Back in March, when I was still daydreaming of giving birth at home, but we were looking at other options, I called my insurance, a company whose name starts with a neutered bull and ends in an American car, to inquire of their policy regarding home births. And, yes, the answer was a definite yes, they cover home births. Relieved, I put that beast on hold for the time being, while we took time for some soul-searching on our own home vs. hospital conundrum.
Fast forward some 4 months ahead: we made our decision and love our midwife. Coming up is another ultrasound exam and I thought I should call the insurance to see if I need some such silly thing as a referral. I’m part of a the Freedom Plan so, no, I don’t need a referral. Three ultrasounds are covered. Awesome. But, my midwife isn’t. Or, she will be, but at 70% of the “reasonable and customary charge” and only after I pay $2,000 “deductible.” Wha’!!! First off, and I don’t really want to get into it but here it is, this “reasonable and customary charge” is a black hole. There is no way of knowing that what you pay your doctor will be considered reasonable and customary by your insurance and, get this, it most likely IS NOT. Especially if you live in New York where things cost more.
If anyone has ever dealt with insurance deductibles (and this is the first year I am ’cause I got hooked on my out-of-network doctor), you pay your medical bill and then you submit the paperwork to insurance. So, say you paid $1,300 (with your credit card, of course) for 3 months of out-of-network exams. You submit your itemized bills thinking how you only have $700 more to pay before they’ll pick up the 70% and you can breathe a little easier. Eventually, you get a letter back with all those itemized prices that tells you how much of them will go towards this deductible. It’s something like $800 total. You see, at least 500 of those dollars were above the insurance-deemed reasonable amount. You get mad the first time, and you may even call and give them a piece of your mind. But then, you learn and start to expect it and I think they bank on that. You complain once and then you just roll over and take what’s dished out to you.
To get back to my home-birth midwife, she’s not in network. The insurance lady gives me her deductible-reasonable-customary spiel and is ready to get off the phone. Excuse me, I say, but I thought you covered home births. We do, she says. Well, is there anything else I can do to get this completely covered? Only then does she give me something I can work with. I need to call three different nurse-midwives that are in the insurance network and only after they can’t accommodate me, I can call the Medical Management office and ask for an “in-network exception.”
The very next day, I get on the phone again. I know my way around the automated system a little better today: Pressing 1 for English, then 1 again since I’m a member and I need to talk to a representative, 5 because I want to talk about benefits, 5 again because I don’t know what else to press here. I then enter my ID number including the *, I listen to some recorded message about who I am then finally I get to press 0 to speak to a representative and listen to some elevator music while waiting. Ten minutes into this, I’ finally conected to “Cathy.”
- Hi Cathy, I’m pregnant, baby’s due late November. I am planning a home birth but it turns out my midwife isn’t covered. Someone yesterday told me I need to call three nurse-midwives in the plan….
- Oh, you are trying to get in-network exception.
- Yes. - I want to kiss her over the phone.
- Ok, I’ll give you the names of nurse-midwives to call. Ready? The first one is Carol………..
- Hello, hello… hellooo - my phone got disconnected.
Man. I have to try again. Pressing 1 for English, 1 again since I’m a member, 5 for benefits, 5 again for the lack of better option, entering my number including the *, listening to recorded message, finally pressing 0 to speak to a representative for more elevator music while waiting. Twelve minutes and I get “Trish.”
- Hi Trish, I’m pregnant, baby’s due late November. I am planning a home birth but it turns out my midwife isn’t covered. I just got disconnected with someone else…. She said I can request in-network exception.
- You know it’s really hard to get in-network exception. They are almost never given.
- I understand. I think what I need from you are names of nurse-midwives I can call.
- It’s just really hard to get an in-network exception. You have to make sure that no one around you within 20 mile radius or 20 minutes of travel isn’t providing a service you need.
- Yes, I understand. The rep earlier on the phone mentioned I needed to call three nurse-midwives and see if they would do a home birth. So, if you would, please let me have some names to call.
- Ok, but I just wanted to let you know that it’s hard…
- The names, please.
What was that all about? Did she just enjoy the pleasure of torturing me with the impossibility of the coveted in-network exception? She finally let me have the names and numbers of three midwives, two of which were in the same practice. And no, none of them do home births. One of the receptionists even chuckled in disbelief when I asked her. I chuckled to myself at the same time. Goody. It looks like the “providers” insurance supplied me aren’t really offering the service I need.
Dial again. One, 1 again, 5, 5 again, ID number including the *, pause for recorded message, 0, elevator music while waiting. Fifteen minutes and I get “Rhonda.”
- Hi, Rhonda. I need to speak with Medical Management Department about in-network exceptions.
- Right away, hon.
Thirteen minutes of elevator music. Quick talk to “Sandy”, ten more minutes of being on hold:
- Thanks for waiting. This is now being processed, we’ll let you know in two days. Keep your reference number handy.
[Oh, Canada....]
TO BE CONTINUED
