Tips for Navigating Co-Managed Prenatal Healthcare

For both of my pregnancies I have opted for co-managed healthcare between a non-hospital birth center and a clinic/hospital that my insurance contracts with. This definitely isn’t the easiest option, but I couldn’t imagine doing it any other way. Co-managed healthcare has allowed me to have immense support from my midwife team while balancing the cost of birth.

I’m sure you’re wondering what led to the co-managed care conundrum. Well, my insurance (both what I had with Jemma and what I have now) is not contracted with the birth center. Therefore, they do not pay anything towards my prenatal, labor, or postpartum care. My rant on this is a completely different post as the birth center cost is significantly less than what is offered through a clinic/hospital, but, because it isn’t “traditional” it isn’t considered an in-network or even an out-of-network option. Not to mention that statistically it is safer for a low risk mama and baby to birth outside of a hospital. It is my hope and prayer that more insurance companies choose to cover alternative options for their members in the future. To lessen my out-of-pocket cost I have decided to pursue co-managed care with a clinic that my insurance does work with. This means all my prenatal appointments are at the birth center, but when it comes to tests like bloodwork and ultrasounds I go to the clinic. This allows test expenses to be billed to my insurance. Since the clinic isn’t my primary care, they usually aren’t too excited about helping me, which is totally lame and frustrating. But, I guess that’s how the cookie factory crumbles in the healthcare world.

So, for those that might consider co-managed care, or are just curious here’s a few tips I’ve gathered …

Double-check everything! This means asking the same question, multiple times in a few different ways to a few different people.  

Then, document it! When someone tells you something will be covered, a procedure detail, or anything that might be important – jot it down. I haven’t done a great job at this as I’m usually making calls on the go or with Jemma close at hand; I need to get better. Documentation helps build your case if something ever comes up. If you can reference a name, date, and statement of what is said they’ll know that you mean business.

If you speak to someone helpful, ask for their name and contact information. At the birth center I get such one on one attention (I have my midwives cell numbers and email addresses!) I forget what it is like to be routed through a call center/receptionist to get a question answered. When I find someone helpful, or at least someone without an attitude, I’ll ask if I can have their name and direct phone number in case I have additional/follow-up questions.

Confirm the price. Even if you are sure something is going to be covered, it always brings some peace of mind (or at least a level of preparedness) to know how much a test or procedure will cost in the event you do receive a bill.

Be kind. Often times, you’ll be speaking with the frontline. They aren’t the ones making things difficult. Be thankful for their efforts and don’t hesitate to sweetly say something like, “It seems like I might need to talk to someone else to better clarify, can you transfer me to your supervisor or another department?”

It’s ok to be different. You will hear 100 times, “This is a unique situation” and “I’ve never run into this before”. That’s ok! You’re different, not crazy, don’t let those pregnancy hormones ruffle your feathers! I’ve let that happen one too many times! Just because everyone and their mother receives healthcare one way, doesn’t mean it is the best way for you and your baby.

Most of these tips are geared towards how to navigate the insurance/clinic/hospital side of things. That’s because the midwife/birth center is not difficult at all! Both my midwives and the admin/billing gal at the birth center have bent over backwards to help make my care as affordable as possible. They’ve sent multiple faxes (because somehow the clinic loses faxes that come from someplace different), made phone calls, returned phone calls/emails, called insurance and the clinic on my behalf, and offered me emotional support … all within the same day I contacted them. They are pretty fabulous :)