Anyone had a homebirth reimbursed by Blue Shield?

[laurata]

My last two births were UP/UCs. This time I'm wanting to hire a local midwife for limited prenatal care and possibly on-site/ out of sight birth care. Unfortunately, I'm seeing a disconnect between what my benefits page says I'll have to pay, and what my midwife says her experience with BSCA pays out. According to my benefits page says, I'll have to pay my deductible ($400) plus 10% ($430) plus whatever they don't pay that is above the "usual and customary" fees (or whatever they are called).

Blue Shield claims they can't give me a pre-approval letter because I have a PPO. Anyone ever succeeded in getting one?

How do I find out, realistically, how much I will be stuck paying out of pocket? All I could get from them, without diagnostic/ billing codes, was that they pay only $1900 per vaginal birth.

Is it possible for me to submit claims after each prenatal and get reimbursed so that I'm not paying as much out of pocket when I pay my balance in full at 36 weeks? (assuming I don't succeed at getting a pre-approval letter from BSCA)?

I have to admit, I feel a little discouraged. I loved my UCs, but feel called to have a midwife available to me this time, even if I end up not calling her (she knows this is a possibility). My dh thought our benefits looked really straightforward, and that BSCA would pay without a fight. But my midwife clearly hasn't had great experiences with them. "They cover a lot, but covers nothing well."

Anyone?

[RachelGS]

BCBS paid for ours (minus deductible), but we had to ride them for a year to get that check.

[runes]

we have bcbs ppo. they paid ours, but they only did it as a 'global' maternity care payment so we had to wait until (as i recall correctly) 6 weeks postpartum and then the midwife submitted everything. we ended up getting a check for approximately 1/2 of what we paid out of pocket to the midwife.

[todavia]

BCBS promised to pay $6000 for my homebirth midwife earlier this year and then they sent me a check for only $3900 . we have a record of their committment for the full amount so i know we'll get it eventually but it seems like it'll be a struggle.

[imommajen]

Anyone who did get reimbursed (even a partial amount) use a CPM vs a CNM?
Talked to them (bcbs) on the phone & they said "absolutely homebirth is covered, but must be a CNM". But, we have chosen a CPM... Met someone from MA (I am in CT) who said not to worry about it, she just submitted after the birth and was covered (minus deductable). Her motto was "ask forgiveness, not permission"!

[KBinSATX]

We used a CPM but we are in Texas and I believe our midwives are licensed (which migth elevate their status?). BCBS reimbursed us at the 75 percent minues deductable that the benefits booklet promised.
The 75% had nothing to to with homebirth or anything. For all they cared for I could have been giving birth on a boat with a goat or in a house with a mouse, etc. The determining factor for this was that the midwives I chose were 'out-of-network'.
My midiwves gave me a 'cash pay' discount. If they had to file for insurance then the global fee would have been $4,000 but if we paid upfront in full by week 36 it was only $2,500. We chose to do that because the allowable for vaginal birth was $2,800 and with that we could be sure that we wouldn't be stuck with anything 'above the allowable', plus the 25% we had to cover was small.
Since we also had to cover the deductable I sent in my bill for all birth supplies (our midwives had us order those ourselves ahead of time from a company called In His Hands). BCBS counted those birth supplies towards our deductable which was a nice bonus.

[mysticmomma]

we have a bcbs ppo national account, and at about 6 weeks pp my mw submitted her claim and got full payment. She is a CPM.

[HerbanGirl]

My head is : with all the different experiences people have had! I'm researching insurance plans before I get pregnant, in order to find the best plan for a homebirth with midwife. Any questions I should ask BSCA and/or midwives in order to make sure we get the best coverage? TIA!

[XanaduMama]

Originally Posted by imommajen

Anyone who did get reimbursed (even a partial amount) use a CPM vs a CNM?

We're also using a CPM, which aren't licensed in NC : so BC won't cover it. Even with a CNM, this issue of the "usual and customary" fees, which aren't specified anywhere, means that they could cover as little as they felt like, despite what your policy says. We met with a CNM when we were interviewing MWs, and she said she's had many people receive only tiny amounts back because of this issue.

[mom2tillie]

We have BCBS federal plan (ppo) and I was told that CNMs were covered but CPMs, which are licensed in this state, are not. I didn't press the issue of how much was covered in the CNM case because I have chosen a CPM. I am prepared to pay the full amount (even though it is a struggle) but I am still going to submit the claim and we'll see what happens. Trying to pay the full amount by 36 weeks too... we are scrimping and saving wherever possible, but I know it's worth it.

[HerbanGirl]

Thanks for the feedback, I'd like to hear more! mom2tillie, are you in California?

[pixiepunk]

we have Carefirst BC/BS and we pay for a maternity rider, so it might be different because of that. but they pay 100% - up to $3000. we had a homebirth with DS (with CNM) and they did exactly that. we ended up owing the midwife around $800 which was the difference between what they charged and the $3000 limit. we also had to pay for the birth assistant, which was another $500.

since i live in a more rural area now and the midwives i'm talking to have fees in the neighborhood of $2500 (both are licensed CPM's in the state of VA, where they live), i'm figuring it won't be a problem. though one of them will process the insurance for me (she pays a service to do it) and the other one i'll have to file it myself... which is a bummer because i think i like the second one better *sigh* but i do expect it to be covered, one way or the other.

[mom2tillie]

I'm in AZ... and although BCBS Fed told me specifically that they do not cover CPMs; my CPM said that she has been reimbursed by them in the past so I might as well submit it and see what happens.

-Iris

[pampered_mom]

Originally Posted by XanaduMama

Even with a CNM, this issue of the "usual and customary" fees, which aren't specified anywhere, means that they could cover as little as they felt like, despite what your policy says.

What usually happens with u&c is that it's based on what comparable providers in the area charge. It's not like they can just decide on that amount themselves - they do have to have some basis for it. There are companies that provide software that makes that decision for them.

[mlis]

BCBS paid our homebirth as an out of network provider. We had to pay our deductible and 20% of costs. After the birth, the midwife submitted a claim and they paid within a few weeks. No questions. I called prior to having the homebirth and the lady on the phone said that if you don't specify that its a homebirth, just an out of network provider, there is a higher chance of getting covered. We don't use cnm's.

We did have to pay the midwives up front, they reimbursed us when the insurance check came in.

[raelize]

i actually talked to them just this week. i had a code from my midwife that she had submitted before to them. they told me that the code was accepted adn even the fine print said it did cover homebirths. it is bc/bs carefirst ppo in md.

[HerbanGirl]

Thanks everyone!

[Momma2DoubleCuties]

We have BCBS of Oregon and I haven't had the baby yet, but they are covering the birth at 70%, so I have to cover about $900 + the $500 deductible I had.

[almadianna]

i didnt have mine under BCBS but i have them now and i know that they have "gap" insurance. As in if you dont have anyone near you that is a midwife that is in their network that is within a certain number of miles (i dont know how many) they will reimburse you for it. I did this with United Healthcare when I had my daughter. I fought and fought and was on hold for ever and wrote letters and all that good stuff, but it finally got done. I know that Blue Cross has done it before as well, I think you just have to really push it.

[attachedmamaof3]

WHA??!?!??! I've had 2 homebirths under BCBS and NEVER got reimbursed for it!! The WHOLE time they've been telling us they don't cover MW's AT ALL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!


ARGH!! Does anyone know how I can resubmit the claims for my 3 yr old and almost 1 yr old?? We paid ALL costs out of pocket.