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Discussion Starter #1
Well, more than a year after the home birth of our son and lots of headache using a midwife billing service, I'm giving one last push to have our home birth covered before taking things to small claims court.<br><br>
I would like to include in our letter the names and birth dates of families covered under BCBS of MA (PPO) who have had home birth covered in order to demonstrate that I KNOW that it is sometimes covered even though they insist that it is never covered.<br><br>
At one point, someone told the billing service on the phone that it would be covered, but then it was later retracted. Anyway, if anyone reading this (or someone you know) might feel comfortable PMing me your name and the date of your home birth, I feel like it might help support my point that I know that home birth is sometimes covered by BCBS MA PPO despite their claims to the contrary.<br><br>
Thanks so much for any help. If we have any success, I'll update the various posts on this topic to help others. I know it is tough.<br><br>
Thank you very much,<br>
Elizabeth
 

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Hi Elizabeth<br>
I think this is a good way to progress - if you can prove that they do pay sometimes then this is a good way to show how inconsistent they are. Try searching for old posts and pm'ing the people who did get it covered - I know there are several.<br>
I actually took BCBS to the small claims court in July 2008 and won (we had HMO), although I also know two others who didn't win - so you need to be prepared for that possible outcome. I think some of the reasons I might have been successful was that they messed me about by saying it was covered at first, then fobbing me off with lots of different reasons to refuse it, before finally coming up with the real reason - which was that CPMs aren't licensed.<br>
I had also been very persistent with BCBS having written many, many letters so the judge could see that I really had tried every option before going to court.<br>
I think one of the ladies who wasn't successful, probably lost because they had covered a previous HB, but BCBS had written that although they would cover this one they wouldn't cover anymore.<br>
Best of luck - PM me if you want anymore info.
 

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Discussion Starter #3
Thanks so much for your reply. We've made a lot of phone calls and are now writing lots of letters. At this point, it is hardly worth the money (although that would, of course, be very nice) but it is almost more about the principle. Given the number of hours we've spent on it, I think it will hardly pay minimum wage if we do end up getting some of it back! C'est la vie. Again, thanks for the info and support. Forward ho! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> Elizabeth
 

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I'm sure you're already on top of this but just in case: make sure you document every person's name who you speak to so that you can say: Jane Smith said.....<br>
and then there is a specific person you're talking about instead of one big organization.<br>
Just a thought.<br>
I work in the mental health field spending most of my days on the phone with insurance to put forth the case that this or that patient needs care. It is so important when doing this that I document names - I assume the same would apply in your case. Good luck!
 

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One thing of note is that BCBS changed their language to be much more specific about not covering homebirth and not covering CPMs as they are not "standard of care" <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked"> in MA...that policy went into effect October 1, 2009. I was planning on fighting them previous to that because of the vagueness of both the previous policy, and from what I've been told on the phone by BCBS reps (homebirths covered but only with a CNM) but it doesn't seem like it's even worth a shot given their new policy language. They even seem to cover their "didn't make it in time" loophole with language about a 911 call being made.<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Midwife/Home Birth Coverage Clarification<br>
In response to requests by our members, we are clarifying our position on care given by certified professional midwives and other types of midwives. Home births are not the standard practice of care in Massachusetts, and therefore, our benefits are specific to certified nurse midwives (CNMs), and cover only the services that these clinicians provide.<br><br>
In addition, any home births taking place in Massachusetts on or after October 1, 2009, will only be covered when the delivery is made in the home in an emergency or unplanned situation and when rendered by a network provider (i.e., CNM, obstetrician).<br><br>
Unplanned births are those in which circumstances prevent the mother from delivering at a hospital or birthing center. To seek care in such a situation, the mother should call 911 if appropriate, and/or her certified nurse midwife or obstetrician (or their covering provider).</td>
</tr></table></div>
 

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Discussion Starter #6
Thanks so much everyone for the feedback. I spent the WHOLE DAY yesterday getting all the documentation together, writing a detailed letter tracking all of our conversations and communications with the company. If they deny, it will not be for lack of a well-documented, clear, and, if you ask me, pretty persuasive letter! We hope this works, but if not, its off to small claims court. Jule, like you, two separate people told us it would be covered and then, in the end, it wasn't, so I hope that will help to make a stronger case if we do have to go to small claims court. We have the names of the people who said it would be covered and the date of the conversation, so we'll see. Also, we have the names of two people who were covered in 2008 (thank you you two!) so I hope that will help making the point that we know this has been covered before. So we shall see. It seems like after Oct 2009 it would be much harder to get covered, but my hope is that we'll be off this insurance by the time we have our next baby!<br><br>
Thanks all! E
 

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So here's some food for thought. This might not help your particular situation, but it's been one I've been thinking about and who knows? I'm 99% sure that most if not all policies by BCBSMA (and I did work there, as I've stated many times here) contain a rider that Christian Science practitioners are to be compensated for their services. And that's ALL it says, so it doesn't matter what the services are, including homebirth, because what devout Christian Scientist is going into a hospital to have a baby?<br><br>
So I guess my point is that if you are of a particular religious group, the standard of care is different and covered regardless of what the service is. And so yes, BCBSMA does cover homebirths, but only if you are a Christian Scientist.
 

