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Do any Ma health care plans cover HB? - Page 2  

post #21 of 32
8/5/08 at 5:25pm
Hi ErinsJuneBug
For our HMO policy it was the part of the contract that details when you can use an out-of-network provider (Part 11 - Coverage for services by Non-Network Providers). You can use an out-of-network provider when "your condition requires covered services that cannot be furnished by a network provider and your PCP approves a referral to the non-network provider for the covered services. In some cases, in addition to your PCP, the plan must approve the referral in writing before you receive the services"
Rocco -
I don't know what the contract for a PPO would say but presumably the point of a PPO is that you should be able to use any provider.
BTW - I forgot to say congratulations on your new arrival!!!
post #22 of 32
8/19/08 at 9:02pm

Another question Jule

Hi Jule. I have decided to take BCBS to court re: HB coverage.....I am interested in getting more info from you- how do I send you a PM....
post #23 of 32
8/20/08 at 10:40am
So I figured I would tag my question onto this thread instead of starting a repetitive one. It seems like the "catch 22" is that most of the ins. will cover CNM's but CNM's don't homebirth in MA (is that b/c of law?).

I really want a homebirth for my next birth. My last was a birth center birth and I loved it but I like to think that I deserve a homebirth this time b/c that went so well- and my DH is all for it. However, I don't know what I am going to be doing for insurance. I am moving to MA in 2 weeks and I don't currently have any, DS has state insurance in the state I am in that means if I were pregnant I would qualify as well. I don't know if Mass uses the same qualifying rules though, and I guess I am "required" to have insurance there. DH will get it free through his school as part of his scholarship but it is a LOT Of money for me and DS to be covered as well, more money than we can afford. If we can't afford the insurance through the school I highly doubt we will be able to afford anything else. Which means I will likely have state insurance and I am guessing that they don't cover homebirth. Argh.

I doubt anyone here would think this, but I feel like I need to defend my situation-since I am probably going to have a second child while my first child is on state insurance. My husband it in school (getting his doctorate) he also works part time. I don't work because if I did we would have to pay for day care and I probably couldn't get a job that would make enough for that to be worthwhile, plus I am still full-time nursing (DS is 14mo but he still nurses around the clock) and I don't want to force him to wean before he is ready. Plus I worked part time paying taxes since I was 16 and full time in the 3.5 years before I had my son and in just 3-4 years DH will be working full time to support the family (once he gets his degree) and we will be paying back into taxes so I don't feel bad about using the system to temporarily help us with insurance, which I wouldn't even need if the US medical system weren't so out of control and charged WAY to much money for everything.
post #24 of 32
8/20/08 at 11:42am
Hi Rocco
To send a PM click on a name and it will then pull up some options - one of them should be "send a PM to ....". Try this. I'm really pleased your going to sue BCBS - since your claim was after my court case they obviously haven't changed their policy. I think this is very much a rights issue - health insurance (especially a PPO) costs a lot and it should really cover something as basic as a baby's birth regardless of where it takes place. Good luck.
post #25 of 32
8/20/08 at 10:50pm
Dear Sarah Faith,
In Massachusetts there´s Commonhealth, the state insurance where you pay on a sliding scale according to income you could see if they pay for certified midwives as out of network maybe...
We have Harvard Pilgrim and they paid for half of my homebirth with a CNM this May. They just billed as out of network provider.I only paid 1500.00 worth every single cent!!!
Good Luck, you do deserve a home birth:
post #26 of 32
8/23/08 at 12:59pm

Quest for KGrace

Congrats on your hb....How did you find a CNM that does them?
post #27 of 32
8/23/08 at 11:56pm
Oh sorry´for the confusion I did use a CPM, not a CNM!
post #28 of 32
8/25/08 at 9:23am
Quote:
Originally Posted by rocco102475 View Post
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.
My 2006 HB (with a NH CPM) was covered by BCBS PPO (of MA). My DH was initially told the same thing as you were, and it took a while to get the cust. service rep to understand that it's not possible to have a HB in MA with a CNM. He went around with them for a while on that point. They finally sent our case to their legal dept & it was approved and our midwife was covered as an out-of-network provider.

