Had my homebirth, now insurance won't pay!

[secondimpression]

Long story short, I had a homebirth assuming my insurance would pay for it based on the research DP and I did and my MW's experience with my insurer. The EOB letter came back with a big fat denial of the claim my MW submitted and they're saying it's not covered under my plan. My MW has never seen my insurer (Blue Cross Blue Shield) deny a client before. DP and I did more research into our coverage and found some contradictory and vague wording.

What originally led us to assume our HBMW would be covered was this:
Also covered are services rendered in a birthing facility, provided that the physician in charge is acting within the scope of his license and the birthing facility meets all legal requirements; and midwife delivery services, provided that the state in which such services are performed has legally recognized midwife delivery, and provided the midwife is licensed at the time delivery is performed.

We did some more searching and found "Expenses related to home birth" under "Services, Supplies and Medical Expenses Not Covered". It didn't elaborate or say anything else at all.

I get that the wording that led us to believe our HBMW would be covered is most likely referring to BC's but it doesn't seem all that clear. The section on maternity care itself is extremely short so I never would have assumed that paragraph was inclusive to BC's only since other paragraphs under the same heading include multiple subjects. And this insurer routinely covers HB without appeals!

Anyone else been there and have advice to offer?

[AZgirl2207]

I got Cigna to pay out of network for my homebirth almost three years ago. It took 24 phone calls/faxes over the course of 10 months. My advice is to carefully document every time you talk to them--full name, date & time, exactly what they said.

My guess is you were denied because 1) they deny everything the first time through and 2) some number code is wrong somewhere. My midwife provided a 'global bill' that included 'all prenatal and maternity care'. Through MCD, I found some magic billing numbers that made BCBS happy.

I think the 'related to homebirth' means they won't pay for birth pool rental, birth kit, vitamins, etc. Based on what you posted, they don't have any real reason to deny you, they are just hoping that you will forget about it and save them some $$$. HTH!

[HappyMommy2]

I had Cigna pay for my last one too. But now I am with BCBS .... and a little nervous. I saw a thread on here that said for the mw to charge separately for the birth vs. prenatal visits. And that they paid for the prenatals, but not the birth itself.

Care to share those magic billing numbers so the rest of us can use them too!?!?!

thanks!

[IdentityCrisisMama]

Do you have a PPO or an HMO?

[stephbrownthinks]

I have been reading and studying for months ways to get an insurance company to pay. We paid out of pocket but were hoping to get something back after the birth, and were willing to cut our losses if we didnt. We had our [perfect] homebirth May 3rd. About a month later I called BS and the person I talked with had NO clue about anything. I wanted them to give us an in-network exception for our midwife since there were no in-network home birth options. After being placed on hold a million times, the lady told me to call the claim department. I was pissed off and got busy and forgot.
Last friday I finally called the claim department and got the nicest lady! We could understand eachother, she was funny, and very helpful. When I brought up the in-network exception she told me that my midwife would automatically be covered as in network since they don't contract through any LM's. Then she gave me the fax number I'd need to send in the claim, double checked to make sure I didn't need any additional paperwork, and went and asked her supervisor if it would be better for the bill to have the visits separately, or globally. She said that obviously they'd need to review the claim, but I should be getting 80% back! She made all sorts of notes in my profile about me so if I ever call back I dont have to start at square 1. I wrote down her name
I really really think it depends on who you talk to and if they WANT to help you or not. Also I'm sure what State you live in. Just keep calling back and asking questions and taking notes. I also think in general people try harder to help you when they know you're keeping track of their name ya know?
BTW, I'm in CA and have a Blue Shield PPO.

[Overthemoon]

I'm sorry you have encountered trouble.
Prior to going with a midwife and after reading over our plan (which did not say they would not pay for homebirths), I called my insurance company to see if they'd be paying or I'd be paying out of pocket. If I was going to be paying out of pocket I'd be using my Flexible spending account to do so.
They asked me if she was licensed and in my state they don't have to be so I responded that way. They said she would be paid as an out of Network provider and if we wanted we could submit a pre-authorization. My midwife is not great at paperwork so she didn't do so. I had to call and remind her to get the bill in before the year deadline as they had the right to deny after a year had gone by. She sent a handwritten bill. They denied coverage. I had checked and saw that on my account. I then called them and asked why. They said it was because of the date of service. She had listed the first date we met and then the end date of the birth. When I explained she saw me monthly and did the birth and baby care, they were like "oooohhh", so they put it back in for payment and paid her all but $400 of the $2,000 bill, which she wrote off for me. She was actually willing to not receive any payment since she felt it was her fault for not getting the pre-authorization in.

