We also had BC/BS Carefirst when we had our son's homebirth. You should call and call and call until you get the right person who will tell you it is indeed covered and that you can send your papers to them directly - ask for someone in appeals. I was told prenatally that we would be covered, then when I submitted after the birth all of the birth related items were denied, the prenatals were all covered. I called and somehow landed at the appeals desk and the guy kept going away and checking things and then coming back and asking more questions. Eventually he told me that birth happens with a provider (Tammi) not a company (natural beginnings) and so I needed Natural Beginnings to send me a letter that said Tammi is a provider with them (of course, this was all just coming from Tammi!). Anyway, we sent that in and I resent all the forms directly to this person and they covered us! Of course, they covered 70% of the contract rate only because Tammi isn't in the network. In the end they paid about 75% of our total birth expenses. They didn't cover the birth tub, but I wouldn't have given that up for the world.
Here's the guy's name and address who helped me, not sure if you're dealing with the same plan, but maybe it will be helpful:
Craig Turner
BC/BS Carefirst
840 First St., NE
Washington, DC 20065
I'd pay out of pocket for a homebirth before I'd go into a hospital...
-Katie
I fought and engaged my company and the vendor that sold my company the BCBS policy and was ultimately able to reimburse my CPM 60% of the services she charged BCBS...which equaled more than she billed me. This time around, BCBS denied a number of her services because her social security number (which she uses as her unique identifier) was the same as the Drs. code for a psychologist. Obviously psychologists can't perform birth services so they denied the claim rather than trying to figure out why that glitch came up! I worked with my midwife’s billing service to clean this one up. Anyway, I echo the statement that you must keep hounding the company and take names and dates of the calls. -Linda
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Absolutely there's something you can do!!
You APPEAL and APPEAL and APPEAL!
You drive them CRAZY going BACK over and over.
It’s the client that gives up who doesn't get reimbursed.
Copy all your correspondence to your state Insurance
Commissioner. Make SURE Carefirst Blue Cross KNOWS
you are making complaint to the Insurance Commissioner.
Ask for help from an insurance billing company in your
city. Be prepared to PAY for their help, but you are more
likely to win an appeal with help from a professional biller.
Blue Cross is notoriously HORRIBLE about MOST
"non-conventional" maternity healthcare services... so you
have to be willing to FIGHT and FIGHT HARD and LONG!!
-Kim Mosny, CPM-TN ~ Senior Midwife
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The patient/client rarely gets the answers needed when calling for eligibility/benefits...
you need to know WHAT questions to ask and to WHOM and HOW. Find a midwife
who either files insurance herself or has a billing service. She/They can verify your
benefits in a more effective/productive way.
Your insurance is a division of United Healthcare, which is GOOD! IF you have
an HMO, it WILL be VERY hard to get them to pay anything, I am almost sure there
are no home birth midwives in your area who are "In-Network" (perhaps CNMs but
I doubt any CPMs.) Getting credentialed "In-Network" is VERY complicated and
most CPMs just don't jump through all the hoops and red-tape. I've been practicing
for over 14 years and still file ONLY "Out of Network."
Anyway... IF you have a POS or PPO plan, then there SHOULD be "Out-of-Network"
benefits. You will be out of pocket MORE for your deductible, higher co-pays and
more % (20-30%) of fees... (70-80% paid by insurance for Out of network instead of the
90-100% in-network)
-Kim Mosny, CPM-TN
I have Optimum Choice and I am having a home birth (due in Feb.) with the midwives at BirthCare. I have only had to pay the one-time maternity copay which covers all my care, including the birth. I indicated my choice of home birth at my very first visit and I assume this has been processed with my insurance company by BirthCare's insurance specialist. I have received no information suggesting that my birth would not be covered.
I had my first child almost four years ago at The Maternity Center (also CNM's but a birth center birth) and never received any bills whatsoever for anything related to my prenatal care or birth. I just paid the copay at the first visit and that was it. So I have every reason to assume the same experience with coverage this time around.
-Dana P.
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I haven’t had a homebirth yet (planned, at least!) but in preparation for #2, I called BCBS last week (I live in VA) and inquired about coverage for a homebirth with a CNM. I was told that I have a $15 copay and then they cover everything according to the rate schedule with no deductible/cap. I’m aware that if the cost exceeds what is “allowed”, I will have to pay the midwives directly, but other than that it seems like the prenatals/homebirth are covered in full. I do not know if coverage would be the same with a CPM. I agree—I would appeal the denial.
JErin
I'd appeal it.
I have BCBS of MN and they only paid for the prenatal care basically. Sigh.
But when I was in NY and had BCBS of NY, they paid my homebirth in full.
-Jamie
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I worked very hard to get my insurance company to pay my midwife. Almost all the initial claims were denied. I set out on a nine month mission and was ultimately successful. I had to do most of the leg work, and communicated with her billing agency when necessary to resubmit charges. My policy only covered Nurse midwives, yet my persistence and gaining the assistance of my employer and the vendor we purchased our company insurance plan through finally paid off and I was able to get them to cover MORE than my costs which meant that my midwife got paid extra for my birth. I documented every call, wrote letters, and did a lot of "educating" of the BCBS staff. They just didn't understand that a midwife was performing services normally billed through as nursing charges. I found that they denied my claims out of ignorance of the homebirth process. It was a frustrating experience. I actually had one insurance/claim processor tell me that I should have had my baby in a hospital if I wanted my birth services covered - hassle free. I also had the representative from our insurance vendor tell me that it was helpful I was a "Vice President" at our company because that implied to them that I had some say over the insurance carrier we chose...i.e. if I wasn't happy with the BCBS coverage/service I could influence a change in vendors and carriers...and that would motivate them to pay up. We definitely have a messed up system! -Linda
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Another thing with insurance is to ask your insurance company for an in-network exception. My billing service has a form families can use to ask for such from their insurance company. They can authorize this if they can see that there are no contracted home birth/birth center birth providers in the area – and if you are using a CPM, then there won’t be any in-network CPMs, so you can try. Birth Care might be in-network for some plans, but if they aren’t, this could additionally work to your advantage. I know it worked to the advantage of a Birth Care client a few years ago – there were no other in-network homebirth providers.
Also, when you call, ask if they cover a licensed midwife. Not a homebirth midwife.
Also, know that some families are told no and then we bill and voila, they pay something. Not always the case, but worth a shot.
And don’t forget about your medical/health savings plans for 2008 – if you are paying for services out of pocket, those charges can go against your accounts.
-Tammi
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I have NCPPO insurance and they said numerous times that they would NOT cover a homebirth unless it was with a CNM. I had my homebirth with a CPM and submitted the claim anyway. To my surprise I got a big check in the mail. Both the prenatal AND the birth were covered as an “out of network provider” at 70%. I second the advice to just submit anyway and appeal if you have to.
-Lori Q