Sunday, July 10, 2011

Ha Ha! Triumph Over the Health Care Insurance System!

So, a while ago, Brian and I decided that we wanted to have this baby at home using a certified midwife. Rest assured, this was not a decision we made lightly. We have done tons and tons of research on this--books, films, articles, discussions with midwives, nurses and women who have given birth in hospitals. In fact, we made this decision before we ever made the decision to go off the pill!

Because we had researched this route, we knew it would not be easy to get it covered by insurance. Our first step: find an insurance company that covered midwives and home birth. Our midwife had recommended a couple of different insurance companies that she had worked with in the past. It just so happened that at this time, I started my new job and was signing up for my new health insurance options. Amazingly, one of the better insurance companies was offered (United Health, in case you were wondering)! I called, double checked that they covered midwives and got a list of midwives in their network. Cool.

So I called the in-network midwives. None, not one of them still did home birth. Well, poop. So we went back to the midwife we liked, and decided to go with her. She wouldn't be in network, but the insurance company would still cover 70%. Well, that was still pretty good. 70% of $5,000 (her fee) would still cover a lot, and probably still be cheaper than a hospital birth. We were resigned to that. Until we had our first midwife appointment.

She mentioned that many of her clients got something called a Gap Exception. If your insurance company doesn't have a provider that offers the services you need in network, they can cover an out of network provider 100% with the Gap Exception. Awesome! We could have our home birth midwife AND get 100% insurance covereage.

So, I called the insurance to find out how this works. I spent two days just figuring it out. Then I spent another day emailing back and forth with my midwife to get all the info that the insurance company will need. A Gap Exception isn't a form, a doctor or service provider needs to refer you. So I made sure I had ALL the information my doctor would need to do this as easily and pain free as possible.

Finally, I gave all the info to my doctor and they made the call. They talked with the insurance company for an hour. No go. Poop. Apparently (according the insurance company) there were midwives in our area that were in-network. What??? I had done this research and found NONE! So. I called these in-network midwives. They did not do home birth. Sigh. Back to the drawing board.

So I called the insurance company again (mind you, we were in the car now driving to Victorville for Pop Pop's funeral), talked to the people in charge and asked them "WTF?" (actually, I didn't. I was pretty calm and rational for the most part). I simply told them that yes, they did have midwives in network, however I want to have a home birth, which the midwives did not do. To which they stated, "Well, you can't have a Gap Exception just for personal preference of midwife." To which I stated, again, "Your midwives in network DO NOT DO HOME BIRTH. That is the birth option that my husband and I have chosen. We picked this VERY EXPENSIVE health insurance specifically because they supported midwives and home births." To which the insurance person said that they would put our information into the system and see what they could do. It could be up to a few weeks for the request to go through.

Oh, and this only works until the end of December. You will have to reapply in January (since baby is not due until February).

Anyway, to make a long story short (ha! Too late for that!) yesterday, we get a letter from the insurance company in the mail. Our Gap Exception has been granted! It took 3 weeks of wrangling with the insurance company, but it has been done! We still have to reapply in January, but if all goes to plan, we will have 100% health insurance coverage for our home birth! Triumph!

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