I would press your insurer, expenses related to HB is not the same as HB in my opinion so I would start a paper trail and press them until they pay the bill, especially as they have done so in the past for others.

[misskira]

Both the midwives I've talked to have been clear that I should use the wording "non hospital birth with a licensed, non-nurse midwife"

Maybe that wording would be appropriate for trying to get a claim approved after the fact? They said that "homebirth" is scary and confusing to them.
I'm working on preauthorization, and have sent my first request via email so I can get something in writing. From there I'll start my phone call campaign.

[Earthylady]

We were never able to get our two previous homebirths covered. They CLAIMED they would cover IF someone on their list was in network that provided that service. There weren't any midwives that were on the list that provided homebirth. I was so angry. Why CLAIM to cover a service when you clearly don't cover anyone that would provide that service. Out of network had to be covered by us 100%. So our choices were, use someone in network and have insurance cover it, or use someone out of network and we completely cover it. There were no exceptions and no middle grounds.

It looks like we MIGHT be able to get our homebirth paid for this third time though with a different insurance company and living in a different state.

[ShwarmaQueen]

You might try calling again and speaking to someone else. We have UHC and I had to speak to the "dispute resolution" dept many times to get our reimbursment. They picked it apart for 3 months. If that doesn't work, I'd try resubmitting it under different codes.

[nashvillemidwife]

Originally Posted by AZgirl2207

My guess is you were denied because 1) they deny everything the first time through and 2) some number code is wrong somewhere. My midwife provided a 'global bill' that included 'all prenatal and maternity care'. Through MCD, I found some magic billing numbers that made BCBS happy.

No, she was denied because her policy very clearly states that home birth expenses are not covered under the section titled "Services, Supplies and Medical Expenses Not Covered". The wording about midwives is misleading, but there's no bones about this part!

Have her re-bill for just prenatal and postpartum care, they should cover that as they clearly do cover midwifery services, just not the home birth.

[luckiest]

Hm. I'm assuming that in their wording the mention of midwives is a continuation of the conditions under which they will cover a birthing facility. It sounds intentionally vague, and you could probably get into a lengthy debate with them over that semicolon. I read it over and over trying to figure out whether "midwife delivery services" was a completely separate thought, or whether they intended that to refer back to the birthing facility. The semicolon should indicate that the phrases on either side are independent and could also be correctly separated by a period, in which case "midwife delivery services" should include homebirth, but the addition of the word "and" after the semicolon means that they either used the semicolon incorrectly, or they intended its use as a "super comma" to avoid excessive use of commas in one sentence, which would mean that the entire sentence is one thought, and "midwife delivery services" means that they will cover a birthing facility if either a doctor or licensed midwife is present. Phew. Yeah, definitely intentionally confusing.

Have you tried to see if there is an independent billing service you can hire? I don't know how common they are, but my midwives hire a third party to bill the insurance. They charge a fee, I think it was about $50, and then they get a percentage of whatever you get from the insurance company. If you don't get anything they only get that small fee, so they try really hard to get you your money. You wouldn't get every penny due to you, but it would be better than nothing.

Good luck!

(Hi, by the way. This is s.r.y on OD

[laehmichal]

Check on your state's insurance regulations. We are in the appeal process to get our insurance to cover our hb, and we have found in our state they are required to do so, as long as the midwife meets minimum state requirements, and there is no in-network homebirth provider. It is a hassle, but they will make you jump through hoops if they can, to get out of paying. Hang in there, momma!

[secondimpression]

Thanks everyone who has replied, I guess I owe an update.

