Getting an out-of-network referral after the fact? (Blue Cross)

[paisley]

I called BCCA today to check and see how much of our HB fees were going to be applied to our deductible (we have a high deductible plan - we pay for everything until we meet our deductible). Somehow the operator ended up looking up for me how many CNMs there are within 30 miles of my zip, 30 miles being their standard of how far someone should travel. There are none. Then he mentioned that if we had another birth with our CNM in the future that we should call at least 2 weeks prior to the date of service and they would grant an "out-of-network referral" and cover her rates at 70% since there are no in-network CNMs within 30 miles! They are currently covering 15% of what she billed.

Does anyone know how I can go about getting them to cover my CNM under this out of network referral after the fact? He said it doesn't apply retroactively but I refuse to believe that especially since this is the first I have ever heard of any such option. Oh how I wish I had gotten his name!

[Gray's Mommy]

I would keep calling & hounding them. I have BCBS also & literally never filed with them. It was less expensive paying out of pocket than filing & using my deductible.
Good luck & look in the sticky section...there are lots of great insurance tips in there.

[DarcyWronk]

Hey you!
We have BCBS (Preferred Choice PPO, I think) and they paid Sue and Dawn at a pretty high rate (almost 50%). Same deal - no in network midwives in a 30 mile radius.
Anyway, if you want I can ask Sue if she did anything special. We didn't deal with them at all. Sue is a whiz at getting the insurance companies to pay their max. You could also call her at 667-baby.

[paisley]

Thanks Darcy!

[MamaVolpe]

Good Luck, I know insurance co, and it is very hard to get them to do that retroactively. I have never hear of them doing it but your best shot is to appeal the claim requesting for the services to be paid in-plan and play dumb about not knowing your provider was out of network.