Anyone been denied homebirth coverage by BCBS(MA) recently? - Mothering Forums
Homebirth > Anyone been denied homebirth coverage by BCBS(MA) recently?
jule's Avatar jule 04:45 PM 10-23-2007
I just want to find out if there is anyone out there in the same position as us. We had a homebirth in March of this year and BCBS(MA) are refusing to cover any of the costs under our HMO policy ($2200 for the birth and $750 for 10 prenatal visits). When we initially spoke to them in Sept 2006 they said homebirth was covered under our policy, then in December they refused coverage because our provider was a CPM (and therefore not licensed in MA) and not a CNM, even though they agreed that there weren't any CNMs in MA who do homebirths. We have appealed and appealed (even to the Office of Patient Protection) and have got nowhere. They are now saying that our only recourse is to take legal action against them. Has anyone else had a similar experience?

UlrikeDG's Avatar UlrikeDG 06:15 PM 10-23-2007
My MW (a CNM in Iowa) said that as of the 1st of the year, BCBS went from being one of the easiest companies to work with to being one of the hardest.
PingPong'sMom's Avatar PingPong'sMom 07:07 PM 10-23-2007
We have BCBSMA HMO and they refused unless I had a CNM. Amazing you were able to get them to agree that CNMs don't do homebirths... two phone calls and they treated me pretty poorly, so basically refused.

I was under the impression that BCBS PPO would cover but not the HMO. We gave up, my dh is doing flex spending for the next year to cover our homebirth, but I've got backup at Newton-Wellesley Hosp and the midwives at Women's Health Associates just in case we end up at the hospital... BCBS seems to have no problem with a $45000 bill but not a $3200 one. Go figure.
mom2tillie's Avatar mom2tillie 08:26 PM 10-23-2007
We have BCBS PPO and I was told the same thing, CNMs are covered but not CPMs... too bad the CNMs here are affiliated with hospitals and do not do homebirths.

I love my CPM too much to switch even if I could find a CNM that does homebirths - wait VBAC homebirths... yeah, that's not going to happen here!
pampered_mom's Avatar pampered_mom 10:23 PM 10-23-2007
I have BCBS (MN) and have had them cover both prenatal visits that were billed to them. Of course, under my coverage I have a HUGE deductible, but they at least applied it to my deductible. They were two different midwives in two different states (we moved in the middle of my pregnancy) and both were CPMs (and each licensed according to state laws).

I won't have the experience of the bill going through them for the birth since I'll have different coverage by then, but my previous midwife never had any problems with BCBS MN paying.
jule's Avatar jule 09:53 AM 10-24-2007
I think they must have tightened up a lot on homebirths recently - we know they have reimbursed people before and have also paid our m/w. When we asked them about this they said all previous payments for homebirth had been "in error" - can you believe it! I agree - I find it bizarre that I could have an elective C-section and they'll cover everything - but a homebirth which costs a fraction of that is refused.
mommy2naomi's Avatar mommy2naomi 11:18 AM 10-24-2007
We have BCBSIL and they list my CNM as a provider under their in-network list. She does homebirths and bills the insurance. She's been operating this way for many years. When I called BCBS to pre-certify and they asked what hospital, I just told them the hospital she transfers to instead of saying homebirth.
laohaire's Avatar laohaire 11:28 AM 10-24-2007
I have BCBS-MA. 2 years ago I called them to ask if they covered home birth. They said yes, but only with a CNM. I didn't realize at the time what I found out a day or two later, that CNMs may not attend home births in Massachusetts, so I didn't get to hear the guy squirm on the phone about that. I didn't bother to call back or anything; we just paid a DEM out of pocket.

Yes, it's very strange that I could march into a hospital and ask for a c-section and get all the bells and whistles and that's no problem, but a $2500 home birth was out of the question. I have wondered if I should have tried harder with BCBS; even if I didn't get it covered, maybe just having an increasing number of voices demanding this might change things. Or not.
loraxc's Avatar loraxc 11:39 AM 10-24-2007
Is it impossible to do a gap exception? My HMO does not have any homebirth midwives in network, but because they're mandated by state law to cover homebirth, they have to cover the MWs.
Nicole77's Avatar Nicole77 12:53 PM 10-24-2007
Laohaire, you probably would have gotten reimbursement had you tried. Two years ago when we had BCBS of MA HMO they gave us the same line about coverage only with a CNM. Someone I spoke to on the phone finally suggested waiting and trying for reimbursement rather than direct pay. Apparently, that is more likely for liability reasons.

My son was born December 2005 and we were 100% reimbursed in the spring without a single problem. My sister gave birth at home with BCBS of MA PPO in August of 2006 and was also reimbursed 100%. From what I hear (mostly on MDC) neither of us would have much luck if we tried the same today. Total nonsense. OP, I hope you do fight them all the way through and get paid.
jule's Avatar jule 01:53 PM 10-24-2007
I was wondering about taking them to the small claims court? - Does anyone know whether this is something the small claim court covers ?
jule's Avatar jule 01:59 PM 10-24-2007
Originally Posted by loraxc View Post
Is it impossible to do a gap exception? My HMO does not have any homebirth midwives in network, but because they're mandated by state law to cover homebirth, they have to cover the MWs.
I don't think there is any such law in MA unfortunately - I think this is why the Office of Patient Protection here was unable to help us.
crsta33's Avatar crsta33 03:33 PM 10-24-2007
I know that BCBS TN won't cover homebirth, even with a CNM, and that BCBS MS will. The odd thing is, if you use my midwives, who practice out of TN, and you have BCBS MS it's actually BCBS TN that pays them.