Do any Ma health care plans cover HB?

[phytoangel]

I was wondering if anyone had any luck with a Ma health care plan covering a homebirth? Our first one was no covered because I had an out of state PPO.

Any info would be greatly appreciated.

Thanks mamas!

[Grivas]

in my experience, they will only cover hb if you use a cnm. as far as i know, cert. nurse midwives in ma can only work in hospitals. yep, you read that right. hopefully you can find some other info, but everyone i know who has had a hb in ma paid out of pocket. anyone else hear otherwise?

[acory23]

Good luck with that. Im having mine in a hospital because I cant afford out of pocket. They wont cover a hb with a mw which is about a total of 6k but they will do a 15+k hospital birth??

[Paige, CPM]

Wow lex 6k!

Most the midwives in MA I know charge around what I do, $3,300.00

Yes, I would say about 25 % pf my cleints get insurance coverage. Usually with PPO plans.

It is not true that insurance only covers CNMs.

Who is your plan with, what type plan do you have hmo or ppo? I may be able to find out.

[PingPong'sMom]

My hb was reimbursed!

I have BCBS MA HMO, I got an itemized and coded
invoice from my hb midwife and sent it in. It must have fallen into the right hands because we got a check for $3100 within two weeks.

Honestly, I don't know how it happened. Prior to the birth, we were told it would not be covered. We did dual-care with the midwives at the Birthplace (what was the birthplace) who work out of Newton Wellesley Hospital. We ended up at the hospital and then with a c-section. Sucked. Our plan is awful so we had a $1000 deductible. This was a lot out-of-pocket. But about 3 months after the birth, I sent in the invoice expecting to get denied a few times before we gave up. But they paid!

Good luck!

[FtMPapa]

Originally Posted by Paige, CPM

Wow lex 6k!

Most the midwives in MA I know charge around what I do, $3,300.00

Yes, I would say about 25 % pf my cleints get insurance coverage. Usually with PPO plans.

It is not true that insurance only covers CNMs.

Who is your plan with, what type plan do you have hmo or ppo? I may be able to find out.

Hi Paige,

Any experience with AETNA/Chickering, the grad student plan at UMASS?

I'm pretty sure it's an HMO plan, but I don't actually understand this stuff AT ALL.

[gracequinn]

ok, how jealous am i you got your BCBS HMO to pay for HB!! I submitted like 10 times DENIED DENIED DENIED. sure wish i had your person on their good day in the office

midwifery care is worth every penny and more. i'd do it again if i was ever crazy enough to have another baby LOL

PPO's will generally cover, you can just call your insurance carrier and ask if they cover Certified Professional Midwives or what their reimbursement policy is on out of network providers, sometimes on their websites they have a search engine for finding out what is covered by your policy

good luck!

[MAMom]

BCBS of MA PPO covered my home birth with a NHCM (NH certified midwife) in 2006 as an out-of-network provider. We submitted the rest of the expense to our flex spending account. I know at least a couple of other people who have gotten BCBS PPO to cover theirs since then.

Several people on this forum have gotten partial coverage for home births in MA with CPM's. If you search the archives you should be able to find the threads.

Good luck!

=================
Mama to DS 5/03 & DD 2/06 (HBAC!)
: ICAN “You never know when you're making a memory.” ~ Rickie Lee Jones

[T&K06]

BCBS PPO covered it as an out of network provider, so we had to pay the $600 deductible and then 20% of the rest of the costs. At least it was something!

[witchygrrl]

Originally Posted by FtMPapa

Hi Paige,

Any experience with AETNA/Chickering, the grad student plan at UMASS?

I'm pretty sure it's an HMO plan, but I don't actually understand this stuff AT ALL.

I used to have a similar plan at BU through AETNA/Chickering (as did my DH through MassArt, which may be the same plan as UMASS, actually), so while I don't specifically know about possible homebirth coverage, I can always help you interpret the gobbledygook to make an educated guess about stuff.

In a former lifetime, I used to be a member service rep at BCBSMA, so I know the lingo, so to speak.