I know someone else who called all the CNM's on the list BCBS provided to document that they all said they could not attend at home, and they then covered her birth.

I don't know if BCBS will look at your case again after having filed a grievance, but it might be worth a shot before resorting to court. Asking BCBS specifically *how* you can have a home birth in MA with a CNM if no CNM's provide that service? Ask them to provide to you a list of CNM's that they say will attend home birth's (which there are none) if they insist that it's possible. Then call a few people on that list and then call them back with the results. It may take a while to get though to them, but there is precedence here. Explaining you know they have covered home birth in MA with CPM's for other BCBS PPO clients.

Here's an old article that might help.

=================
Mama to DS 5/03 & DD 2/06 (HBAC!)
: ICAN “You never know when you're making a memory.” ~ Rickie Lee Jones
post #29 of 32
8/25/08 at 1:48pm
Hi MaMom
I've already gone through this loop with them. They agree they cover HB, they agree there are no CNMs in MA who do HB, they state that all prior payments for HB with CPMs were made in error. (And I have all this in writing from them). Its no use pointing out that their position is nonsensical. I have sent more than 10 letters including twice to the CEO and twice to the Senior VP (in charge of policy) trying to get a sensible response, but they stuck to their statement that CPMs are a provider type they don't cover regardless of whether there are any other providers. The last letter I got from them was from the legal dept and the last conversation I had with them ended with "your only recourse now is to take us to court". So thats what I did.
So I think unless your lucky and your claim happens to fall on the desk of someone who doesn't recognize the distinction between a CPM and a CNM (as a PP has said who got paid straightaway), writing isn't going to work anymore (even though it may have done a few years ago).
Each letter you write takes time and is emotionally draining - each time you hope you'll get the answer you want and they'll pay up. But it didn't work that way for me. I am very, very pleased I did take them to court and it is a pity other people are having to do the same thing just to pay for basic medical care that is way cheaper than any thing their in-network providers could offer.
Anyway sorry for the rant - its all very frustrating.
post #30 of 32
8/28/08 at 10:19pm
My Harvard Pilgrim PPO benefits handbook has "planned home birth" on the list of exclusions (this same list also excluded "any treatment with crystals"). Now how can I have a midwife show up at just the right moment at my unplanned homebirth?

I don't want to be the bearer of bad news, but I wouldn't discount the possibility that BCBS and other health insurance companies are watching this thread very closely. I just started this insurance policy recently, and perhaps specifically excluding homebirths is a new policy as a result of cases having been tested in court
post #31 of 32
8/29/08 at 1:38pm
We've had Harvard Pilgrim for over a year now and they specifically excluded HB from the outset - so I don't think its got anything to do with court cases. But HP did pay for half on a PP. This whole area is full of inconsistencies. Two of the HB midwives I spoke to about suing BCBS were highly supportive of us taking this approach and thought it was a great idea (and had also never heard of anyone doing this before). I doubt very much that BCBS are paying someone to monitor internet message boards!! - especially when in their view this is something that crops up so rarely. But if HP / BCBS are monitoring then they are just doing their jobs and better informed as a result.
I did all I could to resolve this out of court - I spent nearly two years writing letters to all sorts of different people in BCBS trying to get them to cover it. Mental sanity wise, I would have preferred to have had Harvard Pilgrim from the start of my pregnancy as right from the outset we would have known where we stood - they don't cover it end of story. Instead we had to put up with BCBS saying "Oh yes we cover HB", then giving us all sorts of different excuses for not covering it before finally saying they would only cover it with a provider type that is specifically barred by law from attending HBs.
post #32 of 32
9/2/08 at 4:40pm
since we're talking about health insurance and hb, can anyone recommend good plans?

I started reading this thread because I would like to HB someday (not very likely though, I was lucky I could even convince my husband to be comfortable with NSBC )

More importantly, my BCBS HMO plan is being discontinued because of the reform act in 2006 . My little girl and I are currently getting care at NSBC and Beverly Hospital and I don't want to switch to a plan that considers them "out of network". I am between HMO Blue Enhanced Value and Commonwealth Care. Which would be more likely to give me better choices in maternity care (or at least, partial reimbursement for an hb)?
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