Anyone have Blue cross PPO in CA

[rose angel]

That is what I have and they said they will pay 100% of what is "usual and customary" for a CNM. They won't say what that is till my midwife bills them though... she thinks in the end I may owe her 1000$ (gulp!) over what insurance will pay... Anyone with a similar insurance? how much did they pay??

[sarahloughmiller]

I had Blue Cross PPO w ds and I did not owe anything. My midwife billed them for as much as she could and they denied a lot of the stuff, but she still felt like she got enough from them that I did not have to pay anything. I think they ended up paying around $3000 total, but I am not sure. I hope you don't end up having to pay that much, it is hard to say until you acctually get the statements back from Blue Cross.

[MomInCalifornia]

We do, it is an individual PPO plan, and they will cover about $1500-$2000 of our $4000 fee. Our CNM is an out of network provider.

We pay it all prior to the birth, then after he is born, submit the claim, and they will reimberse us.

[3_opihi]

I lived in CA with the birth of my last child, and paid cash. But we looked into getting BLue cross PPO, and they would've paid everything except for about $1000 out of a $3600 birth. Which is probably similar to what you would pay if you had the baby in the hospital, since PPO usually only covers 80% or so.

[rose angel]

Actually I had my last baby in the hospital with a CNM and Blue Cross PPO and didn't pay a penny for the entire pregnancy or birth. No copay, nothing. That is why I am kind of shocked that my midwife thinks her fees will be 1000$ over "usual and customary" I have a suspicion she has never encountered insurance quite like mine though. She will submit 3 claims throughout pregnancy/birth. I guess we shall see when she submits the first claim.

[mommy2peas]

We have Blue Cross PPO as well. Our deductible is $2500 a year. Our homebirth with a CNM will be about $3500. We prepay all $3500 and the midwife bills the heck out of Blue Cross. We should end up paying about $1500-2000 for this homebirth.

My DS was born in the hospital and we paid $2500 for his birth (the entire hospital bill was over $8500!!!! For no drugs, no interventions and the OB wasn't even there to catch LOL).

We were told to expect to pay up to whatever our deductible is for the for any birth- hospital or home! The *most* we would be responsible for is the full amount of the deductible ($2500). That should be the case for you too.