Homebirth and Horizon BCBS
However, she has said she would do it again, so it just depends on how much you're willing to do. She eventually got it covered, but here's what she had to go through:
-multiple (as in weekly for several months) calls to customer service, in which some reps would tell her it was covered, some would tell her it wasn't , some had no idea what homebirth was, etc. She documented every single call with names and dates.
-once she did get it approved (she says their official policy is to cover homebirths - I can find out more about that if you want) she had to make several more calls - again being told it wasn't covered, what's a homebirth, etc - before she could actually get them to mail her the letter itself.
-then she had the same issues all over again when it came time to pay the midwives. she had to pay them out-of-pocket and then get reimbursed. same issues again - call them, tell them about the letter, fax them a copy of the letter, have them tell her it's not covered, what's a homebirth, etc.
-then they paid her the wrong amout (way too little) and she had to go through the process AGAIN to get the rest of her money.
I wasn't willing to do that as a first-time mom who was already stressed and nervous enough. So I went to the hospital and ended up having a great experience, though I know that's not always the case.
Good luck! The end of the story is that she did get it covered, so I guess that's a positive thing
If you're in NJ, ignore this, but just a thought--several of my family members have their insurance through Horizon though they don't live in NJ.
HBCBS are not the smartest anyway. Somewhere along the line they got double charged for an rx I got, and instead of thanking me when I called to let them know they said I should deposit the reimbursement check anyway because I was probably confused about what I'd purchased. Err.... thanks?!
Good luck with it all.
Now we have high-deductible Aetna. Again, it won't really make a huge financial difference whether they allow the charges or not, but I'm actually kind of hoping they pull what they pulled with a friend who had a homebirth and Aetna. They told her that they don't cover homebirth because it's "an experimental procedure." I'm *dying* to get a letter informing me that having a baby at home is experimental. I might have to frame it.
i have BCBS- nj direct10i have nj direct 10, state health benefits plan, the plan anyone working in public education in nj has. i am planning my first homebirth (due in may) and have had a VERY hard time getting a straight answer from BCBS about exactly how much they will cover.
my MW is considered out-of-network. like someone else said, i got the billing code for the global fee my MW charges. (my MW requires payment and then i submit to ins com for reimbursement once baby is born). for out of network providers, i have a low deductible ($100) and my plan says BCBS will reimburse me 80% for out-of-network services of the "usual and customary fee," and then anything over $2000 paid out of pocket. now if i could only get a straight answer about those u&c fees . . .
i could not get an answer over the phone. after about four or five (very frustrating and inconsistent) calls to different cust serv reps, and a fruitless call made by the MW's secretary, i was told i have to submit in writing to BCBS on MW letterhead certain facts and numbers and codes, etc, and they will respond with what their u&c fees are. we will see. i'll keep posting as things develop.
Thanks for all the info..Thanks for all the info, I have called HBCBS and, as expected, got a very polite but confused customer service rep. He said "Gosh, I guess you'd need like a midwife or something if you're going to do a homebirth, right?" Um, yep. I plan to keep calling, and calling, and calling......
I am self-employed, so my insurance is an individual EPO plan through HBSBC, if that helps
It took several calls to customer service asking them to find an in-network HB MW. I was directed to a special case office, who eventually called two MWs I knew were local. And after awhile they let me know they would cover it.
My MW had problems with getting paid despite the arrangement. Now I think it is OK. But she had problems with another woman with the same plan a month or two earlier.
I would pursue it again, but would probably change my plan to the one that has out of network benefits.
I never called them to ask if it would be covered. I knew it would be a headache. The office manager for my MWs did all the calling. Another reason my MWs rock.
This is an old thread, but I'm hoping someone can help. We're planning to have a home birth. Our insurance is Horizon BCBS NJ Direct. We live in New York, so our MW is out of network. BCBS will cover 70% of the fees, but they will NOT tell us what they actually consider to be usual and customary for global MW care. We'd like to have some idea of what we'll be paying out of pocket....
Can anyone share their experience? Thanks!