Insurance Switch at 28 weeks? - Mothering Forums

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#1 of 4 Old 05-01-2010, 02:57 PM - Thread Starter
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Anyone else deal with this?

Until yesterday, we had BShield, which stated quite clearly on their website that home births were covered as an in-network exemption since no midwives were covered as part of their plan. Great. DH's work just switched us to Blue Cross, which not only does not mention home births anywhere on their website (except for a brief line in the "how to choose a birth provider" article that states no one will attend one because they're too dangerous...), but DOES cover a group of CNMs that work out of UCLA. Of course, we didn't get this information until today, a Saturday, so I can't make any phone calls to BC until Monday - if our home birth is no longer covered, we can't afford it. Our out-of-pocket max for non-providers was bumped to $10,000 with this new insurance (whereas the previous was $2000) and we had only budgeted a max of $2000 after reimbursement. We've already put down $1000 to our MWs...

What happens now? I know these are all questions I can probably get answered on Monday, but I'm kind of panicking. I think our home birth might no longer be covered, which means I'll have to go in to the hospital, which I DON'T want to do, especially as we've sort of alienated our back-up OB - she felt insulted by our decision to home birth. I think she'll take us back, but I don't want to. UCLA, where the covered MWs are, is way too far away to be an adequate transfer hospital and frankly too far even for appointments. Has anyone been able to get their new insurance company to accept the provisions of their old plan if they're already in the 3rd trimester? It's the only option I can think of that lets us keep our MWs and our home birth, but I just don't know how to get it...
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#2 of 4 Old 05-02-2010, 07:52 PM
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I'm not sure how much of this is the same seeing as I'm in Canada and I'm assuming your in the US?

But we have Blue Cross through DH's work here too, and my midwife said that they cover homebirth/midwives, so its not a problem

I'd say, if you have a midwife in mind already, just ask them if they've worked with Blue Cross before and if everything is covered.
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#3 of 4 Old 05-03-2010, 02:37 PM
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Blue Cross usually has many level's of coverage, so simply asking about Blue Cross won't get you what you need.

I know that my DH's plan does not mention midwives anywhere, but I called and it turned out that they do. Of course that is under the Out of network provision, and would put you in the $10K deductible.

1. You could readjust your budget.
2. You could speak with the midwife about longer term payment options.
3. You could go to the hospital and have new insurance pay.
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#4 of 4 Old 05-03-2010, 04:46 PM - Thread Starter
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I just got off the phone with them, and they're filing some sort of exemption request and will let me know if I was approved later today...but I'm not sure if it will be at the in-network or out-of-network rate, which obviously makes all the difference.

The big question I have now is: Do you have to have a medical reason for choosing home birth? I was unprepared for this question, and (luckily?) I sort of do, but I'm not sure they'll buy it. I have a really sensitive vasovagal response, which means if you stick me with a needle or an instrument, I pass out - I said I needed to have a home birth because a hospital will require monitoring and internals, etc. that will make me lose consciousness. But I didn't think you NEEDED a reason for home birth in CA - can they deny me coverage simply because my reason isn't good enough?
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