Insurance reimbursement for childbirth education

With third-party reimbursement for childbirth education, one of the biggest barriers that exists in policy discussions is that not all stakeholders, including the educators themselves, understand what the current system is. The system is intricate and always changing, but on the surface, it boils down to three things: What is covered, who can render services, and how much are they paid.

Part of our existing insurance system is controlled by the federal government. A good example of this would be how the Affordable Care Act mandated that breast pumps and breast-feeding support was a covered benefit. Otherwise, most healthcare regulation decisions are made on the state level. This is where childbirth education falls right now: the coverage varies from state to state, and can change as new statutes are passed.

In Minnesota, childbirth education is considered a mandatory covered service by the Department of Human Services for residents who have coverage through Medical Assistance programs. Strangely, newborn care education is not considered essential, so as a standalone class it is not a covered service, but birth classes that include this information can be billed to insurance. Residents who are on Medical Assistance are either enrolled directly through the state’s Medical Assistance or MinnesotaCare coverage. Some of the plans are managed though the state itself, but most are have PMAPs (Minnesota Prepaid Medical Assistance Project plans) that are administered through Managed Care Organizations.

So then, in Minnesota, not all employer-based insurance plans or plans purchased by individuals have the same coverage parameters. So while some do reimburse providers for in-person group classes, other health plans consider access to online information or sending pregnant patients a book as an acceptable way to deliver childbirth “education”.

Most state’s health departments then decide who can provide services– what kind of credentials they need to have and if they have to bill under a supervising provider. Again, in Minnesota, I have to operate under a “supervising provider” as an LCCE. It usually doesn’t take much digging, but each state is different, so what applies here may be different, but states are currently in charge of the “Who.”

As for the how much…that gets really complicated. Reimbursement rates for Medical Assistance services are set at the state level, and many of the rates haven’t been adjusted for inflation in 10-20 years. Employer-based plans set their own reimbursement rates, and those rates can vary even within the same insurer as determined by what the employer has negotiated. For example, you could have Blue Cross Blue Shield insurance and the contracts would say that if the provider bills the insurer for a procedure at $150 and the contractual obligation would be to only reimburse $110 of that money; Somebody else with a Blue Cross Blue Shield insurance plan with a different employer might have that same service reimbursed at $97 when it was billed for $150. And then you have some other insurers who would take that $150 that was billed and only reimburse $35.

Not just anybody can bill insurance though, even if you are providing care within the state’s parameters. If you are not contracted with an organization as a provider, then anything billed would be out of network and would be subject to reimbursement rates set by the plan for out of network reimbursement. This really only applies to employer-based or individual plans; I’ve yet to find a state that allows billing reimbursement for out of network providers.

Hopefully this brief explanation helps you understand the very basics of third-party reimbursement for childbirth education as it exists today. If childbirth education is covered depends on which state you are in. Who can provide that childbirth education in a way that’s billable is also up to each state. The how much is something spelled out by each plan coverage. It’s not an ideal situation in the slightest; however, anyone who  wants to fix something first needs to understand how it works, otherwise it’s very likely any attempts to fix it will break it.

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Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Parent Shame and Car Seats

It’s National Child Passenger Safety Week!

Last week, in a fit of irritation, I wrote a little tweetstorm on how irritated I am with the notion of “parent shaming”.

And I really meant all of it. Yesterday, I got called to help a very well-meaning family who knew something was up with their car seat and wanted it to be installed correctly. Once I got there, though, I looked at the seat and realized it was not only an expired seat, but a recalled seat. But it’s so common to buy used car seats, many parents don’t even question it.  Or what about this viral video from last month? Here. Here’s a screenshot:

bad-car-seat

I haven’t watched the full video, nor do I care to. Why? Because every time I look at this I get sick to my stomach. Not only is this an infant seat that’s ONLY supposed to go backwards, but I’m pretty certain it’s close to 10 years old, the straps aren’t even on one of the little boy’s shoulders, and my WORD…what is going on with the seatbelt? It’s over the arm, it’s…it’s just a mess. There is almost no likelihood that this poor sweet little boy would escape a crash without major injuries or worse.

Or what about this video?

bad-car-seat-2

The straps are too loose, they are falling off, and she’s too young to be facing forward. Truthfully, 99.9% of the videos and pictures parents post of their kids in car seats have at least one horrible, obvious flaw. Nothing else you buy is THIS critical to keeping your child alive. Nothing. And yes, for a variety of reasons, car seats are just really hard to use correctly. It also doesn’t help when parents so commonly are exposed to other parents making unsafe choices, such as:

  • Buying used car seats
  • Choosing to use expired car seats
  • Placing car seats on top of carts, tables, chairs….
  • Keeping babies in a car seat when they aren’t in a car
  • Turning a baby to be forward facing when they turn 1
  • Letting a baby nap in a car seat outside of the car
  • Not keeping a baby buckled in when the car seat is being used in a stroller
  • Using coats under car seat straps

Parents don’t want to hear that they’ve been doing something that puts their children in danger. I would never DREAM of going up to a parent when I see any of the above things. No matter how it’s phrased, it’s never taken well. Ever. So we try to educate broadly, and I go along and say a silent prayer every time I see a baby sleeping in a car seat, head falling forward, or a $450 car seat precariously perched on top of a shopping cart.

