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anthem blue cross and homebirth

post #1 of 6
Thread Starter 

I'm wondering if anyone with anthem blue cross insurance was successful in getting them to pay for any or all of their homebirth, or even partial reimbursement?  i am hopefully going to begin ttc this summer, and want to figure out all the stressful aspects of the pregnancy and delivery before i even conceive.  this will be a hbac as well, which i know can make things tricky with the insurance.  i've read many articles on how to go about getting reimbursement; would just like to hear from someone that was successful with this specific insurance company.  i am located in ct, if that makes a difference.  thanks!

post #2 of 6

Well I can't say for sure because I am still pregnant and we have yet to see how everything will work out, but from what I hear so far and based off of my interaction with them, they will cover homebirth but usually as an out of network provider and only in a PPO plan. 

 

My homebirth midwife actually bills through a DO (doctor of osteopathy) and he is in network but I am also getting prenatal care through my hospital midwife as well who is in network. Supposedly my midwife has had no problems billing and it was not seen as duplicate services.  In a perfect scenario in which both are considered in network and covered then we will be out about 2000 or so for both providers, prenatal, delivery and postnatal care. If they only cover our homebirth midwife as out of network then we will be responsible for a bit more 3000-4000 total (including both care providers etc).  \

Now if I would have just gone with the homebirth midwife from the get go, it would be signifcantly cheaper.  I will post an update in a few months when all is said and done to let you know how it ended up working out.

From what I hear Anthem Blue Cross is one of the better insurance companies to work with for homebirths.

post #3 of 6

I'm wondering this as well, as we were unexpectedly transferred by my husband's employer from UHC (that was AWESOME about my HB, paying 90% of out of network) to Anthem about a week after conception (not that long ago). I will say that we immediately called as their online info was lacking, and my husband really had to jump through hoops just to get anyone to figure out the answer. Our form of insurance with them is the HSA (Health Spending Account) so we have a deductible. We were told that if we go with the one in-network midwife in our area, we would have to meet our $4,000 deductible, then they would pay 60% after that for in-network. If we go with our previous midwife, which we are, we'd have to meet an $8,000 deductible, then they would pay 60%. These deductibles are calendar-year for the whole family for our entire care, so not specific to this birth/prenatal care. The HSA deductible is partially paid for by my husband's employer, so that is good. Get to know what your plan means, especially if you have an HSA. We were told that if our midwife is willing, all she has to do is fill out a paper to become in-network. I really don't know if it's that easy or if there are any catches for her. Either way, we pay her a $500 deposit and the total for her is $3,000. I wish I'd known that they were going to change our insurance because we are planners and savers and like to be prepared. I don't know what plan you have or what your exact situation is with Anthem. My advice is to get on the phone with them to see what you're dealing with. I'm in TX, BTW. Not sure if it makes a difference. If you do call them, I would appreciate if you'd update here what they say, as I've been wondering. Also, since this is would be your first HB and you are doing HBAC, I would check with your prospective midwife as to how they handle insurance (some don't take them, or some have medical billers like mine), ask how they deal with hospital transfers and where they go, if they have any doctors they work with, etc. You will want to know ahead of time what you will be financially dealing with if you have an unexpected transfer, because you will be paying for your midwife (who your insurance may view as a doula and may not want to reimburse if you have an OB if you transfer, or maybe she has hospital privileges), plus you will want to know the coverage for the hospital/doctor if you transfer, need to be sectioned, etc. 

post #4 of 6
Thread Starter 

thank you so much for your responses.  we have a PPO.  my husband is a city employee so it's really great insurance.  i guess my next step will be to talk to the two midwives i'm considering and just know what kind of numbers i'm looking at.  maybe they can also shed some light on what previous clients have been able to do.  my poor husband knows i'd like to get pregnant this summer (he'd like to wait another year if it was up to him!) and he doesn't know yet that i want a home birth.  i know he's going to freak, so i want to have absolutely all the questions he could possibly have already answered (especially about money).  my mother has been a labor and delivery nurse for 38 years and she is going to freak as well.  but amongst all the hospital births i have attended, i've also attended a home birth (i am a massage therapist and do labor support) and i have been researching the crap out of everything home birth related that i can get my hands on, so i'm sure my husband and mom know i'm considering it for my next.

xnwife:  so you are receiving prenatal care from the home and hospital midwives?  that's another thing i need to consider, i'm pretty sure that in order for my mom to be supportive, she's going to want me to receive prenatal care from a hospital midwife/OB and use her as a back up in case of transfer.  but i'm thinking that if i do that, theres no way i'll get any coverage for the home birth midwife.  oooo this is stressful!  this is why i'm dealing with it before i even get pregnant!

so looks like i'll make some phone calls to the two midwives and then the insurance company after that.  i'll keep you updated!

post #5 of 6
Quote:
Originally Posted by lisafalknerlmt View Post

thank you so much for your responses.  we have a PPO.  my husband is a city employee so it's really great insurance.  i guess my next step will be to talk to the two midwives i'm considering and just know what kind of numbers i'm looking at.  maybe they can also shed some light on what previous clients have been able to do.  my poor husband knows i'd like to get pregnant this summer (he'd like to wait another year if it was up to him!) and he doesn't know yet that i want a home birth.  i know he's going to freak, so i want to have absolutely all the questions he could possibly have already answered (especially about money).  my mother has been a labor and delivery nurse for 38 years and she is going to freak as well.  but amongst all the hospital births i have attended, i've also attended a home birth (i am a massage therapist and do labor support) and i have been researching the crap out of everything home birth related that i can get my hands on, so i'm sure my husband and mom know i'm considering it for my next.

xnwife:  so you are receiving prenatal care from the home and hospital midwives?  that's another thing i need to consider, i'm pretty sure that in order for my mom to be supportive, she's going to want me to receive prenatal care from a hospital midwife/OB and use her as a back up in case of transfer.  but i'm thinking that if i do that, theres no way i'll get any coverage for the home birth midwife.  oooo this is stressful!  this is why i'm dealing with it before i even get pregnant!

so looks like i'll make some phone calls to the two midwives and then the insurance company after that.  i'll keep you updated!


Yes, apparently she has done that before and insurance covered both. There are currently 5 of us doing the exact same thing at my hospital midwives practice. I am curious (and a bit skeptical) to see if it will work out. Perhaps you can find a homebirth midwife that has an OB backup as that would make the process much easier and perhaps an easier "sell" to your husband and mom.  I had similar concerns about approaching my husband and parents but they were suprisingly supportive. It doesn't hurt to ask. Definitely talk to your midwives about their billing process and if they have worked with Anthem in the past.  I would be hesitant to choose a midwife who does not have a solid billing process in place unless you are good at that sort of thing.  
 

 

post #6 of 6

I lobbied Anthem for more coverage/in-network/continuity of care/all sorts of things for over a year after the birth.  End result: they reimbursed based on out-of-network, despite various claims, grievances, what have you that IMO should have made them cover more.  They reimburse based on THEIR estimate of charges, not real costs, by the way.  Anthem considers a birth to cost about $2000, regardless of what your MW charges.  I will say, though, at least in our experience, do NOT use the global service charge your midwife will give you.  Anthem doesn't process it any differently than the birth itself, which means they basically don't reimburse you for any pre- or post-natal appointments.  If you bill separately for each appointment, plus another bill for the birth, they'll reimburse (out-of-network) for each appointment.  We got back roughly $700 for the birth itself ($500 deductible), but when we refiled all the separate appointments, we got back I think close to another $500.  Still sucky, but better than nothing.  We're in CA.

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