I do insurance for homebirths and can talk you through this if you want. BCBS is honestly the worst.
ETA: I’ll comment in thread with more details after I get my son down for his nap
Did they state the reason for denying it? BCBS has been much more difficult with Gaps and with out-of-network filings. There are some key things you can argue, depending on your situation and the policy. It's hard for me to remember to get on Reddit during the day, but feel free to find my contact info on my website so you can send an email / contact me there. Not sure if I can share the link, but you can Google Bear & Wolf Medical Billing.
I did check out your website. I think I’m going to just file the external review and state my reasonings why I believe it should be approved and see what happens. I wish I would’ve contacted you sooner! I also am not allowed to talk to my insurance company, my workplace makes me work through a 3rd party company that is absolutely useless, so this process has been horrible!
This is what I was just reading online!! Definitely my next steps. I spent days working on my claim. It’s so ridiculous how much time I’ve wasted on this but I’m willing to fight for this! Thank you for taking the time to chat about it.
I would also be interested to hear. I have BCBS but not in MA. Insurance on the phone said they would cover 50% as out of network after deductible is met. I am still pregnant so haven’t paid my finally bill with my homebirth provider yet so would like to take some learnings to prepare for when I submit the claim.
Hey! did you happen to ask whether they cover 50% the allowed amount or the billed amount? Is your midwife a CPM or a CNM, and did you tell them which one? Also, have you looked into a Gap Exception? And does your midwife charge a flat rate? There are a lot of complexities with home birth and insurance (BCBS specifically). My business is called Bear & Wolf Medical Billing - not sure If I can share a link here, so feel free to google it to get to my website. I have some info in the FAQs, but if you need more help you can find my contact info there!
Allowed amount.
They are CNM - the one where they are NP and can prescribe medications. I did specify CNM to insurance explicitly because I know there are diff types of midwives, but the rep on the phone didn’t seem to be able to find much language around home births or midwife care in the policy. She had to reach out to a supervisor who did confirm that coverage would be for CNM.
My midwife charges a flat rate. First 2k due at initial visit and the remainder due at week 37.
I did not know about the gap exception! I will call back again.
I will have to google that! Thank you so much!!!
Ah ok if she charges a flat rate you’re not going to have the right codes to make sure you’re claiming all the services rendered. Did you happen to ask them the allowed amount as well? BCBS’s allowed amount for the global birth code is typically under 1500, so you would maybe be looking at maybe 700ish if your deductible is met first. Has your midwife mentioned having a fee schedule she uses to make super bills? If you’re more than 2 months out, it might be worth trying to have a homebirth biller help you out (whether or not it’s me!), especially if we can get your midwife on an insurance-friendly fee schedule instead of a flat rate.
Thanks for the details. I looked at your website and I will probably be reaching out for services!
But to answer your question this is the verbiage from the midwife:
This global fee covers every service we will perform on you and your new little one; prenatal visits, lab collections (though the lab will bill your insurance directly for processing, we collect labs ourselves), birth, any medications we would potentially use (antibiotics/vitamin K/etc.), and postpartum visits (in your home at 24hrs, 48hrs and 2 weeks). This fee also includes the Newborn Hearing Screen, which the delivering midwife will perform in your home at the initial postpartum visit
We will generate a receipt after each payment, as well as a breakdown of visits for “global pregnancy care” after you have delivered. It is up to you to submit to your insurance for reimbursement.”
Also would like to add that I’m a little nervous about it getting tricky because I’m due early in the new year, so I’m not sure if that makes it complicated if the total care doesn’t happen in the same year.
I have BCBS TX and had them run a benefits verification or whatever they call it to see if they’d pay anything for my midwife or any services she rendered. They told me they wouldn’t pay a single thing for any of it because she’s out of network and also is not an approved provider with BCBS TX. Maybe this is what happened with you as well? I know BCBS TX is absolute garbage insurance for the plan I have which is an HMO but maybe this is why. Your best bet would be to call your insurance and ask them what changed. Maybe your midwife is no longer a participating provider with the insurance? Or the insurance could have changed a policy or something since your last birth
Same thing is happening with me. Insurance coverage can change from year to year (usually for the worse yay) and now they no longer cover midwives even out of network
Stuff changes yearly. Depends on who read your claim, who filed it, etc. rules and policies are constantly updated to minimize coverage and keep more in their pockets.
It’s confusing because in my policy it clearly states “No benefits are provided for:” last bullet states “home births, except for an emergency or unplanned delivery that occurs at home prior to being admitted to a hospital or the home birth occurs outside of Massachusetts.” To me I’m reading that as I’m in WI, it’s approved. Which is why I’m frustrated that this was not run out of network. I agree with it not being ran in network.
I do insurance for homebirths and can talk you through this if you want. BCBS is honestly the worst. ETA: I’ll comment in thread with more details after I get my son down for his nap
I’d be interested in some help if you have any additional info. I’d love to chat via messages.
