Blue Cross/Blue Shield PPO
I'm having a hard time getting BC/BS of Minnesota to agree to pay for anything except for prenatal care for my homebirth. I've got a $1000 out of network deductible I have to meet with them before they'll pay for anything. I had to get a job just so we could pay for the deductible - it's irritating because I didn't think I'd have to work for a lot longer. Right now, I'm just waiting for them to send us the copy of the contract wording and the complaint form so I can basically start a case for them to agree to pay for homebirth.
Does anyone have suggestions on how to proceed? What research (that I want to send with the complaint form) would be best for an insurance company to see and to read? Can anyone post links to medical journals or government sites or anything that could show them that homebirthing is safe and cost effective? It's one thing to quote some run of the mill website, but a reliable source I think would be my best bet for a postive outcome here.
Does anyone have suggestions on how to proceed? What research (that I want to send with the complaint form) would be best for an insurance company to see and to read? Can anyone post links to medical journals or government sites or anything that could show them that homebirthing is safe and cost effective? It's one thing to quote some run of the mill website, but a reliable source I think would be my best bet for a postive outcome here.
Replies to This Discussion
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Permalink Reply by KM on -
I know some states have a law that says if the insurance company doesn't have an in network provider for the services you want (ie midwife to attend a HOMEBIRTH) then they are required to pay whatever portion they would normally pay with an in network provider. I'm not sure about Minnesota though. Good luck!
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Permalink Reply by Jeannine Fisk on -
Any clue about Wisconsin? That's where I live.
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Permalink Reply by Jeannine Fisk on
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Nope. My husband gets his insurance from a settlement and he is disabled. We get our coverage for free until he is at medicare age. So, I have to "fight the system" that I've been given. Maybe if I can change their minds I can help more women out there.
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Permalink Reply by Jeannine Fisk on
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Just an update on how this is going: Blue Cross/Blue shield of Minnesota sent me the complaint form I needed to start my case on why they should pay for homebirths. Unfortunately, they didn't send me the copies of the contract between my husband's "employer" and BC/BS. Probably because there isn't a single line in there about homebirthing or birth centers. So, I'm still waiting for more information. Hopefully, I will get a response from them soon.
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Permalink Reply by Sarah Atondo on -
I have BCBS also, and they told me when I called them that they would pay 70% of everything as long as it was a CNM and not a CPM. They just had to have the license to back them up. That ended up being almost the same amount on money that I pay to an OB.
You should make sure they aren't giving you false information. Is it different from state to state? It shouldn't be.
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Permalink Reply by Jeannine Fisk on
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So, I recieved the letter today telling me what they will and won't pay for. This took them an entire month! But, it says: "A CNM is elilgible to bill for prenatal care... at a medical facility. All Services related to a home delivery are not eligible for reimbursement even if performed by a certified nurse midwife."
My midwifery team is made up of a CPM and a licensed midwife. I am assuming this is not the same. So. the question is, how to get them to cover ANYTHING at this point. I need to appeal this letter. Any thoughts on how to fight this?
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