Anyone have experience with Anthem BCBS paying for home birth?

[BigDogMom]

So here I am at almost 34 weeks into my 3rd pregnancy and I just discovered that DH might be up for a home birth (which I've wanted since my last pregnancy).  So I'm scrambling around trying to find a midwife that's available so quickly and trying to figure out how to get insurance to help pay.  I spoke to someone at Anthem who said a CNM could do my homebirth and that it would be covered, but I don't even think CNMs DO homebirths in VA... There seem to be only CPMs available.  I currently go to a Midwives/OB practice but those are all CNMs that do hospital births.  I have an inquiry in with Anthem BCBS about the CPM situation but I'm not terribly optimistic that they'll come back with good news.  Anyone have any experience/ideas/suggestions for how to handle this? 

Thanks!!

[firewoman]

Anthem paid for 100% of my homebirth in 2009.  I'm in california.  Are CPM's licensed throught your state's medical board?  I had a point of service plan so I had three tiers of coverage, HMO, PPO and out of network.  I applied for an out of network exception (when no provider in your HMO or PPO network provides homebirth services within a 30 or 50 mile radius).  It took a lot of calls and some people told me it wouldn't be covered but I kept calling and found someone who would help me.  I continued to call after she started the out of network exception and after about two weeks I got a letter saying I was approved to see my midwife(a CPM).  The prenatal, birth and postpartum would be covered at 80% of what is "usual and customary" and I would be required to pay the PPO deductible and that was $300.00.  My initial labs were $300.00 so that was taken care of.  I had to pay the midwife up front and then after the baby was born her billing company sent a global bill for the entire prenatal, birth and postpartum.  Within a month, my insurance paid the midwife and she refunded my payment minus the fee for having her billing company bill my insurance.

Let me know if you need any help getting this covered or have questions.  If you have a PPO it should be covered!

[nilatti]

Arrrrg.

I'm in VA, had an INCREDIBLE HB in September 2010. And also, it's worth noting, if I had tried to go to the hospital, my baby would have been born in the car.

FWIW, CNMs in VA don't generally attend HBs. I think they technically could, but I've never heard of one who does. If you want a HB, you're looking at a CPM. One thing that Anthem will tell you is, "But look! There are other in-network midwives." It is a terrific pain to convince them that not all midwives attend HBs.

I have Anthem BCBS PPO through my employer. They denied my claim for my HB, stating that "a homebirth wasn't medically necessary." Uhm...Actually, leaving my nice comfy house, getting in my car, and driving 40 minutes to the hospital while I was in transition was not medically necessary.

So, I'm in the process of appealing it. I'll let you know how that goes.

I think part of the issue was that I asked for the paper work to have my midwife covered under a "gap exception" (when no in-network provider offers a needed service, they sometimes will cover an out-of-network provider as if she were in-network under a gap exception. Also, I keep typing "newtwork," which sounds way more adorable), but my MW had to file part of it, and I don't think she ever did. With preapproval, it might go more easily.

There's another user on here who also has a VA Anthem BCBS plan and she got preapproval that said that they would cover her HB...but she just had her baby, so I think she's not on as much right now.

All I can say to you is, GOOD LUCK. And let us know how it goes.

[firewoman]

I should note that Anthem did try to say that there were midwives in my area that provided the same services.  I had to inform them that those were CNM's that ran a birth center and did not offer homebirth services.  Then they contacted my midwife and asked her why I needed to have a homebirth.  Whatever she told them made them happy and I got the out of network exception.  I think getting the out of network exception really makes a difference in getting coverage.

[StillWaters]

Anthem paid for my homebirth, and the didn't seem to notice that my midwife was a CPM, rather than a CNM.  

[BigDogMom]

Thanks for the information!  I just signed up with a CPM group yesterday and they said they've had good luck with Anthem paying in the past so I'm feeling good about it.  I guess I was really worried for nothing (hopefully!!!).  They do have a billing company that (for a $20 fee) hounds the insurance company for me.  Pretty nice.  I find out in "5 business days" what the insurance company will do.  Hopefully there will be good news!  :)