HOW MUCH IS COVERED?
The world of insurance is a world of gray areas. They can use several different methodologies to determine their pricing (Medicare Pay Rates versus UCR, for example). The fee your midwife charges is not necessarily the amount your insurance allows – they can choose their own rates. Add to this the fact that insurance companies resist sharing their rates for any given service and you begin to see the enormous haze that surrounds insurance billing.
Amazingly, they can also withhold information from you on a phone call. You may need to request an address where you can mail your request in writing in order to get this information.
Be sure to store a copy of this and anything you send to insurance for future reference.
If your plan refuses to share information on the plan’s allowed amount for the procedure code, you can look up the average rate in your geographic area as a point of reference at Fair Health (fairhealth.org). This amount can also be used for appeals.
You’ve got the info. Now, what’s it all mean?
While you’ve got them on the phone, you may as well ask.
Say something to the effect of:
“What would my costs be if I used my out-of-network benefits to cover my midwife’s fee?”
This will, hopefully, result in a base figure of some sort. This number is not set in stone; we’ve been busy attempting to circumvent the rules set in place to target and deny the use of homebirths and home birth midwives. Do not let this frighten you!
Our experience tells us that with an authorization and some fight, together, we can get your insurance to pay using the full rate billed and subtracting from that only your in-network deductible and coinsurance.
It may take a few rounds but it is usually worth the effort.
Now, get up and go do something nice for yourself. (You’ve earned it)
And store this info somewhere you’ll safe;
the only thing worse than making this call is making it twice