Homebirth and Horizon BCBS

[mamaredbird]

Has anyone done a home birth that had Horizon BCBS in NJ? What was your experience dealing with them and did they pay for it? I would really love to explore the possibility of a HB without the need to pay out of pocket for it when I'm already paying for health insurance. Just rubs me the wrong way, you know? Any advice would be greatly appreciated!

[Smirkin]

I have a friend who did it, and to be honest, her experience was the reason I decided not to pursue a homebirth.

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

[AlexisT]

Question: Are you in NJ? Because I know people in NYS whose insurance is through Horizon (using the same Empire PPO network providers) as their employers are based in NJ, and it might work differently for them, because HB MWs in NYS are CNMs and many bill in-network through BCBS.

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.

[murphysaangel]

Unfortunatley, it really depends on your plan because although lots of people have BC/BS of NJ, everyone's benefits are dependent of the individual group plan. You'll have to do the research. Call and ask all sorts of questions. If they don't have in-network HB midwives you can petition them to consider it like it's in-network because they cannot provide you with one (IF they cover it). I THINK this is a NJ law. Ask what your deductible is, what your co-insurance is and percentage of the rate that is covered. Ask what is "normal and customary" for a global homebirth fee (because although your midwife might charge $6000 they could only consider $3000 of it, of which they'll pay 80% etc). You can get the insurance code for a global HB from your midwife so you can give it to the customer service rep when you call. Also make sure to ask about the covering doctor and hospital. Make sure you get the name of the person you are speaking with, and then call and ask someone else. It's a pain in the butt but you'll truly want to make sure that you're getting the correct information. Your midwife might even have a list of questions to ask (mine did) that will help you through the process. I'd even ask her for information 1st - she should have plenty of experience dealing specifically with BC/BS. Good luck!

[stelly]

We had a high deductible HBCBS plan and they reimbursed us some of our midwife fees. I didn't pursue it because not only did we pay $x thousand for the homebirth midwife, I was then not allowed a homebirth and ended up with a c-section in the hospital, so total cost for all involved was probably around $12,000. I was so sick of the whole thing that I never pushed them to accept more of the charges.

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.

[TortelliniMama]

We also had high-deductible Horizon BCBS. Our homebirth (with CNMs) was covered as an out-of-network expense, but we didn't really recoup much, because first we had to satisfy the deductible. I wondered if that was part of the reason they were so blase about "Homebirth? Sure, we'll cover it!" (since they didn't have to pay much money in the end anyway).

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.

[stelly]

Originally Posted by TortelliniMama

Now we have high-deductible Aetna.

Snap!
I don't see another homebirth in my future though, so I'm not too worried any more

[michelle123]

It really depends on your individual plan. If you can talk to the benefits coordinator through the employer, it might be a good first step. They sometimes understand the individual plans better than the BC/BS people. I know that anytime I call BC/BS, they have a hard time understanding the language of my plan...

[donna-nb]

i have BCBS- nj direct10

i 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.

[mamaredbird]

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

[donna-nb]

good luck!

i wish you persistance and patience. i could use it too (o:

[engineer_mom]

I got mine covered 100% by Federal BCBS, with no out of network benefits.

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.

[cking]

We have Horizon - federal, and they paid about 67% of our HB cost. We had to switch to 'standard' coverage to get out-of-network care. We paid the MWs first, then were reimbursed. Also had an FSA and we were able to use that. It's a hassle to have to pay up front, but honestly, I'm happy with our experience - I feel I had the best birth experience I could have had, and that was worth it.

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.

[HMW1]

Hello,

We are also experiencing issues getting paid for home births through NJ Direct. Where could I find the policy on home birth? Do you have the link?

I appreciate your help!

Thanks.