Can't Have the Birth I Want

[mhschool6]

With my 7th, I desperately wanted a VBAC, but was sick of dealing with hospitals and doctors, which is how I had a completely unnecessary Csection with my 6th. I searched, and searched, and home birth was not an option. Then I went through 4 doctors offices, b/c they would not give me a definite answer that they would let me deliver vaginally and naturally. But eventually, I found an incredible doctor that delivers at a smaller catholic hospital, and she has several midwives in her office. They were fabulous, and even though I was in a hospital, having a VBAC, I had the most beautiful, amazing, natural delivery!! So I hope it works out to where you don't have to deliver at a hospital, but if you do, keep searching for the right doctor!! And be kind, but let them know exactly what your concerns are! Oh, and I actually started scheduling a consult with the doctor to question them, before I chose them as a doctor. I think the most I paid was $40 for a consult. It was worth the money and effort! Hope this helps!

[cheezpoofs]

Originally Posted by jaelynsmommy61607 You've been seeing this midwife the entire time right? Why hasn't the insurance covered prenatal upto this point? Did you check state medical? Often the limits ate higher for pregnancy and they back pay IME.

Yes, I've been seeing her since the beginning. I don't know if she has billed the insurance for prenatal care yet, honestly, but I don't think it would take off enough of the cost to make the balance manageable for us to cover. I have looked into Medicaid and we do make more than the maximum allowed. The limits are higher than for other Medicaid programs, but we're still above it.

Originally Posted by Green Decals One last option... Have your midwife bill in full to the ins co that you were covered under until 12/31, with a date of sometime in December. My midwife gives me the full bill at my first appt, I have until week 34 to pay it in full. Just a thought, and

How exactly would this work without being insurance fraud? It's a global maternity fee code that she uses, but I have no idea if she would be able to bill my previous insurance company. I suppose I could ask her... That certainly WOULD fix my problems.

[Caz]

I also have to have all of the estimated out of pocket expenses paid to my midwives/birth center before 36 weeks.

Another thought - what your employer-sponsored insurance policy does and does not cover is usually under the control of the company itself. Has your husband talked to anyone in HR about the impact of the change in coverage to you when you are at the end of your pregnancy? Depends on the company, obviously, but some places are willing to go to bat for their employees, and a lot of times, all it takes is someone in the administration of a company to just say "yes, we want our coverage to remain the same" and the policy is changed. Not always so easy, but I would really suggest that your husband talk to his benefits representative at work and explain that you had confirmed your coverage at the start of pregnancy and chosen your practitioner and delivery plan accordingly, and now, with just weeks to go until delivery, you have to find a new provider and completely change your birth plan... You may find someone there willing to help out...

[Caz]

Originally Posted by cheezpoofs Yes, I've been seeing her since the beginning. I don't know if she has billed the insurance for prenatal care yet, honestly, but I don't think it would take off enough of the cost to make the balance manageable for us to cover. I have looked into Medicaid and we do make more than the maximum allowed. The limits are higher than for other Medicaid programs, but we're still above it. How exactly would this work without being insurance fraud? It's a global maternity fee code that she uses, but I have no idea if she would be able to bill my previous insurance company. I suppose I could ask her... That certainly WOULD fix my problems.

She can certainly bill for services provided prior to the end of your coverage with that company. I bill insurance for services that I provide, and usually services are not billed exactly when they are provided. As long as it's a reasonable amount of time, say 30 days, since the end of your coverage, she should be able to get reimbursed for all allowed services.

ETA: now, technically, she can't bill in advance for the delivery itself, but all of the prenatal care, as well as any supplies that were purchased in "preparation" for the birth (since you can't wait until you're in labor to order those) should be easily reimbursed... maybe she can work with you how how the bill is itemized so that the bulk of the fees are for prenatal care? I'm sure her costs are below the allowable amount, especially when compared to an OB practice?

[waterisntsomething]

I've seen midwives in training that charge half price and they still bring an experienced midwife to the birth with them.

[cheezpoofs]

Originally Posted by Caz I also have to have all of the estimated out of pocket expenses paid to my midwives/birth center before 36 weeks. Another thought - what your employer-sponsored insurance policy does and does not cover is usually under the control of the company itself. Has your husband talked to anyone in HR about the impact of the change in coverage to you when you are at the end of your pregnancy? Depends on the company, obviously, but some places are willing to go to bat for their employees, and a lot of times, all it takes is someone in the administration of a company to just say "yes, we want our coverage to remain the same" and the policy is changed. Not always so easy, but I would really suggest that your husband talk to his benefits representative at work and explain that you had confirmed your coverage at the start of pregnancy and chosen your practitioner and delivery plan accordingly, and now, with just weeks to go until delivery, you have to find a new provider and completely change your birth plan... You may find someone there willing to help out...

This is really good advice. Thank you! I will see if I can get hubby to talk to his HR and maybe it will help.

[knodceo]

Originally Posted by cheezpoofs This is really good advice. Thank you! I will see if I can get hubby to talk to his HR and maybe it will help.

Our company did this! Definitely worth a try

[kaydove]

I switched insurance during pregnancy, at 34 weeks, due to a move. The midwife in my hometown billed my old insurance for prenatal care during June 2011-December 2011, I just received the notice from old insurance company that it was paid last month. Your midwife should bill your old insurance for prenatal care.

Sent from my iPhone using DS Forum

[Green Decals]

I can't quote right now but it isn't fraud at all - the charges were incurred, and services rendered, while you were insured by the other company. If they break down the global fee, then they may not cover the birth/postpartum services that have not yet been rendered, but there is a very good chance they will pay it all as a global package. You need to read the exact wording of your old policy - the 2 key points of contention are going to be in the "global" and "at the time services are rendered" definitions.

[cheezpoofs]

Originally Posted by Green Decals I can't quote right now but it isn't fraud at all - the charges were incurred, and services rendered, while you were insured by the other company. If they break down the global fee, then they may not cover the birth/postpartum services that have not yet been rendered, but there is a very good chance they will pay it all as a global package. You need to read the exact wording of your old policy - the 2 key points of contention are going to be in the "global" and "at the time services are rendered" definitions.

Thank you! I'll look at that. I just received their coverage manual, actually. Not sure they knew we weren't covered by them anymore....