Birth Centers & Insurance
– Jun 10, 2019(3 replies)
Does anyone have experience getting their HMO to cover a birth center? I go to Sutter East Bay and have Blue Shield HMO. I would love to go to Pacifica Family Maternity Center but want to make sure it’s at least partially covered by insurance.Jun 10, 2019
Have you talked to Pacifica? They know all the local insurances and work with you to bill as much as possible. I had Kaiser so paid for Pacifica out of pocket - it was very worth it.
Hi! I went to Pacifica for birth of my first baby last year and loved the staff, care and facility. I still go there each week for post partum group. I had blue shield ppo so not HMO. But I wanted to share my experience if it helps. The 3rd party company that works with Pacifica to process reimbursement definitely did their job. Blueshield told me they wouldn't cover any expenses but the 3rd party advised they typically can help recover some reimbursement for out of network provider. I had ppo insurance so there was out of network coverage. I expected to not get any reimbursement but did receive some after L&D. Hope this helps!
I gave birth at Pacifica about 6 months ago and had Anthem Blue Shield that covered 40% out of network. Pacifica staff did a great job fighting to get this for the services they provided us and it worked out so that just about 40% was covered. You definitely have to be patient with the process as we didn’t see any refund checks until about 3 to 5 months post birth but they came! We did not apply for gap insurance so I am not sure how that might have helped.
I can’t say enough about how much I appreciated and loved giving birth at Pacifica. So glad you are going with them!