[phytoangel]

Ok, so I think that DH just got us signed onto Tufts HMO. Anyone know anything about this plan?:

[FtMPapa]

Originally Posted by witchygrrl

I used to have a similar plan at BU through AETNA/Chickering (as did my DH through MassArt, which may be the same plan as UMASS, actually), so while I don't specifically know about possible homebirth coverage, I can always help you interpret the gobbledygook to make an educated guess about stuff.

In a former lifetime, I used to be a member service rep at BCBSMA, so I know the lingo, so to speak.

Thanks! I'm not even close to PG yet, but I'll keep you in mind.

The gobbledygood is way complicated for me, I'm Canadian, so the concept of having to understand private health insurance doesn't even make sense to me on some deep level.

[jule]

Hi - We had BCBS HMO and were consistently denied coverage for our HB in April 2007. They said they covered HB but only with a CNM - as the PPs have said no CNMs do HBs. We took them to the small claims court and yesterday the court found in our favor. It was a very straightforward process and I'm so glad we saw it through to the end. :::

[MAMom]

Originally Posted by jule

Hi - We had BCBS HMO and were consistently denied coverage for our HB in April 2007. They said they covered HB but only with a CNM - as the PPs have said no CNMs do HBs. We took them to the small claims court and yesterday the court found in our favor. It was a very straightforward process and I'm so glad we saw it through to the end. :::

Very interesting! I have to say I'm a little surprised that the court ruled in your favor, but you must be excited that they did. Did you have to provide documentation from BCBS that they said they would cover with a CNM only, or did they readily admit to that?

It does seem to be their typical line (about covering HB with CNM only) -- it is what they (well, BCBS PPO) told my DH too. He had to go back and forth with the rep for quite a while explaining that was not possible.

I wonder if they will end up changing their policy to not cover homebirth at all? It all seems so silly b/c they could save a lot of money by covering HB, but apparently the politics with insurance companies are so tied up with the hospitals and MDs and this has some influence on the regs they set.

=================
Mama to DS 5/03 & DD 2/06 (HBAC!)
: ICAN “You never know when you're making a memory.” ~ Rickie Lee Jones

[jule]

We had lots of documentation saying they covered HB. Initially they gave lots of different excuses for refusing coverage with our chosen midwife but eventually they stuck to the one about only covering CNMs - even though they agreed with us that there weren't any who did HB.
I'm not surprised the magistrate ruled in our favor after all its just a "gap" exemption - if they don't have an in-network provider then they should agree to cover an out-of-network provider.
I was very organised and able to show the magistrate all our correspondence, copies of their website articles about HB, details about CPMs (from the NARM website) and details about how much an in-network hospital delivery would cost.
We argued on 2 different grounds. Firstly that it is misleading and nonsensical to say you cover HB but then refuse to cover the only providers who do HBs. Secondly we argued that they were acting unreasonably in refusing to reimburse us when the costs were so much less than using an in-network provider.

[jule]

Oh yes - we did wonder if it would mean they stopped saying they would cover hb at all - but I would have preferred that they were clear and up front about coverage at the beginning so at least you know where you stand. There's nothing worse than being told something is covered when in reality its not.
I think also judging by some of the PPs who got coverage from BCBS that this is a case of the right hand not knowing what the left hand is doing. It seems if your claim ends up in the right hands it gets processed no questions asked - ours just never ended up in the right hands. It was interesting the representative from BCBS said this was the second request for a HB in 2 years - therefore lots of HBs are going through under the wire.

[Nautical]

I currently have Aetna/Chickering through Emerson. I called to ask about coverage before even getting pregnant. Then, I called to let them know immediately that I was pregnant. Mine states that I always have to go to the school health center to get a referal except in OB/GYN cases, which they said did include a midwife. However, their coverage was so small, especially if for some reason I would have a hospital birth, that I am switching to my husband's.

Anyway, I looked up the coverage for BU. http://www.aetnastudenthealth.com/sc...ochure0809.pdf

A referral is not required for the following services:
• Obstetrical and gynecological services including:
– Maternity care;
– Treatment for acute or emergency gynecological conditions;
– Obstetric or gynecological services;

A lot of the coverage depends on whether you have the Student Complete Plan or the Student Plus Plan.

