Homebirth midwives that are affiliated with Blue Cross?

[dynamohumm6]

My Blue Cross plan covers homebirth 100% (woohoo!), and I'm looking for a midwife in the Cambridge/Newton/Watertown/Belmont/Arlington area that is in the blue cross network.

The way it sounds when I spoke to BC/BS this morning is that it's much easier to go through a network CNM, but that I can get a referral authorization for a midwife that's out of network? If anyone has done this, I'd love to hear from you, and see if it's as easy to do that and get payment as they made it sound.

Thanks in advance!

Hmm...I'm seeing now the catch-22 with CNMs/coverage/homebirth. Interesting.

[Paige, CPM]

Is your BCBS a Massachusetts policy? If so, then they will not cover your homebirth with a CPM. CPM's are the only providers of homebirth in MA. I have clients who have BCBS (non-hmo policies) in other states because the employer is in another state, and my fees have been covered.

You can take BCBS MA to small claims court for something like 40 bucks and possibly win some of the coverage (you present your case in front of the magistrate with the BCBS person presenting as well). One person I know of has won, another person I know of was unsuccessful.

Good luck! And, in case you haven't see this site...here are all the homebirth midwives... www.massmidwives.org

PS If you haven't already, then please call your representative and senator in the MA legislator and ask them to co-sponsor the Board of Midwifery Bill...this will help change insurance reimbursement policies and open up all birth options to everyone in MA.

[dynamohumm6]

It's HMO Blue New England.

I was told on the phone this morning that out of network would require a referral from my PCP but that "it shouldn't be a problem". Wouldn't CPMs fall under out of network?

update: I spoke to two midwives in my area this afternoon and both of them say they've had several clients covered by BCBSMA with no friction. I do need to get a referral from my PCP. Sweet!

Now the trick is deciding between the two of them, they both seem lovely.

[Mrs.aLifeofReilly]

I have HMO Blue New England and they won't cover a cent of my homebirth. My husband was able to set up a health flexible spending account with his job, and they do consider homebirth a valid expense. So we're still paying for it 100%, but the money going to it is pre-tax income.

[Paige, CPM]

I am very surprised and to be honest sceptical to hear that BCBS MA covers hb still...what I understood from my billing service is that in the autumn of 07 they changed their policy. I just got my last payment from bcbs ma because the mom got approval right before they changed policy (can you believe how long that took to get reimbursement?!!...they are not an easy company to deal with at all!!!

Anyway I will post to the midwives list tonight to see what is going on, to make sure I am not giving out incorrect info.

[dynamohumm6]

I was very specific in the questions I asked the insurance companies...so I don't know. My policy is HMO Blue New England, I don't know if it's different than BCBSMA or not, but I called back BC this afternoon to verify. As long as I get a referral from my PCP it's treated as an out of network provider - so it won't be covered at 100%, but whatever non-network is (80% for my plan).

and yes, I plan on getting that in writing

Also, when I first learned my dh's company was changing to BCBS I called them to ask if they covered homebirth (his previous insurance, CIGNA, covered 100%). His company did not yet have their policy, and the woman I spoke to said that whether or not homebirth is covered depended on the policy, and that until I had my insurance card she would not be able to tell me for sure, because some policies covered and some didn't. This was in November '08, his company changed over Dec 1, '08. For whatever that's worth.

[Mrs.aLifeofReilly]

This is what my plan says:

"Delivery of one or more than one baby, including prenatal and postnatal medical care by a Physician or Nurse Midwife. These benefits also include prenatal and postnatal medical care exams and lab tests by a General Hospital or Community Health Center."


So they would probably cover an out of network CNM (if CNMs did homebirths in MA), but not a CPM.

So when you called, did you ask about a CPM, or just say 'homebirth' and 'midwife'? Because from what I understand they'll say sure, we cover care by a midwife, sure we cover homebirth - as long as the midwife is a CNM. Which of course is out of the question in MA - so in effect they are saying no.

[dynamohumm6]

I specifically asked about CPM and made the distinction. CNM's only for "in network", and it doesn't matter for out of network.

Dunno.

For what it's worth the insurance person I spoke did mention that the information wasn't "readily available in their literature".

[Mrs.aLifeofReilly]

Well, if you're able to get something in writing for them - I'd love to know how you went about it so I can give it a try too.

[dynamohumm6]

Here's a thinking outloud kind of question...being that I'm not that far from NH, and my insurance covers providers in all of the new england states, I wonder if I could work with a CNM from NH and have it 100% covered...

[lthw]

This is all very helpful for me, since we just switched to bcbs and I was also told homebirth would be covered 100% as an outpatient situation, but now that I have read the policy - yeah it looks like they'll only cover a CNM, and CNMs don't do homebirth here in Mass. If anyone has an update or info to share, I'd be very interested!
Thanks so much,
L.

[katie9143]

my mw, audra karp, has a billing service that got me a huge chunk of her fees refunded to me. she is not in-network, but because she has had a lot of clients that used bcbs, she does have an out of network id number which may be how things are expedited better than with others? i didnt even end up having dd at home and the billing service was still able to get me much more that i would have ever hoped! this was 2 yrs ago...but i doubt all that much has changed.

if you want her number or email, pm me.

