BlueCross covers my midwife but not a homebirth? How do I fix that?

[Leiahs]

My family started a new plan through my husband's employer very recently. It's a CareFirst BlueCross BlueShiled PPO plan. I live in Maryland. My CNM is an in-network provider through this insurance. But today they informed me that they called the insurance and found out that a homebirth "isn't covered" under my insurance. Since I expressed some confusion, they called and asked again during my appointment, and got the same answer.

I'm looking at the limited plan information I have sitting in front of me, and under the "Maternity Services" section, Delivery and Facility Services are covered in-network with no charge after the deductible is met. The only footnote to that is that preauthorization is required. My plan also has a funky program where they offer up to a 30% discount to a variety of alternative therapies and wellness services, including acupuncture, chiropractic, meditation instruction, nutrition counseling, even yoga. So I'm not really understanding how homebirth can be just "not covered", period. Especially since my midwife IS covered (if I birth at a hospital, apparently, which is about my last choice at this point in time).

I'll admit I'm an insurance dunce. I have no idea how billing works, claims, all that...it really makes me :. I've read enough threads here to see people talk about "global charges", "gap extensions", and things like that, but I really could use someone's help with figuring out what I can do. I feel like if I just call up the insurance with the one clear question in my head ("Why isn't my homebirth covered?") that I'm not going to get anywhere and possibly even prevent progress if I get it figured out in the future.

So what do I do? How do I communicate with my insurance company to figure things out or even get my homebirth covered? The good news is that we have a HSA account provided by my husband's employer (since we have a $4000 deductible plan), and while funds are only deposited every pay period and not immediately available, we should have the ability to pay for it, even if insurance doesn't cover it. But I'd feel a HECK of a lot more comfortable about proceeding with the plan if I could get the midwife's fees covered and applied to my deductible, in case there should actually be any need, heaven forbid, for us to continue racking up enough doctors appointments to MEET that deductible. I don't want to end up using all our HSA money to pay for the midwife, but maybe have a baby who needs extra medical care and have to come up with another 2 or 3k that we simply don't have, just because the midwife's fees weren't applied to the deductible. Anyway...babbling...I really just don't know how to work with the insurance company, in any way. shape, or form.

[Turquesa]

I'll tell you how it worked for me, and you can see if you're able to do the same. I'm not sure what allowed me to do it--maybe a state law?--but my midwife coached me through the process.

If you need a particular medical service, and your insurance company does not cover that service as a "preferred provider" within a thirty-mile radius of where you live, you apply for an "Exemption." You'll have to make a good case for homebirth being an unprovided medical service.

For us, going through all of this was a pain in the derriere. We called our insurance company about 5 times, each time to be greeted with a different (albeit) creative excuse for refusal. FINALLY, we talked to the HR rep at DH's employer (he works for a big corp) who went to bat for us. The exemption was finally granted, although we're still waiting to get the final bill a whopping 8 months after the birth!

Anyway, you might see if you can do something like this. A good midwife should also have some ideas for you, as I'm sure she deals with this mess all the time. :

[True Blue]

It's quite possible it can be billed without telling them it was a homebirth...have your midwife bill it as 'global maternity care'.

[Leiahs]

In the case of billing it as global....would that type of billing have to occur after the birth? I ask because I'm pretty sure my midwife bills the same way a typical OB would - expecting you to pay the full fee at about 36 weeks. I know with my OB for baby #1, they had already billed my insurance and I had to pay my small portion in the office at 36 weeks.

[pamamidwife]

Most birth attendants bill globally - which means after the birth, they bill for the prenatal visits and the birth as a whole. This billing depends on credentials, not place of birth (unless there is a separate facility fee that the facility charges for).

Your CNM should know about this. Perhaps you could talk to her about it.

[Leiahs]

Yeah, she probably would know. Unfortunately the receptionist seems less than helpful, and she was the one I was talking to today, and my actual appointment was with the midwife assistant. I didn't think to ask her, maybe she would have known.