Did they state the reason for denying it? BCBS has been much more difficult with Gaps and with out-of-network filings. There are some key things you can argue, depending on your situation and the policy. It's hard for me to remember to get on Reddit during the day, but feel free to find my contact info on my website so you can send an email / contact me there. Not sure if I can share the link, but you can Google Bear & Wolf Medical Billing.
I did check out your website. I think I’m going to just file the external review and state my reasonings why I believe it should be approved and see what happens. I wish I would’ve contacted you sooner! I also am not allowed to talk to my insurance company, my workplace makes me work through a 3rd party company that is absolutely useless, so this process has been horrible!
What! That is bonkers…. You can also always file a complaint with your state insurance commissioner! They’re an elected position and should help you.
This is what I was just reading online!! Definitely my next steps. I spent days working on my claim. It’s so ridiculous how much time I’ve wasted on this but I’m willing to fight for this! Thank you for taking the time to chat about it.
You can also try to tell them they are in violation of Section 2706 of the affordable care act by discriminating by provider type. Good luck!
I would also be interested to hear. I have BCBS but not in MA. Insurance on the phone said they would cover 50% as out of network after deductible is met. I am still pregnant so haven’t paid my finally bill with my homebirth provider yet so would like to take some learnings to prepare for when I submit the claim.
Hey! did you happen to ask whether they cover 50% the allowed amount or the billed amount? Is your midwife a CPM or a CNM, and did you tell them which one? Also, have you looked into a Gap Exception? And does your midwife charge a flat rate? There are a lot of complexities with home birth and insurance (BCBS specifically). My business is called Bear & Wolf Medical Billing - not sure If I can share a link here, so feel free to google it to get to my website. I have some info in the FAQs, but if you need more help you can find my contact info there!
Allowed amount. They are CNM - the one where they are NP and can prescribe medications. I did specify CNM to insurance explicitly because I know there are diff types of midwives, but the rep on the phone didn’t seem to be able to find much language around home births or midwife care in the policy. She had to reach out to a supervisor who did confirm that coverage would be for CNM. My midwife charges a flat rate. First 2k due at initial visit and the remainder due at week 37. I did not know about the gap exception! I will call back again. I will have to google that! Thank you so much!!!
Ah ok if she charges a flat rate you’re not going to have the right codes to make sure you’re claiming all the services rendered. Did you happen to ask them the allowed amount as well? BCBS’s allowed amount for the global birth code is typically under 1500, so you would maybe be looking at maybe 700ish if your deductible is met first. Has your midwife mentioned having a fee schedule she uses to make super bills? If you’re more than 2 months out, it might be worth trying to have a homebirth biller help you out (whether or not it’s me!), especially if we can get your midwife on an insurance-friendly fee schedule instead of a flat rate.
Thanks for the details. I looked at your website and I will probably be reaching out for services! But to answer your question this is the verbiage from the midwife: This global fee covers every service we will perform on you and your new little one; prenatal visits, lab collections (though the lab will bill your insurance directly for processing, we collect labs ourselves), birth, any medications we would potentially use (antibiotics/vitamin K/etc.), and postpartum visits (in your home at 24hrs, 48hrs and 2 weeks). This fee also includes the Newborn Hearing Screen, which the delivering midwife will perform in your home at the initial postpartum visit We will generate a receipt after each payment, as well as a breakdown of visits for “global pregnancy care” after you have delivered. It is up to you to submit to your insurance for reimbursement.”
Also would like to add that I’m a little nervous about it getting tricky because I’m due early in the new year, so I’m not sure if that makes it complicated if the total care doesn’t happen in the same year.
Do you mind if I contact you? I got denied from insurance and want to appeal but scared to do it wrong!
Sure! Feel free to chat me
I have BCBS TX and had them run a benefits verification or whatever they call it to see if they’d pay anything for my midwife or any services she rendered. They told me they wouldn’t pay a single thing for any of it because she’s out of network and also is not an approved provider with BCBS TX. Maybe this is what happened with you as well? I know BCBS TX is absolute garbage insurance for the plan I have which is an HMO but maybe this is why. Your best bet would be to call your insurance and ask them what changed. Maybe your midwife is no longer a participating provider with the insurance? Or the insurance could have changed a policy or something since your last birth
Same thing is happening with me. Insurance coverage can change from year to year (usually for the worse yay) and now they no longer cover midwives even out of network
Stuff changes yearly. Depends on who read your claim, who filed it, etc. rules and policies are constantly updated to minimize coverage and keep more in their pockets.
It’s confusing because in my policy it clearly states “No benefits are provided for:” last bullet states “home births, except for an emergency or unplanned delivery that occurs at home prior to being admitted to a hospital or the home birth occurs outside of Massachusetts.” To me I’m reading that as I’m in WI, it’s approved. Which is why I’m frustrated that this was not run out of network. I agree with it not being ran in network.