Blue Cross Blue Shield PPO and home birth?
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Anonymous
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pp here -- what I started with was asking about an "out of hospital birth" with a "certified, but out of network provider".
I agree with requesting a copy of the fine print. |
Anonymous
| There was some recent discussion about this on the NoVa Homebirth Yahoo Group. One point that came up was the helpfulness of preregistering at whatever your transfer hospital would be, in case you wind up moving to Plan B. Seems like that gets you preapproved and results in fewer billing headaches afterwards. |
Anonymous
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Hi, I'm planning a home birth with Mairi and Erin also.
I'm a graduate student, so fairly tight financial means. I have BCBS State of Maryland PPO. So, I saw this forum and wondered what the outcome was for those of you who mentioned you were planning on it (I see the posts are a couple of years old). I'd be interested in knowing what happened. Thanks. |
Anonymous
I have BCBS Fed plan, the less expensive one--basic? So anyone "out of network" is not covered at all. I got into Birthcare, which is "in network," but #1. They do not allow water births and #2. They are a real trek for me. So I gave up my spot and will be paying $3500 cash again. |
Anonymous
Like the previous poster, I have BCBS (with is contracted with BirthCare), meaning a home birth would be covered at 100% with BirthCare(in network). I went to a couple of prenatal visits at BirthCare and had some serious issues with their outdated philosophies (including no water births- ha!). So, I've switched to a different provider and I'm paying out-of-pocket until after the birth at which point I'll be reimbursed at 80% for out-of-network care. After talking with my midwife and insurance company, I'm fairly certain that I'll be reimbursed the proper amount. It does suck having to pay up front, but worth it for a birth that feels right in my heart and a provider I can stand behind fully. |
Anonymous
Same here for me, when I gave birth last year. I had no problems - good luck, OP! |
Anonymous
| I have BCBS Fed Basic, delivered at home in 2009 attended by Birthcare midwives, no problems getting covered at all. |
Anonymous
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NP saying that I know Mairi and Erin have a great billing company and you should be able to get covered at a regular out-of-network rate. Basically, the birth itself will be billed with a code of "regular vaginal birth" and the only difference will be that there won't be any hospital charges also billed. So, from the insurance company's perspective (with a PPO) the location doesn't matter. As long as your insurance company knows you are pregnant and pregnancy is covered, you shouldn't need preapproval for the birth (this I would check on).
HOWEVER, if you call ahead they might flag your account as an out-of-hospital birth and give you the runaround. I would definitely talk to Mairi and Erin first and see what they advise. Often they do a sort of test run for regular services for one of the checkups and see what the response is. I also had a great birth with them! We were in an HMO so we paid completely out of pocket, but it was well worth it. Good luck! |
Anonymous
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Like the previous poster mentioned, my midwife advised me that with my PPO she bills the home birth globally and lists like POS as office, so really the insurance company has no reason to deny it since the claim is allowable (global maternity fee). My fingers are crossed that everything goes smoothly, we don't have to transfer, and the insurance reimburses us!
It would be nice to have a midwife contracted in network with BCBS (such as BirthCare), but I found BirthCare's practice to be too busy & chaotic and I like the feeling of having a more intimate relationship with my midwife, who is far less busy and frantic as compared to the BirthCare midwives. |