Harrassed by BCBS - Page 2

[texaspeach]

I also have bcbs (though we have a washington plan rather than bcbs of tx)..

in tx, it is the law that they cover any licensed health care provider, though they may do it at out of network rates - but afaik only if you have a PPO. I have a friend who has bcbs of tx and is planning a HB and to get reimbursed by bcbs. I think it really depends on whether you have bcbs traditional, or PPO.

[janasmama]

One thing to keep in mind is when calling you aren't guaranteed anything that anyone says over the phone to you...it has to be in writing.

I think the problem here is asking if they cover homebirth.....just ask about midwives. When a midwife sends in a bill she doesn't stamp 'homebirth' on it or anything.

[nashvillemidwife]

Originally Posted by My*Scorpio

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

They're not going to pay for the birth, you have no way around that. But I still think you should send them a letter complaining about the ignorant lecture you received in lieu of helpful information.

Originally Posted by texaspeach

in tx, it is the law that they cover any licensed health care provider...

A provider is not the same thing as a procedure. They may have to cover midwives (which is a moot point since the poster said her provider is a doctor), but they do not have to cover home birth.

Originally Posted by janasmama

When a midwife sends in a bill she doesn't stamp 'homebirth' on it or anything.

That's not true. Insurance claims have to carry a diagnosis code as well as a procedure code, and the diagnosis code for home birth is "baby born out of hospital". There is no way to distinguish home from birth center with this code, but it has to be submitted nonetheless. To submit a different code indicating the baby was born in the hospital is insurance fraud.

[honeybee]

Wow, Jennifer, that's horrible! Now I'm thinking I really should've pushed the insurance issue for this impending birth, just so I could give BCBS a piece of my mind.... but I just got lazy. Sorry you had to deal with this.

[LoveLife]

I haven't read all the posts, but here's what's happening for me.

I have BCBS of Illinois, and they are covering my HB with and in-newtork exeption. (They call it a PPO waiver.) They sent me a letter w/ my midwife's info on it and the dates she can treat me up until and still be consiered in network. (I think it was 2 months after my due date.)

But I was on the phone at tone every week for about 3 weeks to get what I wanted and they sent me a letter stating they will provide coverage.

Good luck and I hope everything works out.

[Kim919]

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.

I highly doubt they have OB's sitting around answering the phones. Ask what the heck their credentials are to make that kind of statement. I think your 100% right to write a letter, but I would have a hard time holding my tounge on the phone. I would tell the phone operator she is clearly uneducated on the subject and you prefer to take your medical advice from licenced medical professionals and published studies as opposed to insurance company customer service reps. You could go on to say that your not seeking medical advice anyways, your seeking legal information regarding the terms and conditions of your contract.

[Emmeline II]

This is from a BCBS publication, though from a different state; maybe it will be helpful to you; I'll have to pm you the rest as the link no longer works. Have you tried going through the benefits office of the employer that provides the insurance?

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

<img alt="AHealthyMe.com" border="0">

Birth at Home or in the Hospital: What's Right for You
By Chris Woolston
CONSUMER HEALTH INTERACTIVE Carrie Hook had her first two babies in a Minneapolis hospital, where she was surrounded by obstetricians, nurses, and cutting edge technology. When she had her third baby, she was surrounded by a midwife, a house contractor (her husband, Joe), and a tarp to protect the living room carpet. Reviewed by Michael Potter, MD, an attending physician and associate clinical professor at the University of California, San Francisco, who is board certified in family practice.


First published July 27, 2005
Last updated January 9, 2007
Copyright © 2005 Consumer Health Interactive




















Blue Cross and Blue Shield of Massachusetts, Inc. ® Registered marks of the Blue Cross and Blue Shield Association. ®' Registered mark of Blue Cross Blue Shield of Massachusetts. All rights reserved. Blue Cross and Blue Shield of Massachusetts, Inc., is operating under a license from the Blue Cross and Blue Shield Association to use the Blue Cross and Blue Shield names on services provided within Massachusetts. Blue Cross and Blue Shield of Massachusetts makes this Web site available for the sole purposes of providing educational information on health-related issues and providing access to health-related resources. This Web site's health-related information and resources are not intended to be a substitute for professional medical advice or for the care that patients receive from their physicians. Please review the Terms of Use before using this Web site. Your use of this Web site indicates your agreement to be bound by the Terms of Use.

[nashvillemidwife]

The BCBS of Tennessee benefits manual says: "Home delivery services are not covered".

[logcabinmomma]

Blue Cross Blue Shield is different and has totally different services and coverages based on the state you are in (that's why the name ends in "of TN" or "of TX" or "of MA").

There is a call center with healthcare professionals on staff who review claims and talk to patrons. They are typically at least nurse level practitioners and they are the ones who deny and explain claims denials when you call and talk to someone above the customer service level. TN does have a no HB policy, and you won't get any answer wavering from that.

-Kristi

[catemom]

Urrrgh! Health insurance companies really tick me off. I think you should really make some noise about this and even contact your elected officials. Unless we really make it clear to our gov't officials that this kind of BS won't fly with us anymore, then nothing will change and we'll still be dealing with the same companies weaseling out of payment for our health care. Anyway, I hope the b*st*rds have to pay for everything! Good luck to you!

[My*Scorpio]

I called HR today and they are investigating it. Wish me luck. :

[Snow~Pea]

Good luck! :


Anyone have experience with BCBS of GA?

[nashvillemidwife]

Yes, just recently. The benefits manual states they cover all services and supplies related to home birth, but they don't cover MIDWIVES! Because of the home birth policy we didn't even think to check on that before hand so we were sorely disappointed after the birth.

[Snow~Pea]

Originally Posted by nashvillemidwife

Yes, just recently. The benefits manual states they cover all services and supplies related to home birth, but they don't cover MIDWIVES! Because of the home birth policy we didn't even think to check on that before hand so we were sorely disappointed after the birth.

Thanks for the info. It is disappointing, but I am not surprised. I have been hoping to be one of the lucky one's who manages to get some majical reimbursement when the time comes, but have also been saving up in case I have to pay out of pocket. At least this leaves my options open to choose a provider based on my preferences rather than trying to get coverage by going with a CNM or DR that I don't click with. Sounds like I am going to have to pay no matter what. : Insurance companies need to get a clue.