Will my HMO refuse care if we have to transfer to a hospital?

[Nova0929]

We are having a homebirth, our second baby. First was an easy, beautiful homebirth. I'm not expecting to have to transfer to a hospital! But just in case ... Wondering what to do. We have Anthem Blue Cross HMO. I don't have an OB/GYN yet but I've heard that I should basically lie to the doctor and never tell her that I am planning a homebirth. That way I can get any tests, ultrasounds etc covered. But yet I've also heard that if we do have to transfer, the HMO doctors will actually deny care and we would have to pay full cost.

Does anyone have any experience with this? Thanks!

[mclisa]

Maybe try posting in the California tribe section or the birth providers section.  Someone in those areas might have dealt with that insurance before.

[HawaiianBlesing]

According to EMTALA they can not "deny" you care.  I can't see how they can refuse to pay if you have to transfer.

Are you UC ing or do you have a MW?  If you have a MW, you might want to have shadow care that shows some sort of pre natal care on record.  I've heard that is the easiest route to go in the event of a transfer. 

There is some sort of working relationship between the OB and you. 

I have a MW and am only seeing my OB for 1.  an early dating US (which is done) and 2.  the 20 week US

The only way I will go back to my OB is if a complication arises.

You could always call the insurance co and ask or check with the HR dept of whomever carries the insurance (you or DH)

[Momsteader]

I would just call the insurance and ask them what their policy is in case of an emergent transfer. You don't have to tell them you're having a homebirth. Just say, 'Hi, I'm x weeks pregnant and exploring my coverage.  I am wondering about what would happen if I went into labor or had an emergency and was transferred to a hospital that wasn't normally covered?'   You don't need to tell them your homebirth plans, but they can certainly explain the coverage to you. You could also ask for a link to their policy online (most are now), have it emailed to you, or mailed. They need to provide you the information on how to use your coverage.

Our policy (a basic BCBS in network coverage only policy) states that in an emergency, care is covered at ANY hospital by ANY provider. However, if you show up and it's NOT an emergency, they can deny coverage.  Showing up in labor due to a homebirth transfer with some kind of complication is most definitely and emergency, or you'd not have gone to the hospital!

[lillymonster]

Are you sure homebirth is not covered? My DH had Anthem and it was, I would assume if it was covered, and emergency care would be covered too.  My hospital is 30 minutes away, but if I don't make it in time, they will cover care if I have to birth somewhere else, like the other poster said if it's emergency care, they will cover anywhere

[Comtessa]

We had an HMO (Kaiser) with my last birth, and I was worried about being denied coverage if we showed up as a transfer without any record of prenatal care with the HMO docs.  The HMO covered absolutely NO midwives (not even hospital-based CNM's!!!!), so using their OB's as my only HCP for the pregnancy was absolutely out of the question for me. 

I ended up seeing a HB MW and an OB at the HMO.  It took awhile to find one that I liked, but I ended up really glad that I went that route.  It was a LOT of visits, of course, but when I did end up transferring from my HB, the OB came to the hospital (on his day off) to attend my birth there.  And he made sure that my birth plan was followed to the letter.   If I had to do it all over again, I'd absolutely get shadow care again.  The difference in the way we were treated at the hospital, vs.  the way we would have been treated, was night and day. 

FWIW, while I hated most of my dealings with Kaiser, I actually liked a few of their practices and policies.  Since they are both the insurance AND the provider, for example, they don't push all the unnecessary tests or crazy interventions that many OB practices will.  They don't want to pay for anything they don't *have* to, after all.  So my OB was actually really cool about it when I refused almost all the tests and demanded that we do things 'my way.'  He was also (cautiously and quietly) supportive of my HB plans. 

Even though I had a relatively uncomplicated time of it last time, I made darn sure this time around that we got some different insurance that would cover a CNM at the birth center. No way am I dragging my toddler to two prenatal visits a week just to cover my butt in case of a transfer.