If you’ve been committing any of these car seat cardinal sins, today should be the day you stop. Car crashes are on the rise as more and more people are driving while distracted. Nothing is more important than keeping your children safe. There’s always a solution to every car seat problem. Have a trained professional, a Child Passenger Safety Technician (like me!), help you out if you need it. But really, don’t brush it off. Please.

Warmly,

Veronica

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Allina Strike: Another Mom’s Warning

Veronica: I’ve been continuing to collect stories from moms who gave birth during the June strike at Allina hospitals. Another strike started today at 7am. Staffing levels are lower than in the last strike. Not all birth workers share this sentiment, but going to a hospital during a strike is risky. Talk to your doctor or midwife, with the caveat that many of them didn’t take the last strike seriously. Contact me if you have questions, concerns, or stories you’d like for me to share here.

Below, a story from Jessica, shared in it’s entirety with permission.

Upon walking through the doors of Abbotts Mother Baby Center in Minneapolis on June 19th, a cold and erry feeling came over me. The feeling of walking through an abandoned building, the uniforms were different; almost like guards in a prison. I never saw a smile– only the faces of replacements looking confused, frazzled and pressured. Wasn’t this suppose to be the happiest and most friendly place welcoming new life? Not here.
After patiently waiting for my name to be called, bags in tow and my husband by my side, we were lead down an empty hall into a room and simpy left alone. My contractions were fierce, I was hurting with tears of pain, not joy. And finally we were joined by a women who couldn’t explain why we couldn’t hear my son’s heartbeat until she was assisted by another 2 women. He was of course healthy as could be! It was then confirmed, we were having a baby on Fathers Day! My husband was thrilled to have a healthy son born on his day!

But we couldn’t get over the fact of how inadequate the replacements were. Once we arrived in our 2nd room, it was time to be hooked up to countless machines and ivs. It took my nurse and 2 other women with 4 times and blood everywhere to correctly place my IV; it was a bloody mess. My husband had to direct the many women who tried to help but thankfully my husband knew where the blankets were, and many other things in the room were that were needed to comfort his wife and mother of his children.

It was only 7 hours after being admitted that I heard the sweet cry of my baby boy, never was he placed on my chest, never was he cleaned from the mucus covering his sweet glowing skin. I still kissed him and the mess didn’t matter. I was never guided to breast feed, I was never escorted to the bathroom to clean myself, luckily my husband had been through this and helped me. My epidural was not effective , so I was able to care for myself immediately. I don’t think we saw a nurse for almost 2.5 hours after delivery, we enjoyed the time alone but knew I was missing something.

As the nurses prepared to do the newborn screening, my son began to choke and I had to direct the nurse to please help my baby breathe, and they immediately started to do the newborn screening- it took almost a half an hour and 3 attempts to get him to bleed enough to complete the pallet. As we sat there helpless listening to the screams of my baby, I was broken inside. Needless to say, we very adamantly pushed to go home after 24 hours; we knew we could care for our baby alone in the comforts of our home as a family of 5. Since then, we have watched our son grow into a beautiful healthy baby.

 

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Allina’s Replacement Nurses and Patient Neglect: Another mom’s story

Nurses Union

After I shared Lisa’s story Monday and Tuesday, another mom contacted me who had given birth during the strike. This time, the circumstances were a little different; Ashley had a planned cesarean. She was still suffered from incompetent care, and she wasn’t given food, water, or medication for long stretches of time for the duration of her 4 night stay.

When you read her story, please keep the following things in mind:

A few things are starting to become clear: While staffing during the strike might have been adequate in other departments and other hospitals, the night nurses at Abbott from 7PM to 7AM did not take care of the patients. Food, medication, and water were withheld from at least 2 moms for very long stretches of time. Only very vocal family members saved these moms from total neglect.

Penny Wheeler is a former OBGYN. Again, she claims up and down that the replacement nurses took good care of patients, but no decent OBGYN would find this to be safe care. How can anyone justify the care that these moms received? I’ve spent the last decade of my life advocating for good maternity care, and nothing has angered me as much as hearing this care happened within my own city.

As before, if you have questions about your care options after Monday, contact me. If you have a story about your care that you want heard, contact me. My phone number is 651-200-3343 and I can be reached at veronica@babylovemn.com

Ashley’s story is below. It was edited for clarity, and I have been given explicit permission to post it.

