Question
Hello, I live in Idaho.
Thank you for taking the time to read my question.
I am trying to gather information which may help me to better prepare myself to argue successfully for coverage from my insurance provider.
I am expecting my third daughter at the beginning of February 2007. I am determined to pursue an out of hospital birth experience for myself and my babe. My previous pregnancies have had no problems and this pregnancy has followed the same course. I have researched the issue, paying careful attention to both sides of the debate, and have decided that I would be best served by following the midwifery model of care.
There are several qualified practicing midwives in my area who attend out of hospital births. There is one free standing birthing center which is a 10 -15 minute drive from the local hospital. This birthing center has a fantastic reputation both for support provided laboring mothers and for responding appropriately when a transfer has been required (2 times in 3 years). They are able to accept most kinds of insurance, except, as you may have guessed, mine.
A brief consultation with a representative from my provider revealed to me that services provided by a midwife are covered if the following two conditions are met: One, the midwife must be a Certified Nurse Midwife (CNM). And two, the midwife must be under the direct supervision of a physician.
Now, heres the rub -- No CNMs in my area are authorized to attend out of hospital births by virtue of their association with the physicians who 'supervise' them.
A catch 22.
My feeling is that my insurance provider is not particularly supportive of my goal, which is an out of hospital birth experience. I am frustrated by a feeling that I am being harnessed into giving birth at the local hospital. Is there some law that I must? It would seem that my only options are to either give birth unassisted (something I am not comfortable doing), or pay out of pocket.
I have found a midwife who is certified and who works under the supervision of two physicians who are both contracted with my insurance provider, Blue Cross of Idaho. This midwife runs a birthing center almost 150 miles from where I live. She has explained to me that although she is under the supervision of these two physicians, they do not have a financial association. Does this negate the fact that she meets the conditions they have set for covering services through a midwife?
The coverage we have is really quite generous, with a full 90% of costs being covered. Our plan is a PPO through my husbands employer.
In researching the various strategies used by other women in my situation, it has been suggested that a very specific dialog with very specifically worded statements to my insurance co. may be of some help in securing coverage. I am really at a loss....
Can anyone help me to sort out what my options may be here?
This got long, too long. I apologize and I thank you for your polite attention despite your busy schedule
-imtrying119
What is the name of your state? IdahoWhat is the name of your state?What is the name of your state?
Answer
You are not being "harnessed". You are asking them to take on the risk that you MAY incur additional medical expenses by taking that chance. All you can do is ASK your insurance company. If they say no, then you either go to a hospital or pay for your own delivery.
The medical malpractice insurance for both the nurse nidwife and the surpising physician is astronomical, which is why you can't get anyone under the guidelines that you listed.
Answer
Insurance doesn't cover everything end of story. You may file an appeal but, because this isnt "standard care" and is a choice I have a feeling you will be denied.
Answer
You have coverage for childbirth. You have the right to use what you have available to you at the coverage available or choose out of network or out of plan providers- and you cover what's left.
If you want it that badly, pay the additional uncovered costs and thank G-D you have been blessed with three pregnancies and presumably three births. Not all women have that blessing.
My rant: if you were adopting and not giving birth, you'd pay many, many thousands out of pocket and your employer wouldn't be helping with a penny of it. Those who expand their family by procreation at least have their employer plans offer the option of having a good portion of their costs covered. Those who expand their families by adoption don't get squat in help toward their costs.
You ahve nothing to complain about - you have coverage. You just don't want to use what's available.