BCBS in Michigan, not covered - Mothering Forums

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#1 of 8 Old 08-08-2008, 11:13 AM - Thread Starter
 
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We have BCBS here in MI. A homebirth costs $3000 and the MW was fairly clear that it is not covered by insurance. A hospital birth with a CNM would cost $15 total. I would really like to homebirth but the part of me that knows we are deeply in debt can't justify it. I think we have already decided to go with the hospital birth and not dig ourselves deeper in the hole, but since this will probably be my last, I am really disappointed.
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#2 of 8 Old 08-08-2008, 11:37 AM
 
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I'm sorry, that's a hard decision. I'm in NC, and BCBS HMO will not cover an out of network provider, so I understand where you're coming from.

The only suggestion I have is asking your m/w if you can barter, get a deal (maybe she has "scholarships" or something?), or work out a long-term payment plan. In my area, m/w are usually really willing to work with people, because we're all dirt poor anyway!

Mama to Nov '08 and June '10
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#3 of 8 Old 08-08-2008, 01:38 PM
 
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Won't BCBS cover a birth center? I'd check with Linda at the Birth Place in Taylor and also look into the Birth Center at Providence Hosptial. I assume you're in SE MI. Am I wrong?

Carrin Mama to Sawyer 4/06 and TTC #2 I am a WAHM!
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#4 of 8 Old 08-12-2008, 02:12 AM
 
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I don't know what type of BCBS plan you have. I have BCBS PPO of Michigan. I spoke with them today and they told me that they will cover a CNM in a birth center (usually as "out of network" if it's a freestanding center or "in network" if it's like Providence Alternative Birthing Center in a hospital). They told me they won't cover other types of midwives even in a birth center. They also said they won't cover CNM or even a doctor in a homebirth. I don't know how much of this is true -- they may just be telling me this to prevent a homebirth. I am going to call again tomorrow to get more clarification on the benefits.

Good luck to you.

Edit: From my understanding, the information I was previously given was incorrect. An insurance biller familiar with BCBS said that BCBS won't cover a freestanding birth center facility fee in Michigan because they are not licensed (due to the laws we have here). They will cover the CNM professional fees, though, for any birth setting unless your specific policy excludes homebirth.
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#5 of 8 Old 08-12-2008, 10:32 AM
 
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I know it's been said a lot on this board, but I just want to add that insurance companies SAY a lot of things. . . with DS #1, I specifically asked if they covered a breast pump, they specifically said "No, we do not." Well, they paid for 80% of the Pump In Style. HA!

When I called to ask about our homebirth coverage, I got a resounding "NO. And we will only pay 20% of an out-of-network provider." We were freaking out because there was no way to afford the $3500 homebirth. However, BCBS of MN paid 70% of the homebirth (all the prenatal and postnatal, and probably other stuff too) no questions asked. We probably could have squeezed more out of them, but we had an HSA account with a little left in it to cover the rest. If you have a health savings account/flex, you can use that for midwifery expenses.

The point of this is that it's possible that BCBS of MI could end up paying a significant part of the homebirth care---the problem is that you won't know until AFTER the birth happens, and after you've paid the midwife. We received checks to reimburse the cost of what we paid her, with the understanding that anything over the $3500 would also be signed over to her.

The money part is definitely the hardest thing for so many families. It makes me so sad that it's an obstacle for people who want to birth at home. I absolutely understand not wanting to go into debt to birth at home, but I also know that my homebirth was priceless. Ack, now I sound like a credit card commercial.

Best wishes,
Jen

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#6 of 8 Old 08-13-2008, 05:21 PM
 
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Don't ask the insurance company - ask your MW or provider. Usually if they've submitted to them in the past and gotten paid, it will happen again. There are codes MWs/providers can put in to attempt to get paid.

Autumn (1990) Blake (1993) Zoe (2001) Dmitrios (2002) and William (April 2009) born still @ 39 wks - my 4ever
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#7 of 8 Old 08-13-2008, 07:51 PM
 
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I'm a CNM doing births at home and my birth center. BCBS of MI may say they won't cover any out of hospital birth, but we have received as much as $3000 from them for a home birth. Our usual reimbursement from them is $2200-2800. It will specifically depend on the plan you have.
Also don't mention the word home birth, kind of freaks them out. Just ask about coverage for OOH births, gap coverage and in network exceptions if the service is not offered by any of the midwives that are in network.

I only know of 2 CPMs who have been issued BCBS provider #'s in Michigan. One is now retired and the other has moved out of state.

Linda Johnson

Wife, mother, midwife, triathlete
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#8 of 8 Old 08-13-2008, 08:29 PM
 
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As mothercat just mentioned, the key is to have a CNM...at least for most plans I'm assuming. When I spoke with BCBS of MI (PPO) yesterday, they said they cover CNM only. Maybe I'm wrong and someone has gotten exceptions to this, but that is what they said.

I was also just told by an insurance biller that if there are "no location restrictions," homebirth is usually a covered benefit. When I first called BCBS, they said a birth center is a benefit, but not homebirth. The insurance biller just told me that many birth center facility fees are NOT covered by insurance, but since there are no facility fees for homebirth, it could actually be cheaper. So I'm really confused myself! The biller did say that many times you can get an "in network exception" because there is not network of independent CNM here. So sometimes you can get reimbursed a lot more than you thought you would.
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