[ZoeyZoo]

In my area, all of the HB midwives want to be paid up front and then you get to keep any reimbursement. Blue Cross has a good reputation for paying for home birth in my area. I have been advised by the insurance biller not to call it a home birth. They call it a "out of hospital" birth. I believe they also use the global billing codes when they bill.

[maguire708]

Blue Cross covered my Maryland homebirth

When I called to ask BC/BS, the answer was that homebirth was "Not Prohibited" and the woman took about 2 minutes to check and double check the policies and said there was no place in my policy that said they would not cover it, so to "go for it!" Now nobody has ever claimed that insurance companies are consistent, but I'd call and ask for them to tell you where in your policy homebirth is prohibited... someone may just be making assumptions and not actually checking the policy!
The midwife was covered (Evelyn is a preferred provider) and we could have submitted our supply receipt for reimbursement, but honestly, I hate dealing with insurance companies so much that I never did... the $30 was not worth the 1/2 dozen phone calls and me looking for the right forms, you know? We did have to pay a check directly to the other midwife who attended, she was in training, had not yet completed her LPN licensing, and basically she was viewed by the insurance company as a doula but we might have been able to bill for that afterwards as a "birth expense" but that midwife was killed in an accident just a few weeks after my daughter's birth and I was not mentally in a place where I could even consider it.
We didn't rent a tub (third baby so I know from experience that I love a shower in labor, but a tub is not comfortable for me) and I cut down the supply list because I know what I did and didn't use for the previous births (like industrial strength "hospital" sanitary pads... ick!) so I took them off of our order. I would guess that a birthing pool would not have been reimbursed by the insurance company, but other than that we proabably could have gotten back everything except our copay.
For me, paying for the second midwife (really not cheap... $500 I think?) and paying for the supplies out of pocket was totally worth it (other option I considered was driving 45 minutes to a birth center, and considering how quickly my labor went, that drive might have ended with a car-birth if we'd hit traffic!)... my husband wants me to submit the other midwife's fee... but since he doesn't want it badly enough to do it himself, it hasn't been done.

[Leiahs]

Maguire, I'm happy to hear your experience. My midwife is Evelyn also. After some talking with others, I'm suspecting that the receptionist who called the insurance company just didn't know the right way to ask, or something (which is something I'm afraid of not knowing, myself), so I think it's definitely worth trying again.

[maguire708]

Evelyn's daughter is one of the receptionists and she is more likely to know, but I'd call the insurance company yourself (the 1-800 # is on the back of your card) to be sure.
ETA:
I just called and said something along the lines of: "I'm planning a homebirth and wanted to be sure it was covered by my policy, can you check? My friend's homebirth was covered by you, but I've just got to reassure my husband that ours will be covered as well."

[Romana]

When I called to ask BC/BS, the answer was that homebirth was "Not Prohibited" and the woman took about 2 minutes to check and double check the policies and said there was no place in my policy that said they would not cover it, so to "go for it!"

Different employers can opt for different plans. It's entirely possible (likely, even) that one employer would have a plan that includes homebirth, and another would have a plan that does not. The employer, not the state or the health insurance company, determines exactly what's included in your plan (the employer has a number of plans to choose from).

[pixiepunk]

employer choices are very rarely *that* specific - my DH ran his own business for years and we shopped around for insurance for us/his employees for a long time. I never saw anything that got into such specifics, it will generally either cover maternity or not. sometimes the dollar amount they'll cover varies, based on the policy, though, so you might have to come out of pocket for anything over that dollar amount. we did.

we have private coverage through Carefirst BC/BS (we lived in DC when we got it), and ours did cover our homebirth with a CNM, up to a certain $$ amount (with our policy we had a maternity rider, and it covers up to $3000 - that's where an individual policy might vary, the total amount they'd cover). and we've still got that insurance, and it's the same deal now. it covers 100% of anything related to routine maternity care (blood work, u/s, prenatal visits, birth) up to that amount.

insurance people are notorious for saying 'no' when they hear the word 'home' - in fact, they didn't originally cover my pediatrician's newborn visit at my house because they don't cover home visits. but when i explained that it was in lieu of a hospital visit (she'd have to leave her office regardless, and did all the same things she'd have done in the hospital) they covered it 100% less our co-pay.

it seems to me that, worst case scenario, your m/w could bill them for all the prenatal visits regardless since those seem to be taking place in her office. so then all you'd be on the hook for is whatever remainder there is for the birth. she could probably even bill separately for the post partum visits, not specifying that they took place in a different location than the prenatal visits did. so it seems like the very worst case would still not drain your HSA.

definitely talk to the m/w directly, though. it might just be a new receptionist or something.

