Claim 100% From Your Medical Aid On Birthworks Products

To achieve this you need to have authorization for the full cost of your birth covered by your medical aid and for that, three things are required:

* Start as early as possible in your pregnancy – from 12 weeks ideally.
* Be tenacious – but polite! It will take commitment and time (weekly follow ups) – it makes it easier to dedicate some space in your diary for this or to keep a small note book.
* Don’t accept no for an answer

* Begin your request for full home birth cover from your medical aid as soon as you know you are pregnant (or the moment you see this information!) – start with their regular procedure for lodging an authorisation request. This usually means you make a request to a call center where they log your call and give you a reference number. Home birth is an utterly foreign concept to them, so your request is unusual – you need to respect that and be mindful of it when tensions rise.

* Take note of the call log reference number, the person you spoke to and when you called.

* Follow up within 1 week if you don’t get any feed back – be polite if they delay you again, but find out who will be responsible for making the ultimate decision (usually the fund manager).

* Politely follow up with the call center each week (or two days!) at least 2 more times

* Should no proper answer be received at this point, contact the fund manager or their assistant – and press them to tell you a date when their decision may be expected. Keep following up on this until you have an answer.

* If the decision continues to be delayed or it comes back as “no” or that they will only pay at NRPL rates (a quarter of the midwife’s fee), then log a complaint with the “Council for Medical Schemes” (independent umbrella body who watch over all schemes). This complaint is made in writing. When you prepare this, it helps to get a written quote from your local private hospital for a natural delivery – the comparative cost to home birth is reason on its own! (bear in mind, they quote you ward fees – not gynae/midwife or anesthetist fees – that’s extra!)

* A complaint logged with the Council is then sent to the Medical scheme – they get 30 days to respond. If their response is not favourable, you can complain to the Council, who will take it further. This is unusual however, because if your request is fair, the moment your medical aid know you have gone this route, they are more likely to accept it – but its important to go through the regular channels first (don’t try to short cut!!).

* Always follow up – check that the Council has the complaint logged (call a day or two after lodging your complaint medical aid have received the complaint from the council

* Once you have authorisation from you medical aid for a home birth, then birth products such as those supplied by Birthworks would become part of the expenses for birth aids (auxiliaries) covered by the midwife. This means that you could arrange for the costs to be included on your midwife’s invoice (for the claim to the medical aid), or you could submit the Birthworks invoice. You would most likely need to pay your midwife and Birthworks first and then claim from your medical aid afterwards, but this does depend on which company you are with and how they manage their claims.

Written for Birthworks by Claire Roy Mother of 3 , thanks Claire