldn't happen to be stuck with Aetna, would you? Link: http://www.aetna.com/cpb/medical/data/300_399/0329.html Barb Bingo. Hit it in one shot.:glare: We had to pay out of pocket for our homebirth too and I know it stinks, but it's money well spent. You seem to misunderstand. I'm not against paying a genuine worthy wage well spent. I do NOT have the funds to give. In fact, a midwife is cheaper than my previous ob. Under the OB's conditions I would have paid my insurance portion PLUS 100 an hour or the higher portion for the more expensive c/s. (That's not including hospital fees.) The midwife is charging me $2k for the entire thing. Worst case, I'd break even with the cost of the ob! My ob told me point blank that unless I paid an additional 100 an hour beyond the insurance contract for my time in labor or consented to a c/s then I needed to get another provider. How legal that is... Aetna was okay with homebirths and midwives up until recently, but now are claiming to be falling in line with the ACOG stance. We don't have a copy of a policy. The company my dh works for gets the policy? We just get the deduction from his paycheck and a different story with every person they transfer us to.:glare: Quote Link to comment Share on other sites More sharing options...
lighthouseacademy Posted August 19, 2008 Share Posted August 19, 2008 My ob told me point blank that unless I paid an additional 100 an hour beyond the insurance contract for my time in labor or consented to a c/s then I needed to get another provider. How legal that is... Again, if your ob was contracted with Aetna and a preferred provider then part of her contract with Aetna is that she will accept as payment for the birth x dollars. There are codes she can use for staying at the birth extra and being there after hours. There are codes to use for phone standby etc. The dr, unless not preferred can not charge beyond what the insurance company requires you to pay. Now, if the OB is not preferred, then they can charge anything they want beyond the insurance but they must bill insurance for that. So for example, the charge 4000 for the birth and insurance pays 2000, then you would be responsible for the other 2000 with a non-preferred provider. It would be fraud for the OB, if preferred to require you to pay the extra 2000. Quote Link to comment Share on other sites More sharing options...
Murphy101 Posted August 19, 2008 Author Share Posted August 19, 2008 Again, if your ob was contracted with Aetna and a preferred provider then part of her contract with Aetna is that she will accept as payment for the birth x dollars. There are codes she can use for staying at the birth extra and being there after hours. There are codes to use for phone standby etc. The dr, unless not preferred can not charge beyond what the insurance company requires you to pay. Now, if the OB is not preferred, then they can charge anything they want beyond the insurance but they must bill insurance for that. So for example, the charge 4000 for the birth and insurance pays 2000, then you would be responsible for the other 2000 with a non-preferred provider. It would be fraud for the OB, if preferred to require you to pay the extra 2000. She's a preferred provider. She is saying that Aetna only pays for the delivery, not the required sitting in of the ob while I labor, and that's the part she's charging for. The hospital requires that any VBAC performed must have the OB stay in the room the entire labor. She says my insurance doesn't cover that, so she's charging for it as an elective medical procedure. Basicly she says she's got to close up shop and wait for me to deliver so she's losing money waiting on me to push and not making any more than she would for any other delivery. So it's either refuse to do a VBAC, do a c/s, or recoup her losses with this 100 an hour fee. My insurance says that having to attend the labor is incidental to the delivery and is not given additional payment anymore than stitching an episiotopmy would be because both are basic components of delivery. She gave me the codes for standby time and such and my insurance said they would not cover any of those codes because it's incidental to delivery. How true or reasonable any of this might be is beyond me. Frankly, I'm sick of the entire circus system.:glare: Quote Link to comment Share on other sites More sharing options...
Karen sn Posted August 19, 2008 Share Posted August 19, 2008 $2,000 is all she charges? Mine was $4,000! We were going to pay out of pocket, but we both lost our jobs and I got medicaid. I would fight them just for the principle. Quote Link to comment Share on other sites More sharing options...
