1. Speak with different midwives in the area. All the midwives I spoke to seemed to offer different types of advice for getting insurance coverage and were extremely helpful and hopeful. Ask your midwife for specific information like their license number, EIN and NPI number, and even the CPT code. These are all helpful to have on hand and eventually necessary when finally getting through to your insurance company.
2. Call the member services 800 number on your insurance card and explore exactly what your benefits are.
3. Get transferred to the medical management department and explain that you are in need of pre-authorization or pre-certification for midwife services.
sidenote: It is my understanding that all midwifery care is considered out-of-network. In other words, no midwives operate as in-network providers. This does not, however, mean that they won’t cover it. It simply means that they need to agree to cover it before they are billed for such services in order to guarantee payment.
4. Get connected with a nurse case manager. This person is your best friend. Be nice, but be painfully persistant. This person is the one that actually applies for the pre-certification. You want this person on your team. This person will also be in close contact with your midwife, as they need information from both ends to make it all happen.
5. Your nurse case manager will initially try to explain that you need to stick to in-network providers. They will do their own search of in-network midwifery services and tell you to start with that list of providers first. My case manager prompted me to search through what she described as “2 pages of in-network providers”. When I ran the same search, there certainly were two pages. All the providers had the same address and phone number, however. When I called, they explained that they worked out of a hospital in downtown Los Angeles and did not offer home birth services. For those that are familiar with the LA area, you know that trying to get to downtown LA, depending on the time of day, could be insane. Especially for a laboring woman. This prompts the next step…
6. Explain why their list of in-network providers will not work. I explained that not only do they not offer the care I’m looking for, but that I’d also run the risk of delivering on the side of the road as navigating through LA traffic while in active labor wasn’t the safest plan. They will then proceed with obtaining what they call “in for out” coverage or in-network benefits for out-of-network providers.
7. Call daily for updates.
8. Obtain your pre-authorization number.
Wow, I can’t believe it can all be summed up in 8 steps. The entire process took about a week. Here are some additional tips I had found in my research:
-Keep notes of dates, times, people, and departments that you speak with.
-If you feel like you are coming up against a bump in the road, explain that you are trying to save them money. If the person you are talking to doesn’t seem thankful for the fact that a home birth is much more affordable for the insurance company than a hospital birth, then ask to speak to their supervisor. If the supervisor is a carbon copy of the idiot you were just speaking with, ask to speak to their manager. Eventually you will speak with someone who appreciates the save in cost.
-If they deny the pre-authorization, ask for details regarding the appeal process. I fortunately know nothing about this process other than it exists and others have successfully appealed, so if you are in this position, do not give up!
…And now, some inspirational birthing images: