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Homebirth with Anthem BCBC in VA  

post #1 of 14
8/15/08 at 3:38pm
Thread Starter 
I have been trying to read and absorb the wealth of info on this board. I'm new and am hoping I can get some advice on making my first pregnancy a homebirth. I have Antthem KeyCare BCBS PPO. I have called and gotten the following information:

1. They do cover birth centers
2. The do cover CNM and CPM with the caveat that they must be under the supervision of "qualified healthcare provider" which the rep said referred to a Doctor
3. They do cover birth kits
4. They do cover homebirths. I specifically asked, which I later found out can be a double edged sword
5. They do not cover Doulas

Has anyone else had a successful homebirh with this insurance provider?
Do I need to get the above things that were told to me in writing?


I have called Birthcare and was placed on a waiting list (EDD of Dec, I was 2nd on the list).

Is there anything else I'm missing and need to know as far as Birthcare billing for BCBS?
post #2 of 14
8/17/08 at 1:32am
I used Anthem BCBS 2 yrs ago for my homebirth in Virginia
The birth was covered 80/20 after meeting my deductible - per plan for an out of network provider.

I used my Flexible Spending for my Doula - BCBS denied this claim (I expected them to)

The newborn exam was the sticky one - for *my* plan routine care needed to be done "in network" - meaning, I needed to choose a primary care physician for my children's well visits. The newborn exam counts as a "well visit" and the claim was denied. It didn't cause a problem for me and my provider tho.
post #3 of 14
8/17/08 at 2:22pm
We paid upfront to our CPM for a homebirth, and it was reimbursed 80/20.

This is with the caveat that we are on the Federal Employee Plan.
post #4 of 14
8/17/08 at 3:22pm
I don't have specific experience with Anthem, but you can take a look at www.novahomebirth.org and see what others in No Va may have to say.
post #5 of 14
8/17/08 at 4:57pm
I don't have Anthem, but I am birthing with Birthcare (Sept EDD) even though they are out of network for me.

Have you spoken with Leo at Birthcare? He handles all of the billing, etc. and can tell you what the insurance companies normally pay.

In my case, since Birthcare is not in network for Cigna, I've had to pay the fee in full. Once the baby is born, the claim will be filed and hopefully I'll get back 80% of it. You may want to find out whether this is how you'd need to do it for Anthem, since I imagine it could be a bit of a shock to get the call that you are off the list, but need to pay $4k immediately!

Good luck - I've had nothing but positive experiences with Birthcare so far.
post #6 of 14
8/18/08 at 9:40am
Thread Starter 
I tried contacting Leo, at Birthcare but he has been on vacation. I believe he gets back today so I haven't had a chance to talk to him. Birthcare would not be out of network so I know I would have to meet my $200 deductible and then 80/20 coverage would kick in.

Amy, when you say the newborn exam are you talking about the babies first "doctors visit" a few days birth or the exam they give immeadiately following the babies birth? I didn't even think to ask about that. I figured if they cover my birth, it would include care from my new baby. Does that make sense?

I'll post more after I speak to Leo. Thanks ladies.
post #7 of 14
8/18/08 at 9:19pm
Just to follow up - I'm not aware of Birthcare charging anything specifically for the baby after the birth, even though they obviously do an immediate newborn exam (and then expect parents to follow-up with a ped within 24-48 hours)

My understanding is that this is included in their "global" fee - and there isn't a separate cost listed on their price sheet (just checked).

Hope this helps!
post #8 of 14
8/20/08 at 1:45pm
Thread Starter 
Just wanted to update you guys and say I just got a call from Birthcare, saying they had a slot open up and can take me!!! :

I still haven't been able to get in contact with Leo. I think I read somewhere that Birthcare requires you to have a birthing assistant and that it's often not covered by the insurance co.

Should I just let them submit the claim and hope they cover it? Money is definitely an issue. I'm not even sure how much a birthing assistant cost
post #9 of 14
8/22/08 at 9:09pm
Congrats, the Birthcare midwives are fabulous.

Our birth assistant charges $600.00, I believe. With our first, we had Carefirst BCBS HMO and they covered almost all of the birth assistant fee. We paid upfront and then a check came to us via Birthcare.

HTH!
post #10 of 14
8/25/08 at 11:28pm
Quote:
Originally Posted by chocolatemama View Post
Just wanted to update you guys and say I just got a call from Birthcare, saying they had a slot open up and can take me!!! :

I still haven't been able to get in contact with Leo. I think I read somewhere that Birthcare requires you to have a birthing assistant and that it's often not covered by the insurance co.

Should I just let them submit the claim and hope they cover it? Money is definitely an issue. I'm not even sure how much a birthing assistant cost
Congrats!

Anthem paid 80/20 for my HB. My MW submitted the paperwork, and I had a "preapproval" letter before my birth.

I paid out of pocket for a birth assistant, and it was $400.

Our first ped visit was covered like any doctor visit.
post #11 of 14
9/17/08 at 10:07pm
can I just ask this? I have anthem BCBS and had a HB with CPM in January. Any chance of getting it covered now? I wish I had looked into it more then. My MW doesn't file for me, how do you get the forms to file?
post #12 of 14
9/18/08 at 9:12am
Quote:
Originally Posted by wearbaby View Post
can I just ask this? I have anthem BCBS and had a HB with CPM in January. Any chance of getting it covered now? I wish I had looked into it more then. My MW doesn't file for me, how do you get the forms to file?
Emily, Before licensure I had a client who submitted months or even a year after the birth. They reimbursed her. It was Blue Cross Blue Shield. It's worth trying, that is for sure.

Tammi
post #13 of 14
9/20/08 at 11:33pm
Quote:
Originally Posted by wearbaby View Post
can I just ask this? I have anthem BCBS and had a HB with CPM in January. Any chance of getting it covered now? I wish I had looked into it more then. My MW doesn't file for me, how do you get the forms to file?
Call the 800# and ask for a claims form. Post on the NoVa Homebirth yahoo group or PM Tami and see if you can get the code for your the form.

Good Luck!
post #14 of 14
9/22/08 at 4:32pm
Thread Starter 
I have my second appt at Birthcare next week. I'm doing the Glucose screening test. I'm getting worried about the cost and everything regarding my insurance paying for it. I'm just so scared I'll go through all this, them saying they cover something and then BAM! They renigg on it.

My main question is: Is a birthing assistant and a doula the same thing. I was specifically told that BCBS did not cover Doulas, but reading the description of a BA in my Birthcare paperwork, it seems the function exactly like a doula. Which contradicts a lot of everyone elses experiiences in that they were eventually reimbursed for all or part of the BA fees.

Can anybody clarify this for me?
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