Blue Cross Blue Shield PPO and home birth?

[Anonymous]

My insurance is Blue Cross Blue Shield, PPO, the Federal Employee insurance, Standard option (i.e. the one that costs more). Does anyone have any experience using their BCBS PPO insurance to cover a homebirth in DC? I'm planning to switch to a midwife practice soon, and am considering a birth center or a homebirth. The birth center seems to be no problem, but I suddenly realized I didn't know what the ins and outs would be of getting a homebirth covered. Thanks!

[Anonymous]

why don't you try contacting your insurance company? it seems that your insurance company would be a better source than a random forum ??

[Anonymous]

Good f-ing god, why do people on this forum have to be so snarky? The OP was asking for responses from people who have gotten a home birth covered by their insurance. Yes, she can contact the insurance company directly, but hearing others' experiences of doing so might be helpful in preparing her to make that call. When I see a question I can't answer on this forum, I move on, not suggest that the question shouldn't be asked here. Geez.

[Anonymous]

OP, the best way to find out if your insurance will cover your homebirth is to have a conversation directly with the midwife. Usually when you call the insurance company, the staff person will say "no, we don't cover homebirths" but then when you discuss with the midwife, you might find that she has successfully billed that insurance company in the past. Depending on who you are hiring (by the way, which midwife/s are you thinking of hiring?) you might have to pay upfront, and then the midwife bills the insurance company after the birth. Again, NEVER rely on the insurance company to be able to tell you if they will cover your homebirth. The people who answer the phones honestly don't know, so they usually just say no.

In my experience, several of the local CNM's who provide homebirths have successfully billed BCBS.

Good luck and CONGRATULATIONS on choosing the safest and gentlest way to have your baby!

[Anonymous]

I second starting the conversation with the midwife first. And congratulations!

[Anonymous]

In addition, don't forget to request a manual (for lack of a better word) on the items that are currently covered by your insurance policy. These books are usually comprehensive and many spell out the various birth options. A staff person on the phone may not actually be familiar with the ins-and-outs of what is covered, but it's good for you to have this reference in black and white to point to, copy, etc.

[Anonymous]

Well, yes, usually the booklet of covered stuff is helpful, but as someone who has the same insurance as the OP and is planning a birth center birth, the manual is not helpful. Out-of-hospital births are such a small percentage nationally of births that it feels like most insurance companies don't know what to do with them.

I think talking to your midwife is probably the best place to start.

[Anonymous]

OP here. Thanks for all the responses. I asked if anyone had had experience with this insurance co. because other women I've heard from had an amazing amount of runaround with their insurance co's when they called. It seemed to take multiple calls to multiple people, who did not understand what homebirth or midwives were. I just wanted to see if there had been any "magic words" or a specific office of BCBS where others had been successful. I'm meeting with the midwives next week, and planned to ask them also (BTW, considering Mairi Rothman and Erin Fulham of MAMAS).

[Anonymous]

Just wanted to say that Mairi and Erin are fantastic - you have picked wonderful midwives. They have successfully billed BCBS in the past, so they will have great advice about how to manage it.

Good luck with the birth!

[Anonymous]

I have the exact same insurance as the OP and I'm planning on a home birth with Birthcare in the next few weeks. I have not had to make a single payment, and it's my understanding that the entire birth and prenatal experience is covered. Good luck!

[Anonymous]

I have BC/BS basic option and am planning a home birth with Birthcare in Alexandria also. They will cover everything except the supplies we bought for our home and the Bradley class. We never even had a co-pay.

[Anonymous]

Jeannine here. Okay. I got my verbal denial from BCBS of Minnesota. Customer service was NASTY!!!! Wow. Mention homebirth and all of a sudden you're a criminal. She told me that it stated in our contract that homebirths aren't allowable. She is sending me the complaint form so I can make my case for homebirth as well as a copy of the verbage in the contract. So, I guess this starts the big battle. Hopefully, I get what I want - prenatal care AND a covered homebirth. Any other suggestions?

[Anonymous]

In my preliminary conversations with BCBS (although not the federal plan), I never said the word "homebirth." I simply asked about working with a midwife, and asked if particular names were in-network. (No surprise, none of them were.) I was informed that out-of-network providers would be covered at 80%, and that's what my midwife has seen happen in the past. We'll see...

[Anonymous]

Anonymous wrote:Jeannine here. Okay. I got my verbal denial from BCBS of Minnesota. Customer service was NASTY!!!! Wow. Mention homebirth and all of a sudden you're a criminal. She told me that it stated in our contract that homebirths aren't allowable. She is sending me the complaint form so I can make my case for homebirth as well as a copy of the verbage in the contract. So, I guess this starts the big battle. Hopefully, I get what I want - prenatal care AND a covered homebirth. Any other suggestions?

You really need to address this with your midwife first. Midwives who provide out-of-hospital services have worked with countless couples and helped them to get their insurance to cover it. They will know who you have to contact and what you need to say. In fact, usually the midwife imply handles the billing, and due to certain coding which she uses, it winds up getting covered.

In almost all cases, if you call your insurance company and ask if the "cover homebirth" they will say absolutely not. So lesson number one: don't get in a fight with them about homebirth. Just let your midwife bill (usually she does not indicate the location of the birth) and it will get covered.

[Anonymous]

I birthed with Erin and Mairi (FANTASTIC experience) and billed it to my BCBS PPO (BCBS of Massachusetts in our case). Not fed, if it matters, but there were no problems at all. They covered me at my plans 70% out of network rate without any argument. I was reimbursed quickly, as well.

I called while still pregnant and I was careful about wording, only to be interrupted -- they told me all they cared about was that I had a certified provider, homebirth was no issue. I gave birth in Dec of last year.

They also paid a significant portion of our birth assistants fees.