GREAT NEWS: Today I received my approval for the Oregon Health Plan in the mail, meaning that our baby's birth will be paid for by the state -- and we will have no copays!
Aetna was really giving us the run around and it was really frustrating. First, when I contacted them to inquire about home birth benefits, they said that no home births were covered, and that they would only cover a "birth center" if it were in a hospital setting.
At some point, we had a birth center in town contact them for pre-authorization, and Aetna told THEM that they would cover their services at 80% - the out-of-network rate. So we thought that there was a chance that a midwife would be covered.
Vivante Midwifery -- our midwives -- contacted Aetna only to learn that they could not give pre-authorization and that they would only consider whether or not they would cover the home birth after you file a claim, so the out-of-pocket to us might have been about $800 or it might have been about $3,000, if the insurance wouldn't cover it. And they wouldn't tell whether or not they would agree to cover it -- which is ridiculous because the home birth would cost about a third of what a birth would cost in the hospital due to the hospital facility fee.
That's another thing -- while I am ranting about the hospital/insurance company BS: the hospital leads you to believe the cost is going to be less than it really is. They send you information about the professional services fees with a note about how other fees might apply without bothering to mention the huge other fee - the facility fee - that WILL apply and which is about $5,000. OHSU was really not up front about its costs. I specifically contacted the billing department to find out how much it would cost me to have my baby there and they quoted me the global fee they charge for the professional services, and did not mention the hospital fee, following up with the letter mentioned above that didn't mention the hospital fee either. I only learned about the facility fee from my midwife, who works for OHSU and privately with Vivante Midwifery.
So, anyhow, because I am student with little income, the Oregon Health Plan is going to cover these expenses and I don't have to worry about fooling around with Aetna. Now I just wish that I hadn't already paid the $600 to extend my private health insurance coverage through the summer, but I had to play it safe because I wasn't sure whether or not I would be approved for OHP.
This is another reason why Oregon is so awesome: the social services are excellent. Some people might not feel right about receiving social services, but I am all about it right about now - and don't see any reason why I shouldn't take advantage of it while I am incurring all of this law school debt.
I find it really interesting that OHP covers home birth and that Aetna Student Health won't offer to cover it upfront.
After all the stress over the insurance and costs, it is nice to know that it will all be paid for -- and we don't have to worry about it any more.
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5 comments:
Great news! Oregon has some very wonderful hidden advantages!
Oregon, Oh, Oregon...Oh Boy We Love That State....yippee....Baby Ling is Free......
Just goes to show the incredibly frustrating relationship between the skewed interests of insurance companies and the morally defunct status of our medical community...how does cheaper and better for the baby/mama not become THE BEST CHOICE if parents are willing???
You gotta see The business of being born if you have some free time. And the AMA is now trying to ban midwives nation-wide unless they are supervised by physicians! Arrggghhh.....
Nevertheless, I'm glad to hear things have worked out! The reasons to move to Oregon are only mounting...
First, it's not free. There is an opportunity cost to the issue. Also, the insurance company does a cost benefit analysis. Though many may think midwives do a better job in your case, you must think from a macro point of view. If it was really safer across the board and cheaper, insurance companies would allow it. It's that simple, however, on a specific level, the midwife may have more experience and skill and thus pushing the cost benefit analysis to support this being the best option. Moving to Oregon for the OHP plan should not be given that much weight. All these services come at a cost. I guess if you come to Oregon and don't plan on working much then you win.
In response to Robert: midwives do not claim home births are "safer" than hospital births, but just as safe. And, yes, they are cheaper because you don't have to pay the hospital facility fee. Why insurance companies will not cover home births can only be explained by hospitals and insurance companies being in cahoots. That is nothing new. And, yes, the services come at a cost to taxpayers - a group to which I belong.
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