[mumofboyz]

Our homebirth was partially covered by BCBS (ours is a PPO via Alabama). Because the midwife was an out-of-network provider, we had a sizeable deductible to meet. After initially rejecting our claim, BCBS did pay exactly what they said they would... after the deductible and only a % of the total costs... we recouped about 50% of the total cost of the homebirth. Our out-of-pocket expenses were channeled through our FSA (flexible spending account), so we did save another percentage (varies depending on your tax rate).

Good luck, Mama!

[maplesmom]

I would love to hear updates! According to everyone I've talked to BCBS won't cover Home births... so I'd love to hear!

[ejg123]

We also have BCBS MA PPO and have heard mixed reports about what they will and will not cover for a homebirth. They told me on the phone flat out that they will not cover anything with a CPM, but my midwife has had clients with the exact same plan as me be covered in full, in part, and not at all. I do not think that there is a consistent policy. It depends how you file, how you appeal, and to whom the filings and appeals go. And perhaps how the person who is reading your claim is feeling on the day he or she reads it.... I will make sure to post my experience for others. And I very much appreciate others doing the same.

I have read here and otherwise, that with BCBS MA PPO the best approach seems to be file after the fact, rather than trying to get pre-approval. With my particular plan, I have never heard of anyone getting pre-approval, but I have heard of people getting reimbursed after the fact.

Good luck! Hope it works!

[hmg]

Originally Posted by dynamohumm6

Here's a thinking outloud kind of question...being that I'm not that far from NH, and my insurance covers providers in all of the new england states, I wonder if I could work with a CNM from NH and have it 100% covered...

Be very, very careful with this. I have the same insurance and if your PCP is in MA, they will NOT cover out of state, even with a cross border referral. Now, even though the plan is "New England" they determine out of network based on where your PCP is located, which is stupid to me. I live 5 miles from NH but have a MA PCP. I had to have my Birth Center -and- my PCP write letters to advocate my cross border referral to have a non-hospital birth in NH.

For my first birth at the same center, under the same plan, 2 years prior. I was told I needed no referrals but when the birth actually happened, they refused to pay for services. I did eventually get them to pay BUT:

I suggest you keep a running list of your reference numbers from Blue Cross and have them send you written confirmation of every conversation/authorization. If I didn't have this, I'd never have gotten them to pay for the first birth.

Good luck fighting the Big Blue! Just remember that their customer coordinators will all give you different answers so.. take advantage of that...

[babynatasha]

I have BCBS and it is a PPO. I had a baby in Sept. 2007 and paid for the midwife up front. After the baby, I submitted the paperwork to BCBS and they paid almost everything, some money deducted here and there for co-pays on visits with her. They also paid it very quickly, within a couple of weeks of submitting it. I live in NH but the insurance is with the company my husband works for in Mass. The midwife was out of Portsmouth, NH and was not the closest, being about 30 miles from my home. They gave me no hassles at all.

I am pregnant again and this time I have another midwife, from NH and she is handling all the submitting of paperwork, so we will see how this one goes. I am interested to see the responses other have to this issue.

[amlikam]

I am bumping this because I would love to know how it turned out.

Thank you,
am

[ejg123]

Hi there. I was not the original poster, but we've been through A LOT with BCBS PPO MA and I replied to the post a while back. After a 1.5 year long appeals process, I was told by the patient advocate that our claim is going through (after three denials), but it is important to note that our birth was before an October 2009 policy change where it is now written into the policy that homebirths are not covered at all. We haven't seen the money yet, but are assured the process is taking place.
So, for the specific BCBS PPO MA plan, I think it would be very hard to bill for a homebirth now. It was difficult before, but previously they sort of sometimes claimed that homebirth was covered if you used a CNM which of course there are none that are able to perform homebirths in MA. You then had to make the case (which we finally successfully did) that if homebirths are covered, but there are no CNM able to provide the service, they are obligated to cover an alternative. We did not have to go to small claims court, but that was our next step.
Thus, I think the only way you could get a homebirth covered with BCBS PPO MA is to challenge the actual policy.
Or, one strategy that I have heard used is to get the cost covered not by submitting the big fee for the birth, but my submitting one or two test claims early in the pregnancy for prenatal visits. They will often cover small charges by a CPM because it is not worth it for them to deny it and it just slips through the cracks. Once they approve one or two, wait until the end of the pregnancy or after the birth and try to recoup the expenses via submission of prenatal and postnatal care claims rather than through one big birth fee. Some do the submit all at once in the end, or they trickle the submissions in hoping that no one notices. If they have approved the initial test claims, if they later try to claim they do not cover such care with CPM, you can point out that they have already approved some. We also contacted previous families that they had covered (found on this board) and used that to demonstrate an inconsistent policy. This gets around the policy that they do not cover homebirths because it is not a homebirth they are paying for - it is prenatal and postnatal care. A good midwife billing service should be able to help you with this. We initially used a very very poor one that was extremely inept. But a good one can really help navigate this for you.
Good luck!

[emnic77]

I am the original poster (screen name change), and nothing was covered. In Oct 2009 BCBS changed their written policy to be MUCH clearer on the issue, basically stating in no uncertain terms that they would not cover a homebirth unless it was accidental with an OB (right, because how would that even HAPPEN??).

I did end up with Audra Karp assisting my CPM (Tara Kenny) and I'm pretty sure I had her bill insurance but I haven't seen anything and don't expect to. Don't really care, honestly, my homebirth with them was worth every penny and then some