Homebirth and Insurance in PA

[MamaWilson]

I'm sure this was already brought up before but if you could help me out it would be fabulous. We are planning a HBA2C, what can we expect with insurance? Is there a better insurance that serves berks co PA that would be more willing to pay? Can you get any of it covered up front? Or are we looking to put all the money up front? We are so new to this homebirth experience and could really use the advice. Thanks so much!

[appleseed]

What kind of insurance do you have? I'm in Bucks County and have attempted an HBAC and dealt with the insurance aspect extensively - I had Aetna PPO and they paid 80%. Generally, any insurance that will cover or partially cover out-of-network providers is a good bet that they'll pony up as long as your midwife files the correct paperwork. If you have an HMO, it's far harder and you'll probably have to pay out of pocket. If you have Medicaid/Adult Basic/anything government-sponsored (I do now) you have to pay out of pocket.

In my experience most midwives are open to payment plans but want it paid up by the birth, or you can pay up front.

Hope that helps some!

[PinkinPA]

I am in Berks..you can Pm me if you would like.

[jeminijad]

I am hearing that people either

a) pay upfront, let the MW submit the bill to insurance, maybe coded in such a way that it wasn't obviously a HB, and hope for reimbursement, or

b) there are a few CNMs that are in network providers for some insurances. I would start by looking at your current provider directory.

The MW I'll be using if I ever get PG again has a licensed birth center and is an in network provider for my PPO (BCBS of Mass, I'm in Pennsylvania though.) She does do home births, though, billed a certain way.

[AlexisT]

I'm with Highmark (PPO) and they will not pay for non-nurse midwives. There are billing tricks they can use, and I can't swear you won't get something back, but only CNMs are on their covered provider list. There's nothing in my policy documents saying they will not pay for home birth, though.

[MamaWilson]

we have to pay up front and cross our fingers that it will be covered! Our HBA2C midwife is wonderful and hopefully we will be able to work something out. Though its going to be rough financially to pay it up front. It will be better for my health in the long run even if we end up paying out of pocket. Just hoping it will get covered....even HALF will be a blessing!!!

[paquerette]

I have Blue Cross PPO and they paid 80%.

[butterfly1001]

So what I'm seeing is that highmark in PA DOES cover homebirth? I have a CNM. I also have a weird account through DHs work that you get so much put into it every year and you can use it toward coinsurance and deductibles. I would be sooooo happy if they paid! How does the coding work? If it blatantly states that it was a homebirth, do they still pay? Please help, I want to make sure this is done right.

[TSomm]

Originally Posted by AlexisT

I'm with Highmark (PPO) and they will not pay for non-nurse midwives. There are billing tricks they can use, and I can't swear you won't get something back, but only CNMs are on their covered provider list. There's nothing in my policy documents saying they will not pay for home birth, though.

AlexisT-

I'm going through dealing with Highmark right now for my homebirth in February. They haven't denied my claim yet and I'm still working on them. I've got my fingers crossed. I didn't use a CNM. When did you attempt reimbursement?