Calling Your Insurance Company

You still have some questions. No big deal.

What comes next?

Then call your insurance

Your midwife’s been at this for a while. So have we. But sometimes you’ve gotta get in there yourself. 

And we’ve got your back.

You need information. But what, specifically?  Let’s walk through it. 

Have a pad handy – you’ll want it for the phone call: get a name when you start the call and a reference number at the end.

First, Start with the basics: 

Insurance company is a no-brainer – United Healthcare, or HIP, or Empire Blue Cross Blue Shield, etc. It’s the main name on your Insurance Card

The Plan Name is less obvious. It’s your benefit level, with a name like Choice Plus, or the Bronze or Platinum Plan.

Your Policy Type is probably an EPO (Exclusive Provider Organization), an HMO (Health Maintenance Organization), or a PPO (Preferred Provider Organization).

Do you have an Individual or a Family Plan?

Is it fully funded, self-funded, or federally funded?

Look at you go! 
        This isn’t so bad, right? 

Then let’s dig a little deeper.

Ultimately, we’re looking for your plan’s maternity benefits as they apply to out-of-network midwives and homebirth.

What are your in-network benefits? Your out-of-network benefits?

This is a big one. Start with in-network bens, then ask about out-of network. Make sure it makes sense to you before moving on.

You want to know your deductibles and coinsurance. Ask about copays. What are your out-of-pocket benefits, and out-of-pocket maximums. 

IF YOU’RE PLANNING ON A HOMEBIRTH

Ask if Homebirths are specifically included or excluded, or if they’re mentioned at all?
If the rep cannot answer you, ask them to consult their supervisor.

Are there homebirth providers in your network? 
Assume the answer is no – your own midwife is out of network unless she explicitly tells you otherwise. 

Find out if an in-network exception is allowed. It’s also called an ‘in-for-out’, a ‘gap request’, or a ‘one-time waiver’.

If allowed, ask the exact process for obtaining one.

  KEY QUESTION

What is my plan’s allowed amount (or ‘UCR’) for:  procedure code 59400, with a diagnosis code V22.0 (1st baby) or V22.1 (2nd+ baby)?

We define code 59400 as ‘global maternity care’; it includes prenatal visits, delivery, and postpartum care, though it is not specific to homebirth.

REMEMBER: 

Your understanding is critical.
Do not be afraid to ask the rep to slow down or to repeat him/herself.
If your rep does not know, ask to speak to someone who does.
Get a reference number at the end of your call.

Download and print the CLEARBILL worksheet; make your life easier.