How can I get BCBS (POS plan) to cover my home birth?

[AncientHearts]

I've been round and round with several different reps at BCBS this week and am just learning more about the POS health care plan we have (DS is a professor at a local community college).  I've learned that in my area I must have a referral from my PCP, which is a DO I chose randomly when we were completing our registration paperwork and whom we've never seen since our move to the area last fall, but I'm very hesitant to go to a physician I don't know to ask for a referral to my midwife with the potential that this doc might not be supportive of anything but hospital birth.  YIKES!!  To boot, I'm planning a HBAC and it's hard enough in this area to get a physician to agree to support VBAC in a hospital.  The general birth climate stinks and is very regressive!

Does anyone have any knowledge about:

1) greasing the wheels with a PCP for a good referral

2) perhaps selecting an out of network PCP (who is actually a good friend of my midwife and supportive of home birth) and getting anywhere that way

3) any other methods for getting BCBS to cooperate with a POS plan?

This makes me long for my old BCBS PPO plan but that's not an option this time around.  : /

Any advice and help would be greatly appreciated!!!

Thanks,

Katherine

[LaurenAnanas]

There are about eleventyhundred BCBS plans and they are all different. For example, my husband has Anthem BCBS and I have Federal Employee BCBS, in the same State, and the management, benefits, fees, and co-pays are totally different.

You should ask in your local tribe forum (under the "Finding Your Tribe" section) about local PCPs and there may even be someone there who has your health care plan.

[firewoman]

I have written so many responses to questions like these but it is my pleasure to help women get their homebirths covered.  I had an Anthem POS plan here in California.  My POS had an HMO tier, a PPO tier and an out of network tier, all with different coverages.  Anthem is BCBS here.  If your plan is structured similarly, you should be able to get coverage.  What you need to get is an out of network exception.  This will take pesistance on your part and it will also require getting a knowledgeable and helpful representative.  Once you find a representative that is like this, get their name and direct line.  Keep calling until you find this person.  To obtain an out of network exception they will research to see if any in network practioners in your area provide the same service.  Since she is a homebirth midwife, none will.  Once my out of network exception was granted, I was covered under my PPO benefits which had a $300.00 deductible and after meeting that I was covered at 80% of what was "usual and customary".  I figured I would have to 20% of the birth, but because what an OB charges for prenatal and birth services is more than a midwife, they paid 100% of her fee because her's was less than 80% of what is usual and customary.  If you have any questions feel frre to PM me.  I will be happy to help you.