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January 27, 2005
More Insurance Company Crap. Update #2
So I got a call from the midwife's billing agent today. She said the insurance company told her that homebirth is covered.
You didn't really think it would end there, did you? Oh no...
Our insurance company covers homebirth and would grant the midwife exception (full network coverage due to a lack of any similar in-network provider closer by), but apparantly homebirth is not included in our plan. We have a PPO plan, Preferred Provider Organisation, which I was led to believe actually gave you some good coverage etc. Apparantly not.
The billing agent said to fight it. She said it was illegal for them to deny you a legitimate medical choice and limit my birth choices to only hospital or birthing center, she added to mention contacting local congress persons as well. She also stated that people who fight often win too, I guess this is because insurance companies generally deny initially anyway, and expect little resistance from the vast majority of people.
So PreZ called them up to get some answers out of them. Their first excuse was to say that it wasn't covered because PreZ's employer didn't list it as coverable. Which really takes the cake (and I know "regular" birth stuff is covered, so this just sounds a bit like a cop out). Then when PreZ mentioned he'd be contacting his Human Resources person and local congress woman the woman at the insurance company then tried to claim that the insurance is provided under Washington state law (where they are based), to which PreZ countered that no, the service is being performed in NY state, where we are, thus NY state law applies, not WA state law. He never mentioned whether or not that got much of a response back, my guess is not.
He then phoned his HR person, whom I don't think has gotten back to him yet. Then he googled some stuff, and found a piece of NY state legislation that mandates that insurance companies have to cover midwife services if the midwife is licensed (and in NY that's mandatory for a midwife to practise as far as I know, and our midwife is certainly licensed/certified/registered). It doesn't specifically state what these services are or can be, but homebirth is definitely not an exceptional kind of service for a midwife. Furthermore, they have to cover "at minimum" parent education, assistance and training in breast or bottle feeding. We just signed up for a comprehensive birth class, which includes a breastfeeding class and newborn care class... so here's hoping that waving this piece of legislation under their noses means they'll cough up (some) money for that too.
Right now I'll just settle for them covering my labour and birth choices.
Posted on 01:28 AM to: Pregnancy