FEP Blue & Homebirth

[mauraa629]

I am pregnant with my 3rd and probably last baby, I would like to have a homebirth this time around, but from what I know my insurance won't cover so I will probably end up with a hospital birth. I have read some people that say how they have convinced their insurance company to cover their homebirth, so I wanted to know if any of you have Blue Cross Federal Employee Program Insurance and if you do did they cover your homebirth? (I live in RI if that matters at all). I called and the first person I talked to said they cover midwives but not an out of facility birth, is there anyway around this? Do I just have to keep calling until I get the right person? I don't really know where to go from here.

[spanishcrunchymama]

I have FEP and planning a Home Birth

ETA: I have FEP Basic, hubby works for the USDA

First, I live in IL, though the Federal program should be the same for any state since it is a Federal program and has nothing to do with the state itself.

Ok, with that said.... I too was under the impression that a home birth was not going to be a possibility unless we paid OOP. I called tons of times and I always got a different answer/response.

Finally I got one representative who was very detailed and explained everything very thoroughly. As long as the MW was Certified as a MW whether she was a CNM, CPN or even a Lay Midwife and she was a preferred in network provider (only because I have the Basic Option, otherwise I am pretty sure you can choose an out of network provider without having to jump any extra hoops) my birth would be covered, at home or at a hospital.

So, I began calling every MW in my area, and turned out that only one MW attended Home Births and she was not under my preferred provider list. So, I called again and explained the situation. I was told that I needed to file an exception of coverage to have an out of network provider be covered at 100%. To do this I had to state that there were no providers within my network and within a 75 mile radius who offered the services I "needed".

I file the exception with the same rep over the phone, she required some extra information from the MW such as tax id number, provider name, etc... 2 weeks later I had my approval letter.

We are having to pay the MW upfront for her services ($2,600) and after the birth, she will file a claim for the charges (not to exceed the $2,600, unless there is an emergency Hospital transfer). BCBS will then pay out the claim and she will reimburse us her fee once she has received the full payment from the insurance.

The only OOP expense was a one-time copay of $25 for the first visit to establish pregnancy, every other visit/exam/US/lab work is covered at 100% with FEP.

HTH

[Lit Chick]

I do not have any experience with that, but how much did you pay for your other births? With my first HB, I paid fully OOP but was reimbursed all but a few hundred. My friends who had hospital births ended up paying far more with copays, etc.

I have since changed insurance and have no idea if the coverage will be the same or not, but even if it ends up all OOP it is well worth it.

I hope you are able to habe a HB!

[lizajane80]

spanishcrunchymama - help

I am in the exact same boat that you were in and I'm glad I found your post. I have the same insurance, basic plan, and there are NO homebirth midwives in the preferred providers list. We are in CA.

I have spoken with a few people at Blue Cross who adamantly refuse to let me file for an exception, saying there is absolutely nothing they can do for me and I will have no coverage unless I switch providers. When I suggested that I am eligible for an exception since there are no midwives within 100 miles, they said it didn't matter anyway.

I have to have a homebirth since my deliveries are only 40 mins (this is my 5th) and there's no way I would make it to a hospital in time.

Do you have any other suggestions for getting customer service to allow you to file for an exception? I asked to speak to a supervisor but they said she was on the phone and would call me back (which she didn't).

I also read on the fepblue website:

Under Basic Option, benefits are not available for care that is performed by a Non-preferred provider, except in certain situations:

**the preferred provider is unavailable in special provider access situations.

Any idea what special provider access situations are?

Thanks for your help!!
Liza
(you can email me if you'd rather)

[lizajane80]

Also...

Forgot to mention that I am 32 weeks along and have been seeing my homebirth midwife since February. When I called FepBlue way back then they told me homebirth was covered and didn't go into preferred providers, etc. I really can't imagine switching to an OB practice at this point - not to mention that I would never make it to the hospital in time! I think these are solid grounds for an exception!

We paid a $1000 deposit to my midwife when I told her we couldn't afford to pay $3900 out of pocket and wait to be reimbursed later. (When I had homebirths in UT where we previously lived it was only $1200 and then $1800 total out of pocket for a homebirth - much cheaper than CA!).

So my midwife here took me on in a great act of kindness, saying she would wait until my insurance reimbursed her. Just today her billing person said she verified my insurance benefits and I have none. I am frazzled and want to get this settled asap. We really can't afford to pay the remaining 2900 out of pocket though. I can't imagine making $500/mo payments for the next six months when we are paying for great insurance already!

[motherhendoula]

check out this website: http://www.homebirth-usa.org/choosing/insurance.html
it states: Also, some states require insurance companies to cover homebirth if insurance policies or HMO contracts provide coverage for maternity care. New York, California and Florida are some states mandating such.
I live in NY and was aware of this. Sort of like if the insurance co was to say "oh sorry, we do not have midwives as providers..." the state is saying ...well you MUST provide the type of care this mother is asking for....so its like ALL legal homebirth midwives can be covered for services through ALL insurance companies. I hope that made some sort of sense!!
Talk to local midwives - they will know how they are getting paid and will be able to recommend something to you.
good luck

[spanishcrunchymama]

Originally Posted by motherhendoula

check out this website: http://www.homebirth-usa.org/choosing/insurance.html
it states: Also, some states require insurance companies to cover homebirth if insurance policies or HMO contracts provide coverage for maternity care. New York, California and Florida are some states mandating such.
I live in NY and was aware of this. Sort of like if the insurance co was to say "oh sorry, we do not have midwives as providers..." the state is saying ...well you MUST provide the type of care this mother is asking for....so its like ALL legal homebirth midwives can be covered for services through ALL insurance companies. I hope that made some sort of sense!!
Talk to local midwives - they will know how they are getting paid and will be able to recommend something to you.
good luck

This however would not apply to FEP since it does not have to follow state regulations because it is a FEDERAL plan.

[lizajane80]

Denial Frustration

Well, after talking to Blue Cross/Blue Shield of CA (Fed. employees) for two weeks and talking with different managers and depts., and filing letters of appeals, everyone has said there is nothing they will do for me (again, because my Basic plan only allows me to use preferred providers on their list). They refuse to grant an exception based on location (no homebirth midwifes within 100 miles) since there are plenty of OBs who are their preferred providers I can use, REGARDLESS of the fact that I don't and can't use their care because I won't be able to physically GET TO THEM in time for delivery.

Also I've been denied a medical exception since my births are too fast for me to transport to a hospital/birth center ... for no reason other than they just won't do it. They originally told me to go see an OB who is a preferred provider and get him/her to say it's medically necessary for me to birth at home. Now, this morning, they have called me TWO TIMES to say I should not pursue that route because they still won't grant me any type of exception no matter what one of their docs say.

My husband thinks that means they're worried they'll have to cover me if I do go get a letter from an OB. I am sick of all this at this point!! Most ridiculous thing ever. I'm only asking for a $2500 reimbursement compared to much more for a hopsital birth plus ambulance costs when they find me pulled over on the freeway!!