Anthem paid for my homebirth

[firewoman]

I wanted to post about my success in getting Anthem (used to be Blue Corss of California) to pay for 100% ($4200.00) of my homebirth. I have never attempted to bill insurance for my previous homebirths and decided to bill this time based on an MDC post from another woman in my state that I read early in the pregnancy. I really hope that my success will inspire other mamas to try. If you would like to know what I did to get coverage, read on.

I have a Point of Service Plan which gives me coverage in three tiers HMO (the least out of pocket for me with $10.00 co-pays requires referral to see specialist) PPO ($35.00 copays and 20% of total bill is my responsibility and I can self refer) and out of network (I pay half and they pay half). I was able to get coverage under my PPO benefits. If you just have a PPO with Anthem, I imagine the process would be the same. If I'd had a doctor that would have referred me to my homebirth midwife I could have been covered under the HMO benefits, but I don't know any docs that would have done that. The post that the other woman made about getting her birth covered by Anthem mentioned an out of network EXCEPTION. This is obtained when you can prove that there is no in network provider of the same services within a 50 mile radius. Well, I knew there were NO CPM's or CNM's that attended homebirths in network so I started making calls. It took many calls and about three weeks to get this accomplished. Some people outright told me midwives, even CNM's attending in hospital, were not covered. I knew this wasn't true so I just kept calling until I got a hold of someone who was actually willing to help me. Once I found that person, ( I wish I knew her name still so I could send her a present!) she really fought to get my birth covered. She seemed to think it was neat that I was having my baby at home. After our first conversation she did research to make sure that there were no midwives in network that could attend me. She called me back and said that there were 2 midwives covered in my area so she could not extend an out of network exception. The two midwives she was speaking of were CNM's that ran the local freestanding birth center, but they do not attend homebirths. I explained this to her so she called them and found out I was right! After a little more time and after Anthem called my midwife wanting to know why she was the one that had to attend me I got a letter from Anthem. The wording didn't inspire confidence that they would cover me, but it had a reference number on it and did authorize my midwife to bill them. I was told to hold onto that reference number for dear life. My midwife received the same letter and placed it in my file. I was to be covered at 80% and had a $500.00 deductible. I satisfied my deductible with bloodwork early on. My flexible spending account reimbursed me for that. Fast forward 8 months and the billing company for my midwife submits the global bill (this was the one for $4200.00) on November 23rd. I made several calls after this to make sure they had the reference number and all the pertinent info. I thought they would be paying the agreed upon 80%.

Well, they pay 80% of what is "usual and customary" for the services rendered and I imagine the usual and customary cost of a hospital birth for them must be at least 20% more that what was billed because they paid 100%! My midwife got the check in the mail two days ago. I'm beyond thrilled! Go out there, ladies, and fight to get your births covered!

[frenchkissed]

Thank you so much for sharing your story! Congratulations on getting the homebirth you want and the coverage you deserve. I, too, have a PPO plan through BCBS of IL. The first obstacle was getting them to give me proof that they will cover homebirth at all. It took about six phone calls and I was quoted 80%, 50%, 0%, and then either 80% or 50% depending on whether the CNM is a Participating Provider. As a self-employed homebirth midwife, she is not. So I know I will get at least 50% reimbursed after my $1k deductible. I am now working on doing what you said, proving that I deserve an exception due to the fact that there are no in-network CNMs who attend homebirths. Thank you for the encouragement!
-K.

[firewoman]

My midwife is actually a CPM, not a CNM. Do they license CPM's in Illinois? I hope you can get an out of network exception. Just keep plugging away. It was worth the effort it took to get covered and even though they quoted only 80%, look what happened!

[Nicole730]

Woohoo! How exciting!!!

My midwife put a call into my insurance (Golden Rule) and they told her it would be covered 100% after I paid $5000 deductible, which doesn't make sense because my deductible is $1000, I've been thinking about calling myself. I probably should. Plus, with my last pregnancy/birth (hospital) I didn't have to pay any deductible. Hmmm.

[thursday2]

Thanks for the detailed breakdown! It makes me feel better to know the steps to expect...

I take it from your post that BCBS just paid her directly - is that right, or did you pay her, they paid her, and she reimbursed you? If they paid her directly, how did you set that up with her? Most of the MWs I've talked to (though we're JUST starting this process) want to be paid first and then if insurance covers they'll pay you back. When did you start making the phone calls to get coverage - after birth or while still PG? Thanks!

[MayLibertySprout]

[firewoman]

I paid her in full first then once the baby was born and I had my first two postpartum visits at home, her billing company sent in the global bill. Anthem sent her the check and now she is reimbursing me minus 8% for the cost of the billing company. I get $3864.00 of the $4200.00. WOOT!! I started calling around March ( I was in the beginning of my second trimester) and by April I had authorization to see my midwife. You have to get authorization prior to the birth and the earlier the better. They covered some of blood work early on in the pregnancy.