Yay for Blue Cross Blue Shield!

[Leah_R]

I have read so many times on HB boards about HB not being covered by insurance, so I thought I would post that BCBS will cover mine. I was told my midwife was out of network, so I would have to pay out of network rates. I filed for a Out of Network Exemption and got it. Basically because there was no one in their network that did homebirth, they had a gap in coverage. After 6 phone calls, I got the approval. So I will have in network coverage. Yay!

So hopefully this will encourage others to get their homebirths covered!!

:

[rebirth]

Awesome! My BCBS covers at 80% after 500$ deductible. I hadn't even considered gap coverage, but I will now.

[bajamergrrl]

Congratulations! I just got denied out-of-network coverage for non-CNM midwifery prenatal care and I'll probably appeal it (not BCBS). I know what a relief this must feel like.

[angelachristin]

BCBS covers my homebirth midwife too at 80%. There are about 5 or 6 homebirth midwives in my area that are in-network BCBS providers.

[deymm]

Great job! I tried to get gap coverage with my United Healthcare policy and they turned me down twice. I gave up. They will cover it out of network though.

[sarahn4639]

BCBS covered mine as well. It was covered at 90%! Yay BCBS!

[annettemarie]

Wow. We have BCBS now (we used to have Aetna.) I'll definitely be checking this out!

[averlee]

Originally Posted by bajamergrrl

Congratulations! I just got denied out-of-network coverage for non-CNM midwifery prenatal care and I'll probably appeal it (not BCBS). I know what a relief this must feel like.

I'm jealous. Had BCBS & non-CNM ($$$cash only$$$) midwife!

[Mrs.aLifeofReilly]

curious if it was an HMO or PPO? I've been told many times by women with the same BCBS HMO as I have were denied coverage. I'd love to figure out if maybe they've changed their minds!

[bec28]

I had pretty much the same experience. It took more then 6 phone calls, but that was because I talked to people who had no clue what they were doing. Once I found the right person to talk to, it was a breeze.

Oh, and they are covering 80% after a $300 deductible. And it's a PPO.

[thewaggonerfamily]

Yes, we have BCBS PPO and we are being covered at the out of network rate. But they wont cover a birth center birth because the BC isn't licensed, except that the state doesn't license birth centers, so it can't get licensed. <insert eyeroll> I am going to apply for the out of network exemption. OP, could you tell me what steps you went through to do this and what you put on your form? Thanks!

[Pernillep]

MY BCBS PPO covers my homebirth at 100%. Yes you read right. I only have 1 $15 copay and then the rest is covered.
I was so surprised when I found out. I was expecting to be in for a fight but now we can sit back and relax.

[Mamabeakley]

I've had 2 homebirths covered at 80% through a BCBS PPO. The first time was kind of ridiculous, though - the people who answered the phones did NOT know what they were talking about and told me yes, no, and maybe. I ended up writing a letter, ccing the state insurance regulators, and getting confirmation from BCBS via the regulators that they would cover it.

I'm planning another this summer and now have an Indemnity plan, which means that it's neither a PPO or an HMO - I just go where I want and they pay what they want. The policy documents clearly state that they will cover maternity services as long as they are provided by a licensed provider, which my CNM is, so I'm assuming they will cover it. Unfortunately, it's a High Deductible plan so they will probably only really pay a little bit . . . but it'll use up most of my deductible, so anything else we need this year will be covered . . ..

[Jilian]

I'm shocked! We did not have the same experience with BCS here in FL. OP, make sure you get it in writing in case they battle you later when it is time to pay.

[Leah_R]

I have a PPO. And all I did was call the benefit services or something sounding like that phone number and asked about my benefits. I then told them I wanted a HB and that they did not have anyone in network to cover that. They tried to tell me about the 2 midwives that were in network. I replied that yes they were midwives - but they only did hospital births. So they transferred me to someone else that took my application for a out of network exemption waiver. I gave that person all the facts, and then waited for them to call me. They called me and my midwife more than a couple of times to get info, etc. Then called me and gave me the approval.

Things they do stipulate - you must use a CNM. That midwife must be within 49 miles of you. I guess they use 50 miles as the cut off. They will be asking for their address too.

Also make sure they make your exemption good for a minimum of 2 months past your EDD so your PP check up will also be covered.

When they asked me for my information, I told them that HB was legal. It was my right to choose the provider of my choice. And then that I pay for maternity benefits every month. If I was not going to be able to use them, there was not a point of me paying for them. Plus using a HBB CNM I was actually saving them money, considering the price of their service vs. that of a CNM in a practice plus hospital costs -- not to mention the cost of an OB with hospital costs. I told them they should be begging women to consider HB with the amount of money they would be paying.

So I say, it seemed like more than I could accomplish to get my HB covered and in network. Now that I have, I think we all need to keep fighting for it.

[adlib77]

That's great! I have BCBS, too, and we weren't so lucky. But it turns out it wasn't BCBS that wouldn't do it, it was dh's employer's plan that excluded midwives across the board. We couldn't even go with a CNM at a hospital - no midwives at all. LAME.

[babylightsagain]

Our HB in Pennsylvania with a CNM was covered 100%. We had PPO which we had changed to PPO right before the birth because they payout better and there is no deductible.

Leah - good for you for sticking with it and getting it covered. And for letting them know all the reasons for it. Cause seriously - it is SO Much less expensive then going to the hospital or even the birth center. We should be getting a discount in our rates for doing HB!!

[DahliaRW]

I have premera which is through BCBS if I recall right. They cover 100%. Well, everything but the birth pool because it's not a "medical supply". I'm ok with that!

[annettemarie]

You know, my midwife is a DEM, so I bet this won't work after all.

[Pernillep]

Originally Posted by DahliaRW

I have premera which is through BCBS if I recall right. They cover 100%. Well, everything but the birth pool because it's not a "medical supply". I'm ok with that!

That is who I have too They are awesome. Never had such excellent coverage before.