Just want to see if anyone with this insurance was able to get their midwife and/ or birth center covered. I only have access to CPMs in my area, no CNMs, and only one birth center I'm willing to go to.
I have never been able to get them to cover my births, but the thing is, the coverage in hospital (for us) would have cost more than what I paid out of pocket for waaaaay better care by m/w and a homebirth. It was worth paying (and I would have paid that much and then some with deductibles and copays) cash and having a phenomenal birth (two homebirths). I personally don't know anyone who's had their homebirth covered by bc/bs. Good luck if you try though!!
We live in the Ann Arbor area and have BCBS PPO and had to pay our HB CPM out of pocket. I don't know of anyone who has had an out-of-hospital birth covered by BCBS and our CPM said she has never had any success with clients trying to bill them after the fact.
Our paperwork says BCBS MI HMO covers in-hospital birth 100 percent, PPO in-network is 90 percent after co-pay and out-of-network is 70 percent after co-pay. So you might have some out-of-network CNM options, maaaybe. Definitely call around and ask providers if they take your plan, though- we were just looking for a chiro and the one we chose was not on their website, but we called and checked and it turned out they do take our plan.
I think my situation is unique among home birth midwives. I participate with BCBSM and they are currently paying about $3K toward the total cost for a home birth.
Catch is, as far as I know, that the provider has to be a CNM or physician and be participating with BCBSM.
Payment has been better since I went from "registered, but not participating" to "participating". I know that there are other CNMs that are trying to get at least registered and are not having any luck. I'm pretty sure that the midwives at Greenhouse in Okemos have their clients with BCBSM pay them up front, then give them a superbill, and the client gets at least partial reimbursement from BCBSM after submutting the superbill. For a while they clients had a support group that was working with BCBSM to make this simpler.
BCBSM won't register or allow participation by unlicensed providers so I don't think that any of the CPMs can receive payment, nor can their clients, as the midwife needs a BCBSM provider # to put on the claim for it to be processed.
Not sure if it's still true but BCBSM was one of the few insurance companies that has an inclusion clause. That meant that if the employer wanted midwifery services, CNM, CPM, DEM, whatever, included in the plan, they had to specifically request it. All the other insurance companies had exclusion clauses. Midwives were included by default and could only be excluded by employer request.
I was able to get reimbursement for about half the out-of-pocket costs from my prenatal, home birth and postpartum care. We have BCBS Community Blue PPO. My midwife submitted the forms with the appropriate codes for me after the birth (2/09), and about 2 months later I got a check in the mail. I was not expecting to get anything, but decided to try... Glad I did!! BCBS had to pay out several thousand dollars more for my maternal care the first time I birthed, so it was a great deal for them the second time too!
Good luck to everyone submitting to insurance...
I also have BCBS and called them to ask what their rules are for birth centers. They said I have to get an "authorization request " from the birth center, which to me sounded like they will cover it if somebody fights hard enough for it. But in the end I decided on a hospital that has midwoves and has a super good rep with all the doulas I talked to about this, so I can be sure it is insured. I don't think midwives are an issue if they are catching at an approved 'location', but to be sure get it documented and have the midwife assist since they will be the experts on that topic.