Friday, January 9, 2009

To say I am angry at Blue Cross Blue Shield is an extreme understatement!

So I was suppossed to have an appointment with my midwife at Nativiti Women's Center yesterday. On Wednesday I called my insurance company to give them my midwife's name. (Which I had called before to get in-network benefits since there is not a midwife contracted in 60 miles, and Blue Choice PPO covers should advertises to carry midwifes. They had told me to call back with her name, address, etc and they would give me the referral). In all of my craziness that is my life, I waited until the day before the appointment. The horrible lady on the phone told me that my small group plan has an exclusion and doesn't cover midwifes at all, in-network or out of network. This horrible lady and her supervisor couldn't tell me where this was written in my plan, why this was, and why it was different than other PPO's by BCBS that do cover them. They simply said if it is not referred to in the benefit booklet, they have the right to deny you coverage when asked. Ughhhh! I contacted my agent and the Texas Department of Insurance, and went to town literally. Section 1454 of the Insurance Code defines provider as home health aide, hospital, nurse practitioner, nurse midwife, outpatient care center, physician assistant, registered nurse, or surgery center. In this instance they offer me coverage of services that someone other than an OB can give me. Basically they cannot do what they are doing, and I have filed a formal complaint. That can take 4-6 weeks to resolve.

The feelings I had were overwhelming. I interviewed this midwife months before I even got pregnant. I am a planner. Now I am 8 weeks pregnant and we have no idea who is going to deliver this little bean. My choices are to still go to Nativiti and pay out of pocket, go to my old OB (who I like) but the anxiety I would have could be paralyzing, try to see a CNM (certified nurse midwife) who delivers at the hospital (which might make me lie flat on my back, hooked to an iv, and monitored 24-7 due to Hospital rules, not her rules), or have a homebirth (which is the least expensive option). The reason the CNM will still work is because she bills her services under her OB group she is a part of.

As of right now, I have pushed my appointment back at Nativiti and made a new appointment with the CNM for the 19th to ask her my questions about hospital policy. My heart wants to have a Homebirth, but my head is scared. I am not sure how this will transpire, but I will keep you in the loop!

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