Covered Medical Expenses for pregnancy,
childbirth, and complications of
pregnancy are payable on the same basis
as any other Sickness. In the event of an
inpatient confinement, such benefits are
payable for inpatient care of the Covered
Person, and any newborn child, for a
minimum of 48 hours after a vaginal
delivery and for a minimum of 96 hours
after a cesarean delivery. In the event of an early discharge, delivery. In the event of an early discharge,
coverage is available for at least one home
care visit; this visit will be payable at 100%
and will not be subject to any Plan Copays
or Deductibles, if applicable.
Coverage also includes parent education, Coverage also includes parent education,
assistance and training in breast or bottle assistance and training in breast or bottle
feeding, and the performance of any
necessary maternal and newborn clinical
assessments.

(My health care plan stated that I must stay in the hospital for thsoe minimums or coverage would not be provided.)

I would specifically call them and ask about your coverage.

[rocco102475]

Question for Jule

Hi Jule! I am writing regarding your post where you said you took BCBS to court. I have BCBS PPO and had a HB on July 13th '08- I paid out of pocket because my insurance told me the same thing they told you- they cover HB's but only with a CNM. I filed a grievance- they denied.

Can you give me more info on how exactly you went about this? It sounds really complicated.....

Thanks for any help

[jule]

Reply to Rocco102475

Hi Rocco
It was actually very straightforward. The small claims court is designed to be easy to use so its not a complicated process. We were able to use our local courthouse (for us Wrentham). You get a form from the courthouse (ours had a small claims office) and fill it in (its a three part form so you have to go the court to collect it). You put just the basic details of you claim on the form (i.e. BCBS are refusing to reimburse us for the cost of our homebirth on this date despite it being covered under our policy). When you hand in the form you pay a filing fee of $40 (you get this back from the defendant if you win), the lady in the small claims office was also able to tell me when our case would be (it was about a 4 week wait). In Wrentham this is what happens you go at the appointed time (everyone is given the same time), and you wait in the lobby. They then call all the people here for the small claims court into the courtroom. The Clerk then reads the list of all the cases. When your case is called you say "Plaintiff", if the defendant is there they say "Defendant". In most of the cases either the defendant or plaintiff wasn't there - if you show up and the defendant doesn't then you automatically win your case. On our day there was only one other case being contested. You go up to a different room and wait for about 30 mins to see the magistrate. The court hopes that in that 30 mins you negotiate your case with the other party and come to an agreement without the magistrate getting involved. In our case the representative from BCBS said she had no power to negotiate and she needed the magistrate to make the decision - it was like a test case. Anyway we chatted with her quite a lot - she was very friendly and very interested in homebirth. You then go into a small room and see the magistrate. You get to speak first. I had written down what I wanted to say and I told the magistrate exactly what the situation was - that they covered HB but only with a CNM, there were no CNMs who do HB so I had to use a CPM, the HB was considerably cheaper than a hospital (I had some figures on how much a Hospital birth typically costs). He asks questions as you go along. Then the BCBS rep spoke and said they very carefully select the providers they work with and CPMs weren't in that category. He asked to see the relevant bit of the contract which I was able to show him and he asked whether I was happy with the care I received (which I was) and he asked BCBS whether they supported HB (which they said they did). He then said he needed to think about the case carefully as he hadn't come across anything similar before - he thanked us both for being pleasant and stating our cases well. I gave him copies of our correspondence. We heard via letter about 4 days later that we had won. The maximum you can win in the small claims court is $2000 (plus the $40 processing fee).
Overall I am so pleased that I did it - It was quite nerve wracking because we'd never had anything to do with courts before - but I knew if I didn't see it all the way through it would always annoy me (it became a matter of principal really). I had spoken to a lawyer before about our case and he said the magistrate would look at it from a reasonableness point of view - i.e. were BCBS acting reasonably in refusing to reimburse us.
Anyway if you need any more info or moral support please feel free to PM me - I'd be more than happy to help in anyway I can (I can send you copies of our letters etc). If you do go for it -Good Luck!!

[ErinsJuneBug]

Originally Posted by jule

He asked to see the relevant bit of the contract which I was able to show him

Jule - what is this?