Real experience with BCBS maternity rider coverage?? — The Bump
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Real experience with BCBS maternity rider coverage??

Looking for anyone who has had a pregnancy or childbirth under the BCBS of Florida maternity rider and what exactly was covered and not covered! Getting an answer directly is nearly impossible - as "every case is different, we can't estimate costs for your care" (imagine high nasally voice over phone with customer service)... 

We have the co-pay option where supposedly we pay $35 copay for our INITIAL prenatal visit ONLY and they are free (included) after that... and we'd pay $150/day copay for hospital admission for delivery, up to five days max. We're planning on using a birth center, but assume same rules would apply per day. Other than those two listed copays, I was hoping that all prenatal and delivery care particularly to my pregnancy (high risk or otherwise) would be covered completely, as I have no control over those outcomes... and that would be the whole point of insurance. Sorry for venting.. But then I heard rumors that only one ultrasound is considered "normal care" or "routine" and that we'd be paying for any additional, etc..

There is nothing specific in our benefits package. If anything, all sentences are intentionally vague or could be understood in multiple (contradictory) ways. 

Any real life experience with true billing and level of care that was covered, not covered, expected, or appreciated?

Thanks so much!! Haven't been able to find this out anywhere else on the internet. 

Re: Real experience with BCBS maternity rider coverage??

  • We have BCBS of Mass. and we had to pay one copay at the initial visit and then everything else was covered, including one ultrasound.  When I had genetic counseling done (on the OB's recommendation), I had to pay a copay there too, but whatever right?  Then I switched providers to a midwife and paid another copay there, but everything else was free.  Somehow I even ended up with three ultrasounds (10, 15, and 20 weeks).  The entire birth was a flat $200 (as quoted to me in advance), keeping in mind that it was uncomplicated & med free.  I don't know how that would have worked out otherwise.

    You have some options:

    - Keep calling BCBS until you get a helpful person or have the unhelpful person transfer you to their manager.  You deserve clear answers.

    - Have the billing dept of your OB take care of it (not really recommended but it is an option)

    - See if there's a patient advocate at your hospital.  They are amazing people and might have some better advice for you.

    - Check out the BCBS webpage.

    Good luck!  I *know* it's frustrating!  When I switched to a practice with midwives, I couldn't get a straight answer from BCBS if they were covered.  Turns out they are because they're paired with an OB practice.

  • I know this is a bit late, but I just saw this post.  I have BCBS Florida, with the same maternity rider that you described, and it's crap!!!!  Although all your prenatal visits are covered, if you have anything other than a normal vaginal delivery your individual plan will cover it.  I had to have a c-section, and because they call it " a complication of pregnancy", your maternity rider does not cover any costs associated.  So I was a bit surprised when I received a $5000 bill in the mail from the hospital.. when I was paying almost $500 per month for my policy and the maternity rider.  I suggest if you aren't already pregnant to make sure that your deductible is low on your individual policy, that way if you end up having a c-section, you will only have to pay the your deductible (if you haven't met it, and whatever your co-pay is).  Hope that helps!

     

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  • Hi Kelsey,

    I have the EXACT same questions as you do.  I have the bc/bs maternity rider in FL and have a 10k deductible for my health insurance.  I want to know what is considered normal before I end up with a 10k bill.  Is the doctor administering the epidural considered normal?  If you have any new info on your post, please let me know...I'm going crazy talking to people who all give me different answers at BC/BS. 

    THANKS! 

  • Sorry to give you bad news but I just had my c-section a month ago and now I'm getting bills ! Because according to the shh... Insurance we both share a c- section is not normal delivery so everything went to my deductible ! So the maternity rider sucks now im looking to fight them because theres no way I have 10k to pay ! BC/BS agents are horrible and they give you answers that avoid the truth they told me everything was included on the maternity rider I was paying every month but is was a complete lie! C-section and anesthesia not included! Only vaginal delivery is consider normal! I hope it helps you not to get surprises like us! Is hard to enjoy and relax with the horrible bills hunting you!
  • To anyone having this issue, I suggest seeing if you can get medical assistance to help cover that back cost!! They cover 3 month back so do it asap and try

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