Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

Pregnancy Pregnancy

WHAT THE HECK IS THE POINT OF INSURANCE???????!!!!!!!!?????????? (Warning Cussing)

Posted by on Jun. 20, 2013 at 2:46 PM
  • 59 Replies

banging head into wall

Seriously I am so frustraited!!!!!!!!!! So when I first found out I was pregnant and contacted my Midwife they ran my insurance to find out what it covered. Information came back stating they wouldn't cover anything! My midwife explained to me I could apply for Medicaid (that we would qualify based on income I guess) or that I could send my insurance company a letter asking them to cover our homebirth!! So I did, and never heard anything back, until just this week!! I got the letter from them stating that:

Your Anthem Blue Cross and Blue Shield Health care benefits DOES provide coverage for maternity services rendered by a Certified Nurse Midwives in a home or hospital setting. In regards to your use of our current CMN with Traditional Midwifery of Lynchburg LLC, be advised that she is not a partcicipating provider with your health care plan and that your health care plan does not have out-of-network benefits. Any services rendered by her will not be cover. No exception can be made. The use of a Midwife within your plan's PPO Network is suggested. For your review and possible use I have enclosed a listing of participating midwives in your area!

They then go on to list only hospital birthing Midwives. The ones with the Forest center over an hour from me. The same ones who delivered my second son almost killing him, who told me he was gonna be over 9-10 lbs (he was 6 lbs 5 oz) the ones who faught with the nurses IN the room while I was in labor, the ones I only saw twice the entire time I was in labor, and the ones who refused to even admit me into the hospital or let me out of the bed for over 4 hrs SWEARING I wasn't in active labor and they were gonna send me home. When I actually was! They are JUST like OBs, and I be DAMNED if I am going to go with them!!!! So now to contact my Midwife and see what she says. And then to decide what to do, do I pay the $3,000 out of pocket, $3,500 if I include my Doula fee. Or do I get Medicaid for the pregnancy and pay only $1100 out of pocket. Its just so annoying!! The letter we sent gave all the facts on the saftey of homebirths, and how much money they would save with my homebirth delivery as opposed to a hospital birth. And yet they wont cover it! And I LOVE how they gave me all hospital birthing Midwives as participating Midwives...yea that is because they no damn well that they deliver in hospital! GRrrr

frustrated

I contacted my midwife and she said that all of her patients are getting these denial letters essentially saying they do cover homebirth when they actually do not. She asks for us to contact HRM and let them know that BCBS is essentially commiting fraud by saying they do when they infact do not. So I am gonna contact Hubby's HRM and let them know how I feel, its so frustraiting!!

by on Jun. 20, 2013 at 2:46 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
kmqw229
by Ruby Member on Jun. 20, 2013 at 3:25 PM
1 mom liked this
Ugh what a pain
Posted on CafeMom Mobile
Lili4You
by on Jun. 20, 2013 at 3:44 PM
3 moms liked this

That is because doctors/hospitals work together with insurance companies to make more $$$$$$. If healthcare wasn't all about profit we would be like other developed countries where there is a lower infant mortalilty rate and most of the births are attended by midwives. But that is just my rant on the failing of health care in america. I am having mine in the hospital because my SO is concerned about the "what ifs" and I know he is going to be stressed enough when it comes time for delivery so I am trying to ease his mind a little.

To your actual problems. I would go with Medicaid. They will pay some to all of your back bills to if it happened in the past 3-6 months. You are already paying for it with all the taxes you have paid over the years so I say don't balk. It is about the health of your baby in the long run and you may need that money down the road for something your little one needs.

NoraDun
by Platinum Member on Jun. 20, 2013 at 3:51 PM

ABSOLUTELY couldn't agree more. And it only ticks me off more to think about!!!! Its such CRAP!! And people sit back and allow it to happen GRRRRR!!!

I talked to my Midwife and she said she suggests the Medicaid as well, it wont cover it all but will cover some. And BCBS still will cover the blood work, u/s, etc. So she said essentially my BCBS will be a primary insurance, and what they decline Medicaid (will be a secondary), and what they dont pay I am making in payments. I have already started making payments to here because either way we knew I would owe her some. Its just so frustraiting. And what bothers me most is that they lie and say they do cover it, when they dont !

