Anyone had a homebirth reimbursed by Blue Shield? - Page 2

[SheBear]

I haven't read the whole thread, but our first homebirth was with a CPM and we had BCBS of Florida. They reimbursed us (only after the birth--we had to pay out of pocket throughout the pregnancy) partially. It ended up being about 70%....it was treated as an out-of-network provider.

We didn't even try to get anything with our last pg or with this one, because our mw is a DEM, and her legal status is fragile. Wouldn't want to put her in any way at risk, KWIM?

FWIW, our CPM did not bill the ins company. She gave us the necessary codes/whatever to file the claim ourselves, then BCBS sent her the check and she endorsed it over to us. Or maybe she just wrote us a check herself....I can't remember.

HTH!

[Emmeline II]

Originally Posted by RachelGS

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

:

[Emmeline II]

http://www.ahealthyme.com/topic/printview
Birth at Home or in the Hospital: What's Right for You

Private health insurance that pays for maternity care has to pay for birth regardless of where it occurs unless it is specifically written in the policy that home birth or birth center births are excluded. If not, and you have a PPO type plan, maternity coverage, and CPMs are legal in your state you can get coverage, but your ins.co. will not make it easy for you. Below is an old post I made for someone in Texas. If you have an HMO, I have a post about appealing them also (somewhere, I'd have to dig on the homebirth board.

My ins.co. told me that only CPMs were covered in a hospital and only Drs at home. I had a homebirth with a CPM and she got paid!

Here's my Texas insurance post:

Private health insurance that pays for maternity care has to pay for birth regardless of where it occurs (though it may be at an out of network rate). At the bottom is a link for gentlebirth; there is a lot of information on that site to help with billing. I'm TX; CPMs and DEMs are legal to practice in Texas.

http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

http://www.gentlebirth.org/cgi-bin/q...&maxresults=40

http://www.gentlebirth.org/archives/money.html#HMO

http://www.texasmidwives.com/

From gentle birth:

To get payment from an HMO, I would have the mother call her insurance carrier and request an "in-network midwife." They will
probably tell her that there is none in network, but they have plenty of other options. She will have to stipulate to them that she has researched
the treatment plan and decided that the midwifery model is her preferred treatment plan. Then she will need to say since there are no "in-network," providers I want a "transfer of care (TOC) exception number, or waiver for the services." (different terms for the same thing.) Many company insurance specialists will have the form. If they refuse to consider a TOC you can file for a review for the denial at that point, then appeal, and finally arbitration or State Insurance Board.

And here is the state board site:
http://www.tdi.state.tx.us/consumer/doctors.html

Notice to HMO Patients
Texas law protects your access to medical care.
If you are not satisfied that your HMO is providing you with the medical services
you need, you should write or call your HMO to complain. If your complaint is not
resolved to your satisfaction, you have the right to request that your complaint be
reviewed by a panel that is made up of members who have not been previously
involved with your case. THE HMO MUST MAKE THIS PANEL AVAILABLE TO
YOU.
If you want to know if you have other rights, call your HMO.
For more information call:
Texas Department of Insurance
HMO Complaint Helpline
1-800-252-3439
In Austin, Call 463-6515

For definition of midwfery care and other good info:
http://www.cfmidwifery.org/midwifery/faq.aspx#1

Definition of OB:

"An obstetrician is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth)."

If you decide to challege your insurance company to pay for your midife, remember to talk to their wallet and not their ear :smile:. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top with hb safety info and check out the WHO because they have a lot of good things to say about midwives.. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top with hb safety info.

Here are some links leading to the parts of Title 45 I quoted:

Googled "Code of Federal Regulations", clicked on it, picked Title 45 from the drop down menu, picked Volume 1 - subtitle A - 1to199, clicked 146 Requirements for the Group Health Insurance Market, clicked 146.130
Standards relating to benefits for mothers and newborns., Clicked on Subpart C,

http://ecfr.gpoaccess.gov/cgi/t/text...l=%2Findex.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...5/45tab_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...45cfrv1_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...46_main_02.tpl

http://ecfr.gpoaccess.gov/cgi/t/text...3.33.1&idno=45

http://ecfr.gpoaccess.gov/cgi/t/text...dno=45;cc=ecfr

[~Megan~]

Each BlueSheild is independent. What it covers in my area is not the same in yours. Companies actually rent the right to use the names "BlueShield" and "BlueCross".

Dh actually works for one of them and they did not pay for our birth, not because it was a homebirth but because they do not pay LPs only CNMs or doctors.

[CanidFL]

I have BCBS PPO and in Florida it's the law that they need to cover homebirth as an in network benefit. My co pay is $20 and that is all I should pay. My midwife fee is $4000 and they sent a check for $900. We are currently appealing and if that doesn't work then we have a lawyer who will take on the case for free. Apparently this is all he does because insurance companies are so cheap in Florida. I'm sure he tacks on a huge fee that is covered under the settlement.

I hope we win!!! My midwife said not to worry and that she will get paid. Apparently she goes through this all the time and always gets paid. Thank god for the awesome laws Florida has.

[Mamabeakley]

It does vary by state. What I found helpful, when my BCBS affiliate told me & my MW yes, no, and maybe on three different phone calls, was to write them a letter and CC it to the state agency in charge of monitoring health insurance companies. The BCBS affiliate wrote me a letter which totally did not answer my question (will you cover my birth?) at all. However, the state agency also wrote them a letter, and they responded to that letter in a clearly stated way (yes, they would cover my birth.) I felt that was clear enough to plan finances around. Good luck!

[stellimamo]

Anyone ever deal with BCBS of Michigan? Good, bad? We are Indiana using a CPM.