Homebirth MW in Chicago area--any in network w/BCBS PPO - Mothering Forums
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#1 of 8 Old 06-07-2010, 10:45 AM - Thread Starter
 
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Hi--I interview Sarah Simmons who is not in network for me. She didn't know if there are any CNMs in network for BCBS, but if there were not, that it was possible to file for some exception for in-network coverage with someone who was not. Make sense?

So I am trying to find out, does anyone know? Help?
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#2 of 8 Old 06-07-2010, 10:24 PM
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Jen Gagnon at A Woman's Place was in network with BCBS two years ago when I had my homebirth. And is fabulous
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#3 of 8 Old 06-08-2010, 11:45 AM
 
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Sarah Simmons (city) was in network last I knew... hmm.. actually she's listed on my BCBS page (my BCBS PPO runs out the end of June). Jewel Madea is listed as in her office (she's Jen Gagon's old partner) as well.

Jen Gagon (city) isn't in network for anyone, you just get the out of network rates for her and pay the difference out of pocket.

Hillary Keiser in Oak Park takes BCBS PPO.

Debbie Boucher (north suburbs) I'm pretty sure isn't in network for anyone, like Jen will get paid at the out of network rate.

Christina Oser (west suburbs) - her site is down, but my friend who is using her says she does take BCBS.

Lisa, mama to Lauren, Elliot, angel Marion, and baby due in the fall.
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#4 of 8 Old 06-08-2010, 03:17 PM
 
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Leaw, that's not a true statement regarding Jen.

Quote:
Originally Posted by CEG View Post
Jen Gagnon at A Woman's Place was in network with BCBS two years ago when I had my homebirth. And is fabulous
Yes to this. I had a HB in Dec with her and it was covered in-network.

OP, you should really call your carrier and check on your coverage. Even though we both may be under BCBSIL, there might be variances from plan to plan. You can search for a provider online, I believe it's under 'specialty' and then CNM.

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#5 of 8 Old 06-08-2010, 03:33 PM
 
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Carson, I was just going by what the FAQ on her website says right now. She's also not listed on my BCBS find a provider page, so???

Lisa, mama to Lauren, Elliot, angel Marion, and baby due in the fall.
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#6 of 8 Old 06-08-2010, 03:36 PM
 
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FWIW, I'm searching from the national BCBS directory, not the IL directory.

To the OP - call your 800# for providers, there are currently 5 cnm in the greater Chicago area who attend hb, they are all listed on this thread.

Lisa, mama to Lauren, Elliot, angel Marion, and baby due in the fall.
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#7 of 8 Old 06-08-2010, 04:20 PM
 
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Huh, that's weird. I even went to her for a separate visit earlier this calendar year and it was covered-in-network for me. I guess something changed!

I agree, call the # on your card to check.

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#8 of 8 Old 06-08-2010, 05:47 PM
 
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Oh and OP again - you asked about getting an exception for coverage for Sarah if there weren't any midwives...

The thing is, insurance covers by provider type, not service location. So your plan would have to cover ZERO midwives within 30 miles of your address for you to get that coverage in place. And even then it's tricky to get. It's called a "gap exception" fyi.

My insurance that starts July 1 has no midwives within 30 miles of my home, but they offer midwives in other states, and it's a national plan, so technically I'd qualify for the gap coverage. However, because I'll be within 3 months of my EDD, I qualify for a different type of coverage that lets me keep my current provider.

So if you were to ask for the gap coverage, BCBS will tell you to go birth in a hospital with a midwife. There are a ton of midwives all over the area practicing in hospitals that take BCBS.

Sometimes it's worth planning on an out-of-network provider, if that's what it'll take to have a birth at home. The reimb. rate is 60-80% depending on your PPO plan, and midwives are around $4000 right now, so the out of pocket expense is worth figuring into your budget imo.

We deliberately switched from PPO to HMO for July because the $ difference in premiums that we'd spend each paycheck is more than the out of pocket difference for using an out-of-network provider or just paying cash, after 1 year of the new insurance.

Lisa, mama to Lauren, Elliot, angel Marion, and baby due in the fall.
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