I had a scheduled C-section on June 22nd, 2016 due to my son being breech. When I arrived at Abbott, I noticed that there were hundreds of people walking around protesting only to learn these were the nurses I had gotten to know over my entire pregnancy journey.

I was scheduled for surgery at 12pm, and up until I was brought into the OR everything had been going great. Then things went downhill.  The nurse who was assisting with the surgery was holding the clamp opening up my incision pulled so hard that she fell backwards off of the stool she was standing on. This ripped my incision open larger than needed and made for an extremely crooked scar. I was not allowed to hold my son for a good 45 minutes once he was taken out, but not because there was any complication. I begged and pleaded to get some skin to skin contact with him as I knew it is very important in the breastfeeding process. I was told skin to skin was unsanitary for me while being in the operating room.

Once I had been all stitched up, I was put into recovery while they made sure my uterus was shrinking and I wasn’t going to lose too much blood. At this time, they noticed my son was grunting and took him to special care to be evaluated for fluid in his lungs.

Two hours later I was brought up to my postpartum room and was introduced to my first nurse. She was amazing, and I would take her again any day. She promptly gave my meds and kept my water full, but she wouldn’t allow me to eat anything. She informed me about everything going on and kept me cleaned up well. I asked when I could go see my son and she said as soon as my catheter was removed. I was told the next nurse would do it immediately after shift change at 7pm– at that time, it was around 6pm.

When 7pm came, I paged for my nurse. I was in excruciating pain and I was bleeding so much that I had bled through the pad I had on and the blankets on my bed had become saturated. I paged my nurse at least 3 times, but nobody ever answered my calls. My dad came to visit. He found me sitting in a bloody mess,  bawling my eyes out. I was desperate for help that I was not receiving. My dad was outraged and tracked down any nurse he could to help me. At 9PM I was finally given my pain medication. I asked again about having them take out my catheter; by 10pm it was finally removed and I could go see my son.

While my son was being kept in the nursery, the staff had done an x-ray and his lungs looked clear. I had received a call from special care at 8pm saying my son had still not been fed and he was delivered at 1:18pm. He hadn’t been fed anything at all since he was born, and his blood sugar dropped to 35. I asked to breastfeed him, but I was told that was not allowed. I was told I could pump to feed him, but because I’d had a cesarean, I wasn’t allowed to breastfeed him. I was heartbroken. The only options I was given for feeding him was donor milk or formula.

I got to him around 10pm and stayed until 11pm. I went up to my room to rest and let my body recover. I was told 3am was his next feeding time, and I was welcome to come bottle feed him–but I still wasn’t allowed to breastfeed. At 3am when I came down my son had an IV in his hand. Neither his dad nor I ever gave informed consent for this to be placed. Then the nurses told me they had to give him sugar water because his blood sugar was still too low. They didn’t mention to me that his blood sugar was low when I had been there 4 hours prior. Then they also informed me they started a preventative antibiotic while I was away to stop his grunting, and he was going to have to stay in special care for at least another 48 hours. I cried as they told me if he pulls out this IV would need to put it in his head. I felt scared, sad and angry that not only they had done these things to my baby without me knowledge or consent, but that they could threaten more procedures. Infection had been ruled out prior to this IV, so I knew my son was fine without then.

On day 2 of my stay again my morning nurse did a fantastic job. My night nurse completely neglected me; she never filled my water or told me where I could go to fill it. She didn’t bring me my pain meds until 6am– right before the end of her shift. This occurred all 4 nights I was there. By 7am I was begging my good nurse to help me get the pain managed again. And it would continue to relapse at shift change every time.

My last night I was finally able to have my son with me in my room. The morning nurse was there to help me breastfeed him finally for the first time. He latched great and stayed on 30 minutes each side she was so supportive of me the entire time wanting to breastfeed my son. She promised the second I got him I could feed him myself and kept her promise.

A week and a half after I was discharged, I developed a staph infection in my incision. Originally, they told me I was mistaken. I insisted on a culture. They finally did it and sent me home that I would get results later. Next day they called me and told me I had a serious staph infection;  they sent antibiotics to my pharmacy that I needed to get immediately. If nothing got better in 3 days I was to go to urgent care. Thankfully, the infection cleared.

I encourage anyone due during strike to do your research before going through with your delivery. I also want to apologize to any other mothers who had a terrible experience during their deliveries. The delivery of my son turned into the biggest nightmare I could have never imagined. I expected it to all be so happy and didn’t imagine I’d be so depressed throughout my hospital stay. Thankfully my son and I are both extremely happy and healthy since being home.

Veronica Jacobsen, BA, CLC, CPST, LCCE, FACCE
Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.