Has anyone in VA gotten Anthem BCBS to pay?

[nilatti]

I have an anthem PPO, and so far they are denying everything for my homebirth. If anyone was successful,could you please tell me how?

[MegBoz]

Darn! I JUST got Anthem BCBS PPO based in Virginia (that's where the HQ of my employer is, even though I live in Maryland.) I was going to call & see if it's covered just today. I'm bummed to hear that you're not having luck thus far.

My MW has a billing service (& I have to pay an extra $200 to use it!) What I've heard - both from other Maryland HB Mamas & the billing service - is that you can often get the MW covered at an out-of-network rate if you don't tell them it was an HB. The "facility" and "provider" are generally billed separately anyway - so they get the "provider" bill from the MW & just never realize that a "facility" bill never comes. If they don't officially cover HB, that's the best way to do it.

However, the billing service told me that some plans DO offer coverage for HB - in which case you can get an out-of-network provider covered at an in-network rate! (If there are no other in-network providers offering the service, yet the insurance says they cover the service.) The billing service lady told me she's had better luck with this when the mama calls, as the insured person, rather then when she calls herself to make this request.

The whole thing is so, so, so absurd. Drives me completely insane. Insurance companies are known for watching the bottom line, wanting to maximize profits, and minimize how much they pay out. THEY SHOULD LOVE HB!!! They should encourage it - it's substantially cheaper for them. But, they are quite obviously influenced by the gigantic lobbying-organization that is AMA, in addition to being influenced by a desire to maximize profits. It's just awesome!

I'll let you know what I find out over the phone today. (I'm due in March, so need to plan for how much I'll pay out of pocket, so I can put the right amount into my flex-spending account.)

[Ravin]

I've got AK BCBS, and when I called them it seemed promising enough for me to switch over to the plan with the $1000 flex spending acct instead of the high deductible/MSA plan I'm on this year. Even if they pay out of network, it'll be a fair chunk of the bill I won't have to pay out of pocket!

Keeping my fingers crossed that it works.

[Funny Face]

I'm in Texas and a lot of the midwives here are up in arms because BCBS hasn't been paying even when the benefits state that they should. I called and asked for a letter stating that they would pay my midwife at the out of network rate that my plan outlines, hoping a letter will be beneficial if I have problems when billing after birth.

I hope something works out for you! I'm crossing my fingers for myself as well. :)

[nilatti]

Well, I called Anthem, and a very nice CSR there apologized and recommended that I appeal on the grounds that no in-network providers do homebirths in my area (it might be possible to get it covered at in-network rates with this argument). I should be receiving an appeal form in the mail in a few days. I'll let you know how it goes.

The part I don't get, though, is why they make it so hard. Anthem could pay my midwife 100% of her fee, write me a check for $5K just for fun, and STILL save $$ compared to a hospital birth....they should be begging women to have their babies on their bedroom floors!! Does anyone know what gives?

[MegBoz]

Yes, if insurance companies really place profitability as their #1 most important objective, then they should indeed be jumping to not only provide 100% HB coverage, but provide incentives to encourage it! It's really very odd.

My only guess is that they're influenced by AMA / ACOG. (As we know both officially oppose HB.) AMA is actually one of the largest lobbying organizations in the nation. THey clearly have influence in government, so I assume said influence applies to insurance as well.

I'd guess they have the insurance companies convinced that since HB is so "dangerous" & transfers are always "train wrecks" that if they provide HB coverage, they'll end up paying much more in the end for a diaster that would have been averted had the woman been in the hospital to begin with. 

Ya know, truth be darned.