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Florida law mandates that insurance covers homebirth

Found this blog where another woman uses Florida law to get her insurance to cover her homebirth.

Here is Florida Statute Number 627.6574, but it’s section 7 that spells it out very clearly.  I’ve bolded it for your reading pleasure….

1) Any group, blanket, or franchise policy of health insurance that provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30-383.335.
(2) Any group, blanket, or franchise policy of health insurance that provides maternity and newborn coverage may not limit coverage for the length of a maternity and newborn stay in a hospital or for followup care outside of a hospital to any time period that is less than that determined to be medically necessary, in accordance with prevailing medical standards and consistent with guidelines for perinatal care of the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists, by the treating obstetrical care provider or the pediatric care provider.
(3) This section does not affect any agreement between an insurer and a hospital or other health care provider with respect to reimbursement for health care services provided, rate negotiations with providers, or capitation of providers, and this section does not prohibit appropriate utilization review or case management by an insurer.
(4) Any group, blanket, or franchise policy of health insurance that provides coverage, benefits, or services for maternity or newborn care must provide coverage for postdelivery care for a mother and her newborn infant. The postdelivery care must include a postpartum assessment and newborn assessment and may be provided at the hospital, at the attending physician’s office, at an outpatient maternity center, or in the home by a qualified licensed health care professional trained in mother and baby care. The services must include physical assessment of the newborn and mother, and the performance of any medically necessary clinical tests and immunizations in keeping with prevailing medical standards.
(5) An insurer subject to subsection (1) shall communicate active case questions and concerns regarding postdelivery care directly to the treating physician or hospital in written form, in addition to other forms of communication. Such insurers shall also use a process that includes a written protocol for utilization review and quality assurance.
(6) An insurer subject to subsection (1) may not:
(a) Deny to a mother or her newborn infant eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the policy for the purpose of avoiding the requirements of this section.
(b) Provide monetary payments or rebates to a mother to encourage the mother to accept less than the minimum protections available under this section.
(c) Penalize or otherwise reduce or limit the reimbursement of an attending provider solely because the attending provider provided care to an individual participant or beneficiary in accordance with this section.
(d) Provide incentives, monetary or otherwise, to an attending provider solely to induce the provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
(e) Subject to paragraph (7)(c), restrict benefits for any portion of a period within a hospital length of stay required under subsection (2) in a manner that is less favorable than the benefits provided for any preceding portion of such stay.
(7)(a) This section does not require a mother who is a participant or beneficiary to:
1. Give birth in a hospital.
2. Stay in the hospital for a fixed period of time following the birth of her infant.
(b) This section does not apply with respect to any health insurance coverage that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant.
(c) This section does not prevent a policy from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn infant, except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsection (2) may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.

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11 comments to Florida law mandates that insurance covers homebirth

  • We’ll see how it goes with the actual “getting paid back part”… I’ve already paid my midwife her full $4,000 fee in cash because of how late in the game we found out about the filing policy. So now it will just be a waiting game as to if/when we get paid back.

    What women need to know is this: If you carry insurance that is based out of the state of Florida (like mine for example, is based in Tennessee, and specifically excludes homebirth in the policy), if the claim is filed in Florida, as BCBS requires because this is where the “services will be rendered”, the claim must be processed under FL statutes regardless of what the policy covers/excludes.

    So…I’ll be sure to keep you posted after the baby comes. As it stands I’ll probably only get about $1000 back after my super-high deductible is met because the policy only covers 80% of maternity care.

    • Hi Angela…can you give me a law or precedent where you received this information?

      “If you carry insurance that is based out of the state of Florida if the claim is filed in Florida, as BCBS requires because this is where the “services will be rendered”, the claim must be processed under FL statutes regardless of what the policy covers/excludes.” We’re in Florida and having the baby here and our insurance says they follow Illinois statutes where they are based.

      Thanks so much!

      John

  • Oh, and I forgot to mention. BCBS-TN will gladly pay for a repeat cesarean. But not a low cost home birth. Isn’t that kind? I’m glad I don’t live in TN where isn’t a law that mandates coverage for home births…the women there are completely screwed if the have BCBS-TN.

  • Rebecca Ferguson

    I also have BCBS… my husband works for the VA hospital, so it is a “Federal Employee Program.” When I contacted them to find out about paying for my midwife, I was (very rudely) told by BCBS that since they are a federally contracted, they don’t have to follow any state statues or laws. However I just realized that our statements do come from “BCBS of Florida.” Any suggestions? My husband said he found some law that Congress passed that did indicate that federal employee health benefit packages are exempt from state laws, so that all federal employees in all states have the same benefits.

  • Sandy

    I have been recently working on a project which includes investigation in this service. I working with a federal government entity as well. I would think Tricare is the ultimate government plan that would be exempt from following state law. However, a little known secret, Tricare is required and does provide this option for obstetric patients. There are cost share and network provider restrictions but freestanding birth centers and home birth are included in the insurance. Dig around!

  • Gab

    Rebecca You can try thehollywood birth center in hollywood florida! They are the ONLY BC around in PBC florida . You may want to try private midwifves in your area . or even checking if you obtain a HICFA Form will you get reimbursed for any or all pre ,delivery and postnatal care. Look around or switch your policy you always have that right as well!

  • Delia

    Hi, Angela

    I am wondering how everything turned out for your home birth. Did your insurance cover it? We are trying to get pregnant and I want a home birth. I live in FL but my BCBS is out of MN and their coverage does not include home births/midwives. I really hope that this law can apply to me!

  • Aurora J. Stein

    Has anyone had any luck getting BCBS florida to pay for there home birth or know of a lawyer who understands the issue? Any help would be great.

    • Jen Kamel

      Hi Aurora,

      I shared your question here hoping to get you some good answers.

      Best,

      Jen

      • Aurora J. Stein

        Thank you, sorry I did not see your post earlier. We were told recently that they would cover all but 1000.00, we are very excited. But the baby is still not do until sep. So we will see what actually happens when it come time to bill.

  • Jennifer

    Bcbs-Fl will cover it, but only at the ‘reasonable and customary rate’. That’s right about $2000 according to them. NOT! There is no place in this country that cheap! I argued and repealed as much as I could about this. I gave them quotes from all over and every source of evidence i could get my hands on! They budged a total of $28. Yup! So, just because they say they will ‘cover it’, does NOT mean they will cover ALL of it. Just what THEY deem ‘reasonable and customary’ which is always grossly off base. They can make up whatever number they want, and you are stuck with it. Trust me. I went down this road three times in the last 5 years… :( It’s a disgusting practice…

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