Wednesday, March 7, 2012

Insurance Rant!!

I hate insurance companies. They are inherently evil and their system of billing is so convoluted you never have any idea what you might end up paying. In FL, there is a state law that insurance plans which cover maternity care must cover midwife and birth center care also as an alternative to obstetricians and hospitals.

For this birth, I have been planning to use our local birth center and midwife practice. I've spent the last 8 weeks trying to figure out what I will actually pay in the end. My insurance plan also specifically states they cover birth center births in addition to FL law. The only birth center in the county though, is not considered in network. I was first assured that because there was no other facility and my insurance allowed births at birth centers I'd simply need to apply for gap coverage. It was a formality and once approved the center would be considered in network for me. Formality... WRONG!!!

A new policy my insurance company just put in to place means when reviewing gap coverage applications they look for any physician able to do the procedure in network. That means that although my insurance and FL law require them to cover birthing at a birth center, they've denied my request to have them cover my birth center birth on the grounds that other providers are available. When I ask which provider I'm told only of obstetricians and hospitals. "But don't I have coverage with a birth center?", I ask. "Yes you do," but when I ask where I'm only told names of hospitals. It's an illogical round about.

I was then told well you can stay at the center and just pay out of network prices. That seems expensive but do-able until you read the fine print. Out of Network they cover way less but that's not the big kicker. You have to magically figure out what amount they consider reasonable and customary and that's the number they will pay a portion of. Hoping this would all work out, I got the codes my midwife bills with and the amounts.

Now pregnancy is a weird thing with insurance anyways. The doctors don't bill every time you visit. They bill separately for labs, tests, and ultrasounds but other wise all visit charges and the delivery charge come at the end with one global charge. The of course you have the hospital sending out a ridiculous bill with a million more charges. Most OB's charge between $3k and $5k (then the hospital charges a ton more). My midwife practice charges $4,500 total for all prenatal appointments, post natal checkups, and the entire delivery of baby. There is no second hospital bill or anything.

So if you had to guess how much an insurance company would say is reasonable for all prenatal appointments, post natal checkups, and the entire delivery of baby what would it be?? This is everything no second bill for anesthesia, hospital room charges, nurses etc. I'm so flabbergasted right now I can't even think of a logical argument to make with them.

My insurance company believes if I go out of network the amount they will pay 45% of is $31.97. Yep you heard right. If it was that inexpensive to have a baby I wouldn't pay them thousands of dollars a year in premiums!!!!


  1. That's terrible, I'm so sorry you are dealing with this. I hope you are able to get the delivery you want in the end. Insurance companies are so crooked!

  2. I'm so sorry Miranda, I was talking to Leslie about the birthing center and I believe she was saying that she paid out of pocket for everything and didn't go through her insurance at all because it would be more expensive? I may be wrong, but I would maybe talk to her and Pam about it, since they both used the birthing center for their birth(s). I am sorry you are going through all this, insurance companies are ridiculous. I can't even tell you how many hours I have spent on the phone with them over coverage's. Hope you find a way to work it out!

  3. So sorry about all that, Miranda! I agree, I think insurance companies are such a scam...everybody jacks up the prices and then in the end we pay some random amount, it's always a mystery where all the money goes!