Birth Billing Specialist
Helping Midwives get paid!
Recent News
Read on for news in the insurance billing world....
Insurance Company News
Ruling on the Cigna Anthem merger has been postponed until January 2017. Cigna is stating this week that Anthem has breached it's agreement. I will not be sad if Cigna finds a way to back out entirely. They are two major insurers that are planning to continue offering plans on the Federal Health Exchange so their merger will be most keenly felt in that marketplace.
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The Federal Health Exchanges are changing every year as companies come and go. Aetnam Humana and United are the big companies that have left or are leaving the Health Exchange market. United is pulling out of at least 28 States in 2017. Humana is also pulling out of Alabama, Kansas, Wisconsin and Virginia.
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Policy prices are expected to increase on the Exchange with these changes.
NH Medicaid Managed Care Privitization
There are two managed care companies left managing NH Medicaid members, Well Sense and NH Healthy Families.
Well Sense has been a pleasure to work with. They require a pregnancy notification at the beginning of care or upon the Well Sense effective date. There is also a 24 hour birth notification requirement. A pre-auth request can be filed for providers that are in-network with NH Medicaid but out-of-network with Well Sense. Having at least one prenatal visit prior to the Well Sense effective date and waiting to sign up with Well Sense until the 2nd trimester starts, or having managed a prior pregnancy with the client have both resulted in approvals.
NH Healthy Families also requires a pregnancy notification and all births must be pre-authed about 6 weeks prior to the due date. They also have a continuity of care exception for providers out-of-network with NH Healthy Families if in-network with NH Medicaid, but their pre-auth requires submission of chart notes and home births are restricted to 38-41 weeks gestation. They still require the 24 hour birth notification but it must be in the form of chart notes such as newborn exam and newborn summary.
Vermont Medicaid Expansion & Affordable Care Act
Vermont Medicaid has begun to require malpractice insurance for all Medicaid providers and the approval process for new midwives is taking well over 6 months. One provider is at 10 months and still waiting! They likely don't have the personnel to process all the new paperwork they are requiring. They do expect to get it down to a 6 month process in time.
The Federal Health Exchange policies in Vermont will be underwritten by MVP Health Care and BC/BS of Vermont. Both companies have rigid internal policies that don't make it easy for midwives, but the midwives of Vermont are persistent and educating them about home birth and making good progress there.