[Mamabeakley]

I had Carefirst BCBS PPO plans in MD for both my sons' births. I used Birthcare, not Evelyn, but same deal - they are PP for Carefirst.

With my first DS's birth, they told me and the billing people at Birthcare yes, no and maybe (maybe meaning yes they'd cover but only at the birthcenter, not at home). That was over the phone on three separate occasions. I thought that was pretty wacky, so I wrote a letter. I also sent a copy of my letter to the state agency in charge of regulating health insurance companies. I'm sorry to say that I don't have the info on exactly what that office is anymore, but it only took me a few minutes on-line and on the phone to figure it out at the time, so I'm sure you can do the same.

Carefirst sent me a letter which STILL didn't say whether they would cover a homebirth. However, they sent a separate letter, written by someone different, to the state agency, who sent me a copy, which confirmed that they WOULD cover a homebirth. That was good enough for me to be confident about what kind of financial plans I needed to make with my midwives, and indeed, they paid what they said they would when billed globally after the birth (twice - 1x in 2004 and 1x in 2006.)

Good luck!

[maguire708]

Originally Posted by Romana9+2

Different employers can opt for different plans. It's entirely possible (likely, even) that one employer would have a plan that includes homebirth, and another would have a plan that does not. The employer, not the state or the health insurance company, determines exactly what's included in your plan (the employer has a number of plans to choose from).

Which is why I suggested that the OP call her insurance co. directly... even the most informed staff at a doctor's office can not know all of the ins and outs of every insurance plan... asking the insurer will initially result in "no" until you ask them to give you the specific part of the plan that prohibits homebirth, then you can find out what really is and is not covered.

[TheMommyBlawger]

My advice when dealing with insurance companies is to never mention the word "homebirth". It just confuses them. You can call two different customer service agents and get two different answers on the same day. Some ins. co. say that they won't cover HB and then later cover it; or they say the will and then reject the claim.

You are not having a "homebirth"; you are having an "out-of-hospital birth" with an "out-of-network healthcare provider". Insurance companies pay for services and supplies. A "homebirth" is neither. What you want them to do is cover your midwife's services, lab fees, birth supplies, etc. And I think that someone mentioned this before - have your MW submit it as a global charge, and if they reject it, break it down into prenatal visits, etc.

[Leiahs]

Originally Posted by TheMommyBlawger

My advice when dealing with insurance companies is to never mention the word "homebirth". It just confuses them. You can call two different customer service agents and get two different answers on the same day. Some ins. co. say that they won't cover HB and then later cover it; or they say the will and then reject the claim.

You are not having a "homebirth"; you are having an "out-of-hospital birth" with an "out-of-network healthcare provider". Insurance companies pay for services and supplies. A "homebirth" is neither. What you want them to do is cover your midwife's services, lab fees, birth supplies, etc. And I think that someone mentioned this before - have your MW submit it as a global charge, and if they reject it, break it down into prenatal visits, etc.

Someone else suggested this phrase to me as well, and it makes sense to phrase it that way. However, this is an in-network provider, and they already are covering lab fees, and accepting claims for the prenatal visits, negotiating them down to the agreed rate, and putting the charges towards my deductible. I've now spoken with a few others who have used this midwife and apparently the person who does the insurance billing doesn't work in the office, and does use a generic billing code for labor/birth/whatever when billing the the insurance companies. So I'm inclined to believe that the receptionist calling up the insurance to check if they cover homebirth is just wasted time and added confusion, at this point, since she doesn't know the first thing about insurance billing anyway. :

All the same, would it be worthwhile to try and get something in writing that confirms my insurance will in fact cover labor and delivery fees for my in-network CNM, no matter where I birth, like I suspect they will?