My MW filed the claim with the local claim office (like she was supposed to do) but something went haywire there. I've called customer service a few times now and they can't do anything for me because the claim was never forwarded to the central office. This could be for about a million different reasons but their best guess is that some piece of information is wrong on the claim and holding it up. It has nothing at all to do with my coverage at this point. The most frustrating thing is that I can't do anything except nag my MW to do some detective work herself. The local claim center will only talk to providers and I'm not one so I have to wait for my MW to get enough of a break from catching all the blizzard babies to follow up on this.

So good news, I haven't been outright denied coverage. Bad news is that my claim only kinda-sorta even exists in the first place. It exists at the local claim center but not in the bigger system. And I can't do a darned thing about it except wait

[firewoman]

I have Anthem Blue Cross and they paid 100% of my homebirth including prenatal and postpartum care. I have a Point of Service plan which means that I have coverage on three different tiers, HMO, PPO and out of network. To get my homebirth covered I called Blue Cross many times in early pregnancy to try and attain an out of network exception for my midwife. It wasn't easy and it took finding the right representative who really wanted to help me. Most of the people I spoke with didn't understand why anyone would WANT to give birth at home and in their minds a midwife at a birth center was the same as a CPM at home. I explained to the representative that the care is different with a CPM and because there were no CPM's in network, I would like my midwife covered because she was the only one within a 50 mile radius that could provide that type of care. My midwife had to fill out some paperwork for Anthem explaining why I had to receive care from her. It took about a month of calling and sending paperwork before I got a letter saying that Anthem gave me permission to see her and that they would probably cover the birth. The representative explained over the phone that I would have a $300.00 deductible and then I would be covered under my PPO benefits which paid 80% leaving me with an 20% co-insurance payment. I was happy with that.

At the time of billing, the midwife's billing company did a global bill and some coding wasn't quite right but after a couple of calls we got that figured out and Anthem Blue Cross paid 100% of the bill. That was a surprise because I expected to only get 80% back. Apparently, the insurance company paid 80% of "what is usual and customary". I suppose because they are so used to paying for hospital births that even paying 100% of the midwife's fees was less than 80% of a normal hospital bill.

So that is my story. I don't think I would have had such an easy time getting the claim paid if I hadn't done all that footwork in the beginning of the pregnancy. Good luck and I really hope you get your claim paid.

[nilatti]

Dear PPs, would you mind posting your state and insurance provider? I live in VA and have Anthem BCBS PPO. I'm getting ready to hassle them about paying for my hb. Apparently it varies not just by plan and provider but also by state...

[firewoman]

I live in California.

[alireb]

OP - oh no! That totally stinks! I also have BC/BS in Maryland - BlueChoice Open Access actually and I have been told by 2 homebirth midwives that BC/BS is the one insurance that does cover homebirths. Can I ask you what midwife you used?

Hopefully this all gets sorted out and it is covered. Did you pay the midwife first and expect to get reimbursed or has the midwife not been paid yet? One of the midwives I talked to this week, said that one of her client finally got her reimbursement check from BC/BS after they kept telling her it wasn't covered and it ended up being covered.

Good luck!!

[secondimpression]

Updating again!

The latest round of phone calls and emails resulted in this: my MW got in touch with BCBS and something was wrong with the codes she "normally uses" and she says it was their mistake. She says that it was corrected and they're running the claim through again. In the same message she asked me for another $500 payment at my PP visit. Er...NO WAY! I've already paid her exactly as agreed to this point. Of course I expect to pay any difference after it's settled with insurance (like we agreed to in the contract!) but I'm not about to shell out another $500 before that.

This whole billing mess is leaving DP and I with a really bitter taste in our mouths over an otherwise wonderful homebirth

[IdentityCrisisMama]

I'm glad you're looking for a possible solution. I'm surprised a MW would ask for $500 for a postnatal. What's up with that? Doesn't she charge a universal fee for all pre/post natal services together?

[moderngal]

I'm happy to hear Anthem paid some for a homebirth!! We live in PA, but DH's company is based in CA and so our plan is from there. Hoping we get some good luck!!
We have Anthem and weren't sure what if anything they'd pay for. We are paying our midwives up front and hope we can submit the bill afterward and get even some reimbursement.