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Health insurance hijinks

by Karen on June 16, 2010

Remember a few days ago when I said I’d like to have a midwife, but they’re not covered by my insurance? It turns out I was wrong. Well, EYE wasn’t wrong so much as my insurance company was wrong. Amazing, right?

Yesterday, I set about the task of finding a new doctor in Fort Wayne so I could make my next appointment with them. When I first started looking for a doctor (or midwife), I started my search with my insurance company’s directory of in-network physicians. For an in-network physician, my out-of-pocket costs will be $2,000. For someone outside the network, it would be $4,500. Big difference.

To be honest, I didn’t try very hard to find a midwife. I ran a search for certified nurse midwives (a specialty that was included in the drop-down menu for my insurance company’s directory search). When it said there were zero in-network midwives in the entire state of Indiana, I was skeptical. But I chose an OB, and moved on. I decided I’d give the OB a shot, and if I was unhappy with her, I’d explore switching to a midwife once we were settled.

When I started my search for midwives in Fort Wayne, I found a practice that interested me. Their website listed my insurance provider as one of the plans they accept, so I called to confirm. They verified that yes, they accept my insurance. I asked if it was possible that the midwives would accept different insurance plans from the obstetricians, and she said no. All physicians, midwives, and nurse practitioners in their practice accept the same insurance plans. Great!

I assumed that there was a glitch in the providers directory on the website, so I called to verify that the midwife I wanted was in-network.

As a brief aside, can I just say how much I hate talking to a recording? It’s bad enough when I have to choose my options by hitting a number on the keypad, but at least I don’t have to repeat myself a million times. My insurance company’s recorded message is the WORST. Every time I call them, the menu takes me in so many circles that I’m dizzy and frustrated by the time I talk to an actual person. I’ve actually started repeating, “Representative” over and over again just to avoid the mess.

When I finally got to talk to a real live human, I explained my situation. He responded flatly, “We don’t cover home births.”

Me: “Um. That’s fine. I don’t want a home birth. The midwife I want delivers at an in-network hospital.”

Him: “We don’t cover midwives, because they’re not licensed to deliver babies legally in Indiana.”

Um. WHAT. At that point, it became clear to me that the guy had absolutely no idea what a midwife is. So I asked as politely as I could if I could speak with someone who does, in fact, know what a midwife is. He was pretty annoyed by the request, but he transferred me.

I didn’t have much luck with the next representative. He ran a search in the database, probably using the same search tool I had used, and told me flatly that the provider I want isn’t in network, because there are no midwives in network. I told him what the insurance specialist at the midwife practice had told me about all of their physicians accepting my insurance, and he told me she was wrong. Okay.

Frustrated, I hung up and called the midwife practice again. I told the woman what happened, and she was confused. Apparently, they bill my insurance company frequently. It’s a major one, and a lot of their patients are on it. She even asked about my specific plan, and said that yep, a ton of their patients are on my very same plan. WTF?!

At this point, I was irritated and determined to straighten it out. I called the insurance company again, dealt with the insufferable menu options, and finally got to a person again. Thankfully, this representative was not a total idiot.

He explained the problem, which actually makes complete sense. Midwives don’t come up in the physician search, because they’re not physicians. They practice and bill under a physician. In that case, I don’t understand why “Certified Nurse Midwife” is a search option on their website, but whatever. He explained that I needed to find out my midwife’s attending physician, and search for him or her. If the physician is covered, the midwife is, too. Duh. I’m glad that SOMEONE at my insurance company understands how it works, because the previous two people to whom I spoke had NO IDEA.

The moral of the story? If you’re hoping to have your birth attended by a midwife, search for your midwife’s attending physician. And don’t expect your insurance company to make things easy on you.

Photo by mkmabus

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