Insurance update – the home birth saga continues

A while back I posted that I was trying to get our insurance company to acknowledge a claim for Julian’s home birth. I made phone call after phone call asking them if they had all of the information they needed to process the claim and each time, they would come back with one more thing that was still needed. I’d send them that “one thing” and then there’d be something else. It was always something.

I received an “explanation of benefits” in the mail from them a few months ago that said the claim had been closed because they hadn’t received everything they’d requested from me (BS!), and that they’d consider reopening it if the information was sent in. I threw up my hands in frustration and pretty much resigned myself to the thought that we would never get anything from them.

Then my midwife told me that she had contracted with a billing company and they could take over my case for me. So I sent them the information they required about two months ago and hadn’t heard a word from them until a couple weeks ago. Jody got a call saying that they needed the “explanation of benefits” that the insurance company sent to me and that they were “very optimistic” that we’d get some money from them.

I dug up that form and Jody faxed it in so now we wait and see. It would be awesome if they end up paying for part (or all!) of my midwife’s fees. Considering we paid $2200 for prenatal care, the birth and postnatal care, it would be a serious bargain for the insurance company. If I had had a hospital birth, which would have involved a c-section since Julian ended up being breech, it would have been tens of thousands of dollars and that’s just for the birth and not including the prenatal/postnatal care.

I’m not holding my breath, but I sure would love to see some of that money back in our pocket. :)

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16 thoughts on “Insurance update – the home birth saga continues

  1. I hope you get that moolah too. I’ve always thought it was ridiculous that insurance companies won’t pay for midwife and doula expenses. They’re crazy NOT to. And here I thought money was KING in their eyes. I guess they still see natural birth as a liability. What utter horse shit! (Pardon my French)

  2. I would resend the “needed” info by certified mail, and then take them to small claims court or get the better business bureau involved. Don’t give up :)

  3. I am so surprised that some people actually do get the insurance to pay- I do hope they pay up in your case! But we are going into this home birth with no hopes of insurance paying, unfortunately! But if they do, that would be nice!

    Steph

  4. I do hope you see some money!

    I am greatly disturbed by insurance companies and homebirthing. I receive emails from women on a regular basis who have heard that I have had successful VBAC unassisted births and want some direction and advice because their insurance company won’t cover the birth they want and they don’t have money to pay out of pocket. Unassisted birthing was and is the best choice for me but it makes me angry that women are feeling like they have little choice but to go that route because of hospital policies(for instance, my local hospital has a No VBAC policy and I would have had to have a c-section despite the fact that I had 4 successful VBACS already…and yup, insurance would have definitely covered the c-section costs,no doubt!) and insurance companies not covering midwife’s services.

    Sorry…I suppose I got off on a tangent there LOL. I’m in a ranty mood this evening :P

    Good luck!

  5. I remember this saga in my own case like it was yesterday. We spent hours on the phone and wrote two long letters of appeal to no avail for girl #1.
    I didn’t even try for girl #2.
    Too much work. LOL.
    Good luck, sister!
    xoxo

  6. I can completely understand the benefit of a midwife or in my case lactation consultant who contracts with a billing company. When my twins were born, I knew I wanted to breastfeed, but for all my voracious reading and preparing I was clueless when it came to actual getting those tiny mouths to latch. The deck was stacked against us from the get go. My twinkies were a month premature, low birthweight, and I was medicated to the hilt due to preeclampsia and HELLP syndrome. I didn’t even get them to the breast until a full 24 hours after delievering. Five days after delivery breastfeeding was going nowhere and we were supplementing after every feed with EBM and formula. My pediatrician gave me the name of an LC who would come to my home and I immediately called her to come ASAP. My husband and I resigned ourselves to paying the $175 consultation fee out of pocket. You can imagine our relief and surprise when she said she had a biller who would file a claim through our insurance for us. They ended up paying 100% (minus a $20 copay). Yipee!! Best of luck to you in your reimbursement endevour, I used to work in the financial department of a pediatic hospital, so I completely understand the frustration of dealing with insurance companies.

    Keep us posted and best of luck!

  7. I sure hope you get reimbursed. I was always frustrated when I worked for an insurance company because I would have to deny things just because it was stated in the policy. Didn’t matter if it was money saving or even health saving! Ugh!

    We are now dealing with the hotel’s insurance over Jack’s foot. They are doing their darndest to deny it.

  8. Good Luck! I had some MAJOR drama after #2′s birth with insurance, too. They wouldn’t even COVER the midwives, so we went with an OB practice with lots of midwives on staff. None of it mattered anyway since he was an unplanned home birth, but the stress of dealing with it all through the first two trimesters was a nightmare!

  9. Ugh, that reminds me of trying to get insurance to reimburse me for my breast pump… allegedly something our plan covered, but there was always something holding up the process. I eventually gave up (although the $250 I spent on that is a different ballgame than what you’re fighting for!).

    Good luck! Those companies suck.

  10. I cannot BELIEVE how ludicrous it is that you have to go through all of this. Makes me so mad. Why is healthcare so backwards in this country???

    I hope you get reimbursed the money and soon!

  11. As a homebirth midwife, we have also hired a billing service to interface with the insurance companies on our behalf. Our billing service is worth their weight in gold. It is a huge, convoluted game to get money out of some companies, and they take it as their main goal to NOT pay for anything they can get away with (especially if YOU have already paid for it).

    If it’s any consolation, many companies allow up to three years to appeal a claim, presuming that the original claim was filed within 1 year of the “date of service.” If your midwife’s billing service is worth their salt, they’ll get it sorted out. Hopefully you have records of every bit of correspondence you’ve had with the insurance company, including dates and times you’ve called, who you spoke to and what they told you, followed up by copies of what you sent and the dates on which you sent them. Pinning them down this way is sometimes the only way you’re going to get paid — you have to beat them at their own game.

    Good luck, Amy!

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