Any one with experience with Great West?

[Momtotwo2004]

I did a search and the responses were all at least 5 years old so I'm wondering if anyone has any recent experience with HB and Great West.

I'm in VT. We have a high deductable plan with an HSA. They have told me before over the phone that they will cover homebirth with a CNM.

There are none available in my area. My midwife is a certified professional midwife. Has anyone billed anyway and gotten some reinbursement or had it go towards their deductable?

I've heard it said before to just send in a bill anyway and not specify that it was a homebirth. Is this possible? Do you have to use medical codes that mention homebirth? I'm all very new to this health insurance business so it's like a foreign language to me!

[jenfl]

I had Great West PPO in California for DD's birth 2.5 years ago. We were not able to get reimbursed much at all (couple hundred) for our (non-CNM) midwife, although other people at our company were. I believe a lot of it depends on making sure that it's billed correctly and that the codes are right. Once they actually looked at ours, they started finding ways not to pay.

[Momtotwo2004]

Do you know now, in retrospect, how you would have billed it differently?

I hope my midwife will know ...

[quiverfull]

I have Great West PPO(now Cigna), but a pretty stinky plan. I made a phone call to verify what would and would not be covered (already knowing that our plan does not cover homebirth, but does cover prenatal, postnatal, and newborn care). What I was told to ask is if they cover a REGISTERED midwife, not specifying if it was CNM, or otherwise. At first, the rep said that they covered CNMs,but she wasn't sure of CPMs. I told her that in our state (CO), CPM's are licensed by the state and therefore registered, and she said, well, then yes, they should be covered (doesn't mean much, does it?). I think the billing gal will probably be billing it generically without any specification of what kind of midwife she is.

All the charges will be billed as separate visit codes, and the homebirth itself just won't get billed. I'm crossing my fingers, hoping that they will cover at least all the non-birth stuff. We are going to be out-of-network, so our deductible is pretty high, but I hope it will at least cover some stuff.

Oh, yeah, what I was going to suggest- if you haven't done so yet- is to ask for an in-network exception for a CPM. I don't know what kind of laws your state has, but here in CO, CNMs by law are not allowed to attend births at home. If Maine is the same way, you can explain that to your ins, and they may be willing to give you an exception, esp. since homebirth is a covered expense (unlike my plan).

Good luck!

Holly

[pamamidwife]

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Edited by pamamidwife - 9/10/11 at 11:27am

[Belle]

I don't have Great West, but I do have a high deductable plan with an HSA. Our deductable was met before the birth because dh had an ER visit. We paid the midwives' fee out of pocket before the birth. They paid a lot more than the 60% that was promised. It was reimbursed to us after the birth. I think it helped that our midwives didn't just bill for the birth, but also billed them for newborn exams and home visits. I figured out that they paid close to 92% of the cost of the birth.

[quiverfull]

Originally Posted by pamamidwife

I've been paid almost 70% of my fee from Great West. When calling insurance companies I never ask specifically about homebirth, just credentials.

Pam,
When billing, what place of service do you use?

There are umpteen different plans, and ours happens to be a self-insured plan, so our company dictates what will be covered, not the ins co. (bummer), so there is probably no way around it, but thought I'd ask! :-)

Holly

[LittleBlackBug]

I never submitted to Great West because when I called they said CNM in hospital were covered but CPM were not. My midwife has submitted to see if they will cover the claim, but we have yet to hear if it'll be covered.