Insurance

Believe Midwifery Services, LLC has worked hard to obtain insurance reimbursement for our clients since it’s opening in 2007. However, their increased demands and decreased payment has meant we are extending far too much effort for minimal return and our clients are increasingly becoming frustrated with the process. Because not all clients are able to discern their frustration as that caused by their insurance company, rather than our practice, we need to pull ourselves out of the equation. We are midwives and our primary objective is to provide excellent healthcare.

We have established a relationship with SLB Billing and are thrilled to share that clients can now utilize their services for obtaining insurance reimbursement for a small fee. You are welcome to contact them via their website or after your first visit with our staff, with your permission, we can forward records from our office, which they will use to contact you directly. SLB is a midwifery billing company completely separate from our own midwifery practice, so all billing questions should be directed to their office. We are quite thrilled to be able to make the connection!

Believe Midwifery Services, LLC however, does not accept insurance payments from any third party payer. We expect payment when services are rendered, or as detailed in your maternity agreement, and encourage you to work with SLB Billing to gain reimbursement. If you are paying from an HSA account, we will provide an invoice following payment and any prescriptions you may need to cover expenses for renting our birthing spa, ordering your birth supplies, purchasing a breastpump, or renting the TENS unit.

Those employed at Wabash College on the Cigna plan, please read below.

Many insurance companies do cover the professional services provided by Penny Lane, Nurse Midwife; however, reimbursement rates are dropping significantly and additional clauses are being added to plans that exclude birth outside the hospital. While the vast majority of plans offered in-network exceptions just a year ago, many of those same plans will not even cover maternity care at the out-of-network rate today.

Please understand that insurance companies define global maternity care as 4-7 prenatal visits, attendance by the MD or CNM for one hour at the birth, and the mother’s six week postpartum visit. Payment for labor support, fetal monitoring, attendance by nursing staff at the birth, medications, suturing, newborn screenings, birth equipment, newborn assessment and on-going care including home visits is often part of the facility fee, which Believe Midwifery is unable to bill for because Indiana does not recognize the home as a birthing facility. (Send your complaints to the Insurance Commissioner to rectify this issue.)

For this reason, our $5,995 global fee is determined by some insurance companies to be higher than the standard usual and customary fee for the global maternity package. The usual and customary fee for many Anthem plans is as low as $2,200.

As an insurance holder seeking care, you are responsible for the co-insurance fee for all itemized services outside your global. One might assume 100% coverage means all their bills would be paid, but in reality, the insurance plan will pay only 100% of what they approve (which is inconsistent and exceptionally minimal). Quickly unpaid claims escalate and because we are only allowed to offer reduced fees for early payment, the insured client is then responsible for the exorbitant fees unpaid by their insurance company. Becoming a cash client is indeed the most cost effect option and certainly allows our staff to focus on clinical needs, rather than arguing with insurance companies.

Cigna Plan through Wabash College

While we require payment in full prior to services, Wabash College has sought an In-Network exception with Cigna for their employees to be seen by Penny Lane MSN, CNM for maternity services. They agree that care provided by our practice is both of high quality and is cost-effective, and therefore, want to extend this benefit to their staff. This does not include well woman care, although if an employee were so inclined, I am sure the human resource director would make this exception as well.

Achieving this success was fairly uncomplicated. One of our proactive mothers spoke with her human resource department, respectfully shared her desire for the midwifery-model-of-care and homebirth services and why this would benefit her employer. The Human Resources director agreed and within only a few days the contract between Wabash College and Cigna was up-dated to include this in-network exception. We encourage you to do the same with your own employer.

16% of health insurance claims are denied on the first try

A report by the Government Accountability Office suggests that UP TO 50 PERCENT of patient appeals prompt insurance companies to reverse their denials. Once you rule out clerical error on your claim, start the appeal process by writing a letter to your insurer that states why you’re challenging the decision. Go here for more on filing an appeal, or read below for form letters that might be useful to your case.

Academic OBGYN offers an argument in effort to persuade insurance companies to cover the services provided by lactation consultants.

If your insurance company states they do not cover nurse-midwives or homebirth, this is typically less to do with your insurance company and more to do with the contract signed by your employer’s Human Resource Department. We have had great success with clients approaching their employer and encouraging them to address these barriers to midwifery care. This letter may be of help to you if CNMs are not covered, and this letter can help you appeal a denied in-network exception. I would encourage you to read both, as each can be adjusted to suit your needs. Clients have also argued denials based on the decision that other providers in their area do not provide homebirth services and for that reason the requested exceptions were approved. Most recently however, we have had denied claims or in-network exceptions based solely on homebirth not being “medically necessary.”

Please forward your letters to the movers and shakers in our state. Help other families benefit from your work.

Send copies of your letter to your legislative leaders, the Indiana Insurance Commissioner (see below), the Attorney General (see below), your employers Human Resource Department and to your midwives. Finally, the Health Finance Commission is the General Assembly that has reviewed midwifery bills for the last several years. It would be very beneficial if they could be made aware of issues facing homebirth families.

The Indiana Department of Insurance office is located at 311 West Washington Street, Suite 300, Indianapolis, IN, 46204. The main telephone number is (317) 232-2385.

Indiana Attorney General’s Office is located at the 
Indiana Government Center South, at 
302 W. Washington St. on the 5th Floor. 
Indianapolis, IN 46204
 Phone: 317.232.6201 
Fax: 317.232.7979
E-mail: Constituent@atg.in.gov

The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.

Journal of Nurse-Midwifery. 44(1):30-5, 1999 Jan-Feb.

Indiana Medicaid

Although Believe Midwifery Services was an active participant in each of the Indiana Medicaid plans for a few years, we have terminated such contracts and have no desire to return.

If you do qualify for the Medicaid program however, it will most certainly cover your ultrasound and laboratory testing, and in the event you would choose to or otherwise risk out of our practice, Medicaid would cover those expenses outside our care.

ObamaCare

Keeping up-to-date with today’s quickly changing healthcare plans and billing procedures is an expensive and very complex feat. Penny invested several thousand dollars in training and consultation fees while attempting to collect from various insurance plans. As a cash only practice, we no longer invest in continued education in this regard. This is an on-going discussion however, within our closed family Facebook group.

Food for Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has." Sir William Osler

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Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy. Aviva Romm

Food for Thought

Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Snyderman and Weil

Food for Thought #1

They say that time changes things. But you actually have to change them yourselves. Andy Warhol

Food for Thought

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole." Rixa Freeze PhD

Food for Thought

Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective. Dr. Penny Lane, nurse-midwife

Food for Thought

When the debate is lost, slander becomes the tool of the loser. Socrates

Food for Thought

To accomplish great things, we must not only act but also dream; not only plan, but also believe. Anatole France

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"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'" Grimes (1986)

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American physicians are rewarded for doing things to patients, not for keeping them well. Grimes, 1986

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The false idol of technology. "Having a widget screwed into one's scalp has become an American birthright." Grimes, 1986

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"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days." Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it." Goer & Romaro, 2012, p 35

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Food for Thought

An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't. Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

When you have exhausted all possibilities, remember this: you haven't. THOMAS EDISON

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer

Food for Thought #2

Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast.

Psalm 22:9