Barb_ Posted August 19, 2008 Share Posted August 19, 2008 Bingo. Hit it in one shot.:glare: Can I just reiterate how much I truly, deeply, and violently hate Aetna for this stance? You seem to misunderstand. I'm not against paying a genuine worthy wage well spent. I do NOT have the funds to give.... I can understand that. Is there something you can barter? Is dh good with his hands? Can you tutor her child? We don't have a copy of a policy. The company my dh works for gets the policy? We just get the deduction from his paycheck and a different story with every person they transfer us to.:glare: You know what??? I'm having this exact same difficulty! I've asked human resources repeatedly for the outline of benefits book that we've received from EVERY other ins co we've ever been with. After much hemming and hawing, they finally told me Aetna would be mailing it. That was 6 weeks ago. I don't trust insurance companies any further than I could throw one and I like having the outline at my fingertips. Interesting that you are having the same problem. Barb Quote Link to comment Share on other sites More sharing options...
StaceyinLA Posted August 19, 2008 Share Posted August 19, 2008 was able to write a letter to the insurance and get it covered. I was fairly demanding about it, and basically let them know that since their handbook did not exclude the coverage, that they had to do it. I also put in some points about the costs of hospital births and dr's charges vs the midwife's charges. I'm sure that helped. I wouldn't back down. Quote Link to comment Share on other sites More sharing options...
Mamagistra Posted August 19, 2008 Share Posted August 19, 2008 You wouldn't happen to be stuck with Aetna, would you? Link: http://www.aetna.com/cpb/medical/data/300_399/0329.html :eek: Un.*^#!@ be.lievable. Both Aetna and ACOG suck eggs for such ridiculous, self-serving policies. :glare: :rant: ~self-censored diatribe about ACOG and the medicalization of birth~ (((Martha))) Quote Link to comment Share on other sites More sharing options...
cin Posted August 19, 2008 Share Posted August 19, 2008 Well of course the docs aren't going to recommend it. THEY don't $$$$ from it. Nevermind that some women in the world just squat where they are (rice paddie, dusty field, tropical rain forest...). We are endangering our babies by having them with a midwife in a relatively clean environment. Yeah, right. :tongue_smilie: Quote Link to comment Share on other sites More sharing options...
lighthouseacademy Posted August 19, 2008 Share Posted August 19, 2008 She's a preferred provider. She is saying that Aetna only pays for the delivery, not the required sitting in of the ob while I labor, and that's the part she's charging for. The hospital requires that any VBAC performed must have the OB stay in the room the entire labor. She says my insurance doesn't cover that, so she's charging for it as an elective medical procedure. Basicly she says she's got to close up shop and wait for me to deliver so she's losing money waiting on me to push and not making any more than she would for any other delivery. So it's either refuse to do a VBAC, do a c/s, or recoup her losses with this 100 an hour fee. My insurance says that having to attend the labor is incidental to the delivery and is not given additional payment anymore than stitching an episiotopmy would be because both are basic components of delivery. She gave me the codes for standby time and such and my insurance said they would not cover any of those codes because it's incidental to delivery. How true or reasonable any of this might be is beyond me. Frankly, I'm sick of the entire circus system.:glare: They are both right. Waiting on the floor is incidental to the birth- however, the billing code for delivering the baby includes a certain amount of time in attendance (I think it is 4 hours). Anything beyond that they can bill for the extra time and the insurance company should pay it. (If I remember the billing code for attending the birth I could look it up the definition including time for you but I don't remember how to look it up or what the code is). Will your midwife barter with you? Can she bill the insurance for the prenatal visits and newborn care and then charge you for the birth to make up the difference? Quote Link to comment Share on other sites More sharing options...
kalanamak Posted August 19, 2008 Share Posted August 19, 2008 Not that I know anything about this, but does your state have an insurance commissioner? You might just luck onto someone with a lick of sense. Worth a phone call, maybe. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.