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Anyone have luck getting Blue Shield of California to pay for a midwife attended homebirth?

post #1 of 9
Thread Starter 

I have Blue Shield of California medical insurance and I am receiving concurrent care from my OB and my home birth midwife.  Blue Shield has already committed to 100% coverage of all prenatal care and a hospital birth, but when my midwife attempted to bill them for one of my prenatal visits, her claim was declined. 

 

I know it can be a pain in the rear to get insurance companies to pay for home births, but I was wondering if anyone has had success at getting this done with Blue Shield?

 

Thanks!

post #2 of 9

I have not personally, but I researched this extensively while preg. I had blue shield and my DH had coverage through his job. I was trying to figure out what would be best to go with and wound up going with his. Anyways, I spoke with them about it and got no definitive answers.

In my search I read a few threads here and also heard of someone through my midwife that was able to get them to cover thier homebirth. It seems it was no easy task and took lot's of calls and letters, but they paid.

 

Same with my DH's ins. It took calls, letters and a meeting with the board, but they paid.

Just keep at them and they will eventually do the right thing. They have commited to paying %100, so a homebirth should not change that. It's actually better for them, because it's cheaper! 

post #3 of 9
We had ours covered 80% in 09. my mw had a insurance person who we paid $100 and she did all the work for us
post #4 of 9
Thread Starter 

Wow, that's awesome!  I have a representative from the insurance broker that my employer uses that does a similar service.  I've sent her an email explaining the issue, but she's out on vacation until next week.  I really hope that she can get any of it approved for me.  It's good to know it's been done before!
 

Quote:
Originally Posted by impatient1 View Post

We had ours covered 80% in 09. my mw had a insurance person who we paid $100 and she did all the work for us


 

post #5 of 9

Mine will cover homebirth, but had a stipulation about CNMs only.  After speaking with them, and explaining California's mandate (they are in PA, Blue Cross PPO), the denied covering my CPM in-network, but would cover out-of-network.  I am appealing this.

post #6 of 9
I have submitted appeal after appeal and could only get them to cover my cnm as an out of network provider and then they only paid 50% of what they thought was a reasonable rate for a mw in CA. So, for my $4500 birth, they paid out $1250.
post #7 of 9
Thread Starter 

Thanks for all the responses, ladies. 

 

I had the claims expert from the insurance broker my employer uses do some digging and she found out that there is pretty much no way to get them to cover my homebirth greensad.gif  The only way it could possibly be feasible is if I were to be referred to the doctor my midwife bills through and transfer my care entirely to that practice.  Which would leave me uncovered for the prenatal care I've been receiving from my own OB.  I'm pretty certain it would cost me more to pay for my OB visits out of pocket than I would even get covered or reimbursed for the midwife fees.  Plus, it takes a couple of months for a transfer to occur anyway and I'm due in just a few weeks.  It really sucks because stupid Blue Shield is going to get off not pay for anything other than a few prenatal visits for my entire pregnancy.  They won't be billed for the birth from my OB because I'm not delivering in the hospital and they won't pay for the home birth.  Makes me wonder why I even bother paying premiums at all.  Grrr. banghead.gif

post #8 of 9

I'm in the same boat. Been paying out the you-know-what for my blue shield ppo for absolutely ever. Now when I actually need them (the only other time they've had to pay ANYTHING for me was for the birth of my first child)  it turns out they won't cover me if my midwife isn't a CNW, even though she's a licencsed midwife in the state of California. I filed a grievance today and am waiting to hear back. Not due till October, but have no interest in wrestling with them at that time so trying to do some leg work now. The worst part is that I started with an in-hospital midwife practice and managed to already meet my deductible... and now I'll have to cover my home birth fees on top of that. Can't remember the last time I laid into someone on the phone so hard. Our healthcare is so screwed up. They'd rather pay an hospital an arm and a leg (2-3 nights stay, >30% c section rate, a gazillion unnecessary procedures) than pay for a home birth. grrrrrrrrrr.

post #9 of 9

Hi there,

 

This website (Berkeley Parents Network - http://parents.berkeley.edu/recommend/medical/midwife-HMO.html) is a great resource on this issue. 

 

It gave me a lot of information about getting my insurance company to cover parts of my homebirth (the prenatal care, but not the birth itself).

 

Good luck!

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