BCBS of LA, Homebirth coverage with CPM

[Mrs_CoffeeLa]

I'm having a homebirth with this pregnancy, using CPM Emmy Trammell.

I have BCBS of La HMO insurance. My policy specifically has "allied healthcare provider" coverage in the materinity section, and my policy also specifically has "home health coverage." I called and asked for their list of covered midwifes, and of course, the they do not have any in-network midwifes. They did give me a list of 2 midwives who they would over as "out of network", but neither of these people are currently practicing.

I have been going back and forth with them, and at this point, it looks like they will cover my midwife as "out of network." However, I feel that they should cover her at the in-network rates in since they do not have any in-network midwives available, and I am paying of a policy that should cover these services.

Just curious if anyone in Louisiana has had any experience getting BCBS to pay their midwife, of if anyone had any advice for me on to deal specifically with BCBS of La.

Thanks!

Penny

[Charmie981]

You need to call and ask for an "in network exception" based on the fact that there are no in network providers within a 30 minute distance who provide the service that your midwife provides. They'll likely tell you that they have midwives in network, and you can explain that those midwives are hospital based midwives and that your midwife provides out of hospital birth (I'd avoid the term homebirth). Before you get off of the phone with them, you should have a number that has been assigned to your in-network exception request. It will take at least a couple of days to process and will likely require you to call them a few times to get it processed, but if you get one, it will be well worth the effort.

[Mrs_CoffeeLa]

Thanks for the help Charmie!

I called today, and they told me that I'd actually need my provider to call their authorizations deparatment and request the in-network exemption since there were no in-network providers in my area. So, my next action will be to discuss this with my midwife when we meet at the beginning of June.

So far, it looks like BCBS is saying they'll pay my midwife as an out-of-network provider, but considering my policy should specifically cover midwifery care, I am going to fight my behind off to get this covered at the in-network rate.