Quoting Lili4You:

That is because doctors/hospitals work together with insurance companies to make more $$$$$$. If healthcare wasn't all about profit we would be like other developed countries where there is a lower infant mortalilty rate and most of the births are attended by midwives. But that is just my rant on the failing of health care in america. I am having mine in the hospital because my SO is concerned about the "what ifs" and I know he is going to be stressed enough when it comes time for delivery so I am trying to ease his mind a little.

To your actual problems. I would go with Medicaid. They will pay some to all of your back bills to if it happened in the past 3-6 months. You are already paying for it with all the taxes you have paid over the years so I say don't balk. It is about the health of your baby in the long run and you may need that money down the road for something your little one needs.


rjmac88
by on Jun. 20, 2013 at 6:31 PM
I'd just get Medicaid.
Mommabearbergh
by on Jun. 20, 2013 at 6:34 PM
1 mom liked this

ugh that sounds like a pain and I would call them asap. I would also just cough up the 3500 because seeing how you already had a bad experience its not good to go through it again.

amy31308
by Ashlee on Jun. 20, 2013 at 6:37 PM
6 moms liked this
If you want that midwife then I'd say you should have to pay for it. You have insurance and coverage for maternity care. I guess I don't understand you saying what's the point of insurance. They aren't denying you maternity coverage. I know it's not the kind you want but you still have it avaliable. Applying for Medicaid to have things your way is abusing the system imo.

So my view on this is pay your midwife and doula for their services if it means that much to you. Honestly with insurance that's about what I'll be paying out of pocket anyways so I don't think 3500 is unreasonable or out of this world.

Sorry that your frustrated and that your insurance isn't covering what you want.
his88angel
by Bronze Member on Jun. 20, 2013 at 6:37 PM

I absolutley hate BCBS i think they are the worse insurance. We have medical mutal (i think) i love them i can call and i talk to a friendly person who is excited to answer my call and even jokes up with me. I hope you get everything worked out insurance are just agrovating.

Mommabearbergh
by on Jun. 20, 2013 at 6:55 PM
I think its more the fact they waited till the last minute. Which insurance companies are known for. Not telling you that your covered for a certain thing till sometimes the day before or the week of something.So you end up scrambling.
Quoting amy31308:

If you want that midwife then I'd say you should have to pay for it. You have insurance and coverage for maternity care. I guess I don't understand you saying what's the point of insurance. They aren't denying you maternity coverage. I know it's not the kind you want but you still have it avaliable. Applying for Medicaid to have things your way is abusing the system imo.

So my view on this is pay your midwife and doula for their services if it means that much to you. Honestly with insurance that's about what I'll be paying out of pocket anyways so I don't think 3500 is unreasonable or out of this world.

Sorry that your frustrated and that your insurance isn't covering what you want.

CafeMom Tickers
Devious103102
by Ruby Member on Jun. 20, 2013 at 6:57 PM

If you qualify for the medicaid go for it. 

amy31308
by Ashlee on Jun. 20, 2013 at 7:03 PM
But she said in the beginning they wouldn't cover anything and that's why she sent them info. So she knew it was a good possibility they wouldn't cover. That absolutely would be frustrating waiting that long to get a response though. Luckily, she still has a few more months to save and talk to her midwife about payment options if needed. I think if I was a midwife is rather let someone make payments than lose a patient all together.


Quoting Mommabearbergh:
I think its more the fact they waited till the last minute. Which insurance companies are known for. Not telling you that your covered for a certain thing till sometimes the day before or the week of something.So you end up scrambling.


Quoting amy31308:If you want that midwife then I'd say you should have to pay for it. You have insurance and coverage for maternity care. I guess I don't understand you saying what's the point of insurance. They aren't denying you maternity coverage. I know it's not the kind you want but you still have it avaliable. Applying for Medicaid to have things your way is abusing the system imo.

So my view on this is pay your midwife and doula for their services if it means that much to you. Honestly with insurance that's about what I'll be paying out of pocket anyways so I don't think 3500 is unreasonable or out of this world.

Sorry that your frustrated and that your insurance isn't covering what you want.
Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)