CPM covered by insurance

[rumi79]

I am trying to find out if my homebirth will be covered by BCBS PPO in NJ. There is nothing mentioned in my plan except that they cover 100% prenatal care and birth in a hospital or birth centers. There are no birth centers that want to take me since i had a previous c-section. There are plenty of CNMs in the network but not even one CPM. I saw that CPMs and homebirth are "legal" in NJ but not HBACs which doesn't make sense to me at all but that's another story. So, I found few CPMs that are willing to attend my homebirth but I'm not sure if the insurance will pay for CPM services. Is there a law I can refer to? Does anybody have experience with ahving insurance gys paying for CPM?

[JesiLynne]

I would ask the midwives you talked to. Here they are very skilled at billing insurance to try to get you covered There's lots of different tricks.

[JesiLynne]

or maybe posting in the NJ tribal area ?

[rumi79]

Well, I did already but I though you might be more experienced here since almost everybody in NJ is giving birth in a hospital if it's VBAC.
Thanks anyway!

[munkeesmama]

Your best bet is to call your insurance carrier and ask them. What is my coverage for an out of hospital birth with a licensed midwife. I would not even mention homebirth. Just say out of hospital birth. They should be able to tell you. Also, remember that insurance is billed with codes. Everything has a code and a midwife will use these, so if you can ak a midwife what codes she uses to bill, you can call your insurance and give them the code and ask at what percentage does your policy cover that code. Easy peasy.

[nkintzel]

Well, we got our MW covered by doing this. I called and asked about midwives. They said, "Only in birthing centers."

So, I looked. There are no birthing centers within about 50 miles of me, so I called the insurance back (Blue Cross/Blue Shield) and told them that I would like to appeal it because I am not comfortable driving 50 miles while in labor. They approved it. And covered her in-network. It was SUPER easy.

She was a CNM, but they never asked. This time, I'm using a CPM, so I'm hoping they cover her the same way.

[kalamos23]

We just got our BCBS PPO handbook in today (I'm in Oregon so this *may* not apply, though it's probably fairly similar) and it states that they cover direct entry midwives. I would assume since they cover DEMs that they most likely would cover a CPM too. Look under the definition for physician in the handbook - they state all the different types of doctors/nurses/medical care providers there that they will cover. I thought at first that it was types of providers that they would NOT cover, but they have doctor of medicine right at the top.

[rumi79]

Unfortunatelly mine says only nurse midwives, but it also covers Birth Centers on 100% and since there are none in NJ may be I can ask them to approve a homebirth with a CPM. I will call them first for referral to see what names they will give in network, but I know that there are none. My other concern is that they about getting services on the proper level of care which they may say is the hospital for me since I am VBAC and that puts me in the high risk population.

[naturallyspeaking]

I'm in the similar situation. Is there a recourse when the insurance says they wouldn't pay out of network and there are no midwife in their network?? My BCBS is HMO (FL).

[maryjane]

Originally Posted by naturallyspeaking

I'm in the similar situation. Is there a recourse when the insurance says they wouldn't pay out of network and there are no midwife in their network?? My BCBS is HMO (FL).

Do you have NO midwives, or just no homebirth MWs? If the latter, then I'm pretty sure you won't get it paid. We also have BCBS HMO (KS) and we are having to pay OOP for the HB. If the former, you *might* be able to appeal as "gap coverage", but I know that HMOs tend to much less lenient about this than PPOs are.

[naturallyspeaking]

I talked to a rep and she said I need to call each ob/gyn to find out if there is any mw under them. They can't tell me which ob/gyn has mw under them...

Originally Posted by maryjane

Do you have NO midwives, or just no homebirth MWs? If the latter, then I'm pretty sure you won't get it paid. We also have BCBS HMO (KS) and we are having to pay OOP for the HB. If the former, you *might* be able to appeal as "gap coverage", but I know that HMOs tend to much less lenient about this than PPOs are.

[rumi79]

I can go ot of network if I want since it's PPO and I'll be paying deductible and 20% of the bill but I can't go over $2000 which is not bad at all. My only concern is since they have only CNMs recognized as practitioners that they will say that CPM are not allowed and not proper level of care so they won't pay at all. But we'll see when I call them with a concrete name. They told me that I have to ask for preauthorization of the services prior to the birth with the name of the provider, tax ID, everything I can give them, so I guess I will go from there. I just thought that somebody might have experience with this because I don't know how legal CPMs are and what's the difference between them and CNMs medically wise. And in my case since VBACs are only allowed in a hospital the picture gets really blury. I don't know what to do I don't want to go back to a hospital, I feel really bad about that but in same time we don't make a lot of money and I don't want to put the financial burden on my family. I can charge it on a credit card but after that we have to pay it off right? I feel like my HBAC is slipping away and I feel sad. May be I shouldn't get pregnant at all