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Discussion Starter #8
Oh, that is a very good point. I am not Christian Scientist, but had I thought of this beforehand, I might have argued that to the company anyway. Very good point.<br><br>
And, for anyone out there trying to get midwife costs for home births covered by BCBS MA PPO, I just talked to a woman who had the cost of the home birth covered by billing it all via prenatal and postnatal care. She actually ended up having a last minute hospital birth, but the full cost of the midwife was covered by this piecemeal billing. I think if I had it to do over again, I would do it that way. They seem more amenable to covering the pre and post care (we had a small amount of ours covered this way, but did not bill for very much) and if it saves you the hassle of having to argue for the global fee (which post-Oct 2009 seems almost impossible) it might work. Although it is not clear to me if the Oct 2009 statement will end up also banning pre and post care by midwives that are not nurses....
 

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LOL, all I can think of now is a lot of moms suddenly having the urge to look into Christian Scient(olgy) for a bit.<br>
I wouldn't think that an insurance company can ethically ask you about your religion-- or decide policy that might limit one religion or another? I might have a very broad view of religion that is spiritual and natural based that values natural parenting of which natural birth is a part of??<br>
And another semi-related.... the breastfeeding bill (protecting nip) has an exclusion for religios institutions, but it does not specify a specific religion. (Not that I'm for that exclusion, I think it is disturbing, but it is interesting that BCBSof MA has this specified for a specific religious group and not a more broad view).<br>
Hmmm, that's a stickly slope ethically (one that in MA many might already be debating for the vax exemption since we only have a medical or religious exemption)... very interesting.<br><br>
Jessica
 

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I spoke to a lawyer before I went to the small claims court and he said you need to prove one of two things. Firstly did BCBS mislead you as to whether homebirth is covered under your policy. Secondly are BCBS acting "unreasonably" in refusing to reimburse the cost, this is where you state how HB is common elsewhere and is so much cheaper than a hospital etc.<br>
If you can prove both of these you should be in with a chance.
 

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Discussion Starter #11
Just a little update on this, mostly for the benefit of others who may be searching around on this someday doing this themselves - we filed our long and detailed grievance and it was denied based on the claim that only CNM are covered and not CPM. However, my sense is that if this policy was so clear, they would have been able to tell me that clearly from the beginning rather than having to speak to four people at BCBS, one of which said that the claim was legit and would be covered. Further, they note that they do not question the medical necessity of "the service" [homebirth] and they note that "at the time of the birth, we covered home births when the delivery services were provided by nurse midwives." Of course, there is no midwife in the entire state of MA who will or can perform a home birth (this is correct, is it not?).<br><br>
Does anyone happen to know the exact reason CNMs cannot/will not perform home births? I assume it is an insurance thing?<br><br>
Anyway, that is the update. We are filing the appeal today. At this point, it is hardly worth the money and hassle, it is just so much about insisting that such terribly practices cannot just be let go. I just feel so terrible for all the families that can't pay, or can't hassle with the appeal, and miss the opportunity for a home birth if that is what they desire. Sigh.
 

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<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>ejg123</strong> <a href="/community/forum/post/15614085"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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Does anyone happen to know the exact reason CNMs cannot/will not perform home births? I assume it is an insurance thing?</div>
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Because hospitals don't make any money off home births, insurance companies make less on home births, and ACOG has lots of lobbying $$.
 

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The midwifery bill might change this if it can get passed. (clarify: It could allow CPM to be reimbursed for home birth thru insurance.)
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>ejg123</strong> <a href="/community/forum/post/15614085"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><br>
Does anyone happen to know the exact reason CNMs cannot/will not perform home births? I assume it is an insurance thing?</div>
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A CNM could lose her license for home birth in the MA regulations.<br><br>
To my knowledge, the midwifery bill would not change this.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>xmasbaby7</strong> <a href="/community/forum/post/15625312"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">A CNM could lose her license for home birth in the MA regulations.<br><br>
To my knowledge, the midwifery bill would not change this.</div>
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Your right I was going thru too quickly.... It could allow CPM to be reimbursed for home birth thru insurance.
 

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The bill would be a first necessary step toward insurance reimbursement, but the bill would not resolve it. State licensing would be necessary to make CPMs official providers for medicaid and private insurance, so more steps have to happen.
 

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hence the 'could'
 

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We have BCBS of SC and they fully covered our birth almost 5 years ago. This time they have snubbed our midwife's request for prenatal payment (she does a test billing). My thing is that we have the same exact insurance and now they say they won't cover it. I hate our insurance!
 

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<p>Based on BCBS of MA's clearly written denial of home births, I wasn't going to fight it, even though it is my great preference.  In fact, I am sad that I won't be able to do it, and even a bit nervous about going to the hospital when I know my body is more than capable. </p>
<p> </p>
<p>Anyway, I was wondering about them reimbursing pre and post natal care.  Was that for  CPM or a CNM?  Did the midwife bill them directl, or did the member bill?  If it was the member, how did they do that? Thanks for any help or info you can provide.</p>
<p> </p>
<p>~Lara</p>
 

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Discussion Starter #20
<p>We used a billing service that my midwife had previously used. I was not happy with them at all. In a way, it almost made it more complicated for me. However, there is a midwife on this MA board called Paige CPM and I believe she uses a different billing service. You might ask her about it. Good luck! </p>
 
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