Harrassed by BCBS

[My*Scorpio]

I had BCBS call today to tell me they won't cover my prenatal care or HB. They had multiple people get on the phone with me saying that HB is not a good idea and it's much safer to have a baby at the hospital. : I think I'm going to file a complaint with my company and with the state's insurance governance body.

[nashvillemidwife]

I agree, send a letter to the insurance commissioner and your company's benefits administrator. Include citations to studies showing that home birth is not riskier than hospital.

[tpintsch]

Originally Posted by My*Scorpio

I had BCBS call today to tell me they won't cover my prenatal care or HB. They had multiple people get on the phone with me saying that HB is not a good idea and it's much safer to have a baby at the hospital. : I think I'm going to file a complaint with my company and with the state's insurance governance body.

You absolutely should file a complaint. BCBS has no rights to say that to you.

[spiderdust]

I'm shocked. BCBS is one of the insurance companies that my midwife says usually gives her less hassle about coverage.

[nashvillemidwife]

Really? Here they're about the worst.

[jennyfah]

So this is for a homebirth that's already happened, and you've submitted a claim for, right?

Contact your state's Attorney General office and explain everything that has happened. Apparently this is extremely beneficial in your dealings with the higher-ups at insurance companies, especially once you mention that you've contacted the AG.

Good luck!

Jen

PS--->BC/BS of MN paid about 70% of our homebirth, and this was after they laughed at me when I initially called to inquire. I cannot believe that insurance companies continue to be ignorant of the huge benefit to them for women who choose to birth at home. It's so much cheaper than the cheapest hospital birth!

[thefragile7393]

Originally Posted by nashvillemidwife

Really? Here they're about the worst.

Yeah, same for here too....

PS--->BC/BS of MN paid about 70% of our homebirth, and this was after they laughed at me when I initially called to inquire. I cannot believe that insurance companies continue to be ignorant of the huge benefit to them for women who choose to birth at home. It's so much cheaper than the cheapest hospital birth!

Well, it goes to show the double standard. They have no problems cutting corners on all sorts of things, but when it comes to birth they have no problems making sure that women have nothing but expensive options for birth. It shows they don't care about pregnant women and their children (for normal pregnancies), they don't want to get flack from providers who are losing money because women choose to hb/uc. Doctors rule with a tight fist here, and insurance companies are right there wtih them....since docs are on their review boards.

[My*Scorpio]

No, I am pregnant - the baby is due in March.

I just can't believe they conferenced more than one person on the line to gang up on me. The one woman/nurse said, "If you heard the stories I've heard over the years, you'd never take that risk." My response, "I know it's not for everyone. I feel it's a huge risk to step into a hospital." The only way I was finally able to get them off the phone was to say, "Well, it's a free country."

[jennyfah]

Again, I'm so sorry that they put you through that. Gross. Like I said, they laughed at me when I initially called, but ended up paying.

Does your HB midwife use a billing service? If she does, and if the prenatal and postnatal codes are submitted, there is a good chance that BC/BS will pay for that. My understanding is that it's all computerized and as long as the codes matched it's fairly automatic. Most midwives bill with a "global fee" that includes all prenatal, birth, and postnatal care. The birth code doesn't usually get paid by BC/BS (IME).

Now, we just need a "magic code" that's automatically paid for homebirth!! :

Document everything, and don't be afraid to stand your ground. You have rights, and they don't own you!

Jen
who strongly believes that they make Explanation of Benefits forms as confusing as possible so that you are intimidated into just taking it!

[janasmama]

we had BC in CA with my last hb and had no problems. We got our reimbursement check 3 weeks after the baby was born.

I never did mention a homebirth though...I just asked if they would cover an out of network licensed midwife.

[roadfamily6now]

that sucks. We have BCBS and they are paying for my midwife.

[~Megan~]

Each BCBS is independent for each state. The one in Oregon does cover HB midwives on some of their plans.

I would definitely file a complaint internally with the company and take it from there. They need some education!

[apelilae]

BCBS in my state takes a firm stance against homebirths and will done cover a single dime of the birth. I said I would appeal and was told it was useless as it is an unsafe choice.

[Snow~Pea]

: subbing. I live in MI and have BCBS, and am hoping to hb(if I ever graduate from NMY). Have you asked around to the midwives in the area. I think I remember a thread in FYT a while back that mentioned BCBS being a pain to get payment out of. I will see if I can find it.

[Snow~Pea]

Here's what I found:

Insurance w/ A2 & BC HB MWs

Blue Cross Blue Shield of MI HB question

Birth center questions
I know this one isn't specifically about homebirth, but its the one I was thinking of that states:

I have heard several times from different midwives that pretty much the only co. they have trouble with is BCBS...they pretty much don't reimburse at all, apparently (though it sounds as if there is ONE person who, if it crosses their desk, you hit the lottery!).???

Hope this helps. Good luck and please let us know what you find out. Oh, and congratulations on your new bean!

[dachshund mom]

It's definitely not all BSBS plans. Mine in Texas is covering everything as in network, so it's just copays and 20% of the delivery costs. They said since there are no midwives in network in my area, they will cover anyone I choose as long as I see an ANP (Advanced Nurse Practioner) midwife. Chances are BCBS will attempt to pay less than she bills for, so I'm counting on having to pay some.

I'm so disappointed to hear how others are being treated. I don't get their logic.

[Emmeline II]

I have BCBS of Illinois and they covered my CPM after dragging their heals for about a year.

I agree with global billing if your mw does the billing, and filing complaints with the insurance commission and the AG. Also, you should go with getting the provider covered not that you are having a homebirth. I have some info that may help (specific to CPMs, but anyhoo..).

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 this is the case contact the benefits office of your employer since they buy the plan). 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.

BCBS
http://www.ahealthyme.com/topic/printview



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 in San Antonio/Converse; 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

[white_queen_22]

We have BCBS through Wal-Mart and our policy specifically says it covers midwifery provided care provided the midwife is practicing within the laws of the state. But it's BCBS in Arkansas (WM's headquarters state) so I don't know if that makes a difference.

ALL Wal-mart employees are covered through BCBS of Arkansas though since that is the state headquarters. If you are a Walmart employee you're covered! I just finished getting all my pre-approval stuff set up! :-)

Angela <><

[My*Scorpio]

To answer a few questions: the insurance company is BCBS of Texas. The HB will tentatively be attended by a doctor (who uses the midwifery model).

According to BCBS, the policy states that OOH birth is excluded.

[robynlyn80]

i have bcbs of tx too. my midwife is a cnm which i think is why she was covered.

i wrote this in another post- but i never told bcbs where i was giving birth. i asked if they covered cnm's as advanced practice nurses and they said yes. my midwife billed a global maternity fee at the end and they reimbursed as an out of network provider. WHERE the birth was occuring never came up. but they have to cover the PROVIDER and i'm not sure they will cover a cpm or a non nurse midwife.