Insurance coverage for homebirths?

[2011mama]

How are you paying for your homebirth? I have a PPO with Blue Cross/Blue Shield and the coverage has been pretty good for everything I've used it for so far, but it's a little vague about whether or not homebirth is covered. It says:

"Your benefits include:
• home setting covered with nurse midwives"

Mine is a CPM though, not a CNM. Think I'll run into issues there?

Also my midwife is out-of-network (no CPMs are in network as far as I could tell) so if there is coverage at all, I'll only be covered at the out-of-network benefit which looks like I'd have to pay 30%. If that is the case though I'll be thrilled! My homebirth is going to cost me about $4,000 and will be even more if we rent a pool so if we can recoup any money from the inurance it would be a huge help.

I was wondering what your experience has been. If you weren't covered, did your policy specifically say homebirth is not covered?

My midwife suggested I not call because she said there are certain buzzwords I need to use and certain things I should not say at all or it might result in my not having coverage. She has a biller she uses and recommends I wait until after the birth to submit with her assistance. I know what she is saying but I'm so curious to find out if DH & I will get ANY reimbursement.

 

Edited by 2011mama - 5/30/11 at 8:28pm

[Lynann]

This may help, or it may not. We have BCBS PPO coverage. We used a LM last time and are using a CNM this time (as its a HBAC). We live in Florida, so although our insurance is out of Ohio it still has to abide by Florida law, which states that if there is no network provider within 30 miles the insurance company has to approve the qualified provider as though they were network. There are NO homebirth providers in network in my area. The qualifier is that they consider CNMs as qualified but not LMs.

Last time we had a 30% copay and $400 deductible for out of network. Our midwife charged $4500 total and we payed $1600. However when we got the final statement it showed that the insurance had payed $4500 to the midwife. It was a really long labor (37 hours) with hospital transfer and eventual c-section. Fortunately we didn't have to pay anything towards the hospital bill as we had already used all deductibles with the midwife.

We had to find a new midwife this time because our original midwife was not only out on maternity leave (she had a baby 6 weeks after us) but also does not do HBACs. Our new CNM is fantastic, and much more knowledgeable than our original midwife. I kind of wish we had found her last time. Anyway her fee is $4600, and we have managed to get her approved to be treated as if she was network. From her own experience she did say that the most she has been able to get out of BCBS is $3600, leaving a $1000 shortfall for us (which is still less than if we had to pay out of network fees.) If they do pay out as they are supposed to it should only cost us $500, but we're going to pay the whole $1000 and she will refund us if she can get more out if the insurance company. Most of her BCBS clients have been Florida BCBS, which by all accounts is horrible to deal with, so we might be in for a refund as our Ohio based BCBS seems to have a better reputation.

Personally I can't see that you have anything to loose by speaking to your insurance company. I did find the call center people a bit frustrating, but when I eventually got through to one of the nurses who does preapprovals she was very helpful and gave me a phone number that isn't on my insurance card to call back so I can ask to be transferred directly to one of the nurses (thus avoiding the whole call center waste of time.)

Also I did find the key was to get pre-approval for using the CNM before I actually started using her. I made my initial call for pre-approval request the morning before my first appointment so they back dated my approval once it actually came through.

[firewoman]

My last birth was covered after I obtained an out of network exception.  I had a BCBS Anthem Point of Service plan that had three tiers of coverage: HMO, PPO and out of network.  With the out of network coverage the birth was covered under my PPO benefits which included a $300.00 dedictible which had been met with chiropractic care and labs and the prenatal, birth, newborn and postpartum care was only supposed to be covered at 70% which made our portion 30%.  The caveat to that is the wording they used which was "70% of what is usual and customary".  Apparently what my midwife charged for those services was much less than what the insurance company is used to paying for parallel services through an OB.  So...the insurance company paid 100% of my birth minus the deductible and the cost of paying a professional billing company that my midwife worked with.  That was nominal and I got a huge refund around Christmas time.  It was great.  As far as the wording in my policy specifically stating homebirth was not covered, I'm not sure either way.  Some representatives said homebirth was not covered but obviously they paid so I'm not sure what the policy specifically said.  It was a little difficult to obtain the out of network exception.  I was persistant and kept calling until I got a rep that was willing to help me.  Most were not.  Once I found her, I had to stay on top of it and jump through a few hoops but within about three weeks I received a letter stating that my midwife had been approved as a provider for me.  It also stated that the letter did not guarantee coverage but they covered me and I think that type of wording is pretty standard.

Good luck and I hope you get covered.