BlueCross BlueShield (BCBS) provides comprehensive coverage for prenatal and postpartum care for its members across the United States. Under the Affordable Care Act (ACA), pregnancy is not considered a preexisting condition, and BCBS plans cannot deny coverage or charge higher premiums based on pregnancy status. This ensures that even individuals who become pregnant before enrolling in a BCBS plan are eligible for full prenatal care coverage. However, the specific extent and details of coverage can vary significantly depending on the particular BlueCross BlueShield plan. Members are advised to review their plan details through their Explanation of Benefits (EOB), available online via the BCBS Members Portal, or by contacting BCBS customer service using the number on their insurance card.
BCBS plans must cover prenatal care as an essential health benefit, regardless of whether the plan is offered through the health insurance marketplace, an employer, or Medicaid. The coverage is designed to support expectant mothers and new parents throughout pregnancy and the postpartum period, helping to manage the financial implications of growing a family.
Prenatal Care Coverage Details
BlueCross BlueShield covers a range of preventive and routine prenatal services. The specific services covered can depend on the plan, so verification with the insurance company is recommended. Common prenatal care services covered by BCBS include:
- Routine prenatal visits: Regularly scheduled appointments with an in-network OB/GYN or certified midwife to monitor fetal development and maternal health.
- Screenings, bloodwork, and diagnostic tests: Routine ultrasounds are covered to monitor fetal growth and identify potential complications. Some plans also cover non-invasive prenatal testing (NIPT) for genetic conditions.
- Nutritional counseling: Many plans cover nutritional counseling with a low to no copay, in addition to gestational diabetes testing. Some BCBS plans even cover prescription prenatal vitamins.
- Prenatal lactation consultations: Many BCBS plans cover one or more prenatal lactation education sessions with a board-certified lactation consultant (IBCLC) to address concerns about latching, positioning, or potential breastfeeding challenges before the baby arrives.
- Incentive programs: Some plans, such as FEB Blue, offer incentive programs for completing prenatal visits, which may include pregnancy care kits and wellness rewards. Other plans, like Blue Cross MA, offer reimbursement for childbirth education classes.
Prenatal Care Services Not Typically Covered
Certain types of prenatal care are not covered by BlueCross BlueShield or may require out-of-pocket costs if deemed medically unnecessary. These services include:
- Non-medically necessary ultrasounds: 3D/4D ultrasounds for keepsake purchases are typically not covered by insurance.
- Non-medically necessary genetic testing: Genetic testing performed solely to determine a baby’s gender is generally not covered by insurance.
- Alternative therapies: Treatments like chiropractic care or massage therapy to manage pregnancy-related aches and pains typically have limited insurance coverage.
- Over-the-counter vitamins: While prenatal vitamins may be covered when prescribed by a doctor, over-the-counter vitamins are generally not covered by insurance.
Special Beginnings® Maternity Program
Blue Cross and Blue Shield of Texas (BCBSTX) offers the Special Beginnings® maternity program, designed to help applicable BCBSTX plan members and their babies get off to a healthy start. This program provides education materials and support, pregnancy risk factor identification, ongoing communication and monitoring, and access to an online resource center.
Postpartum Care Coverage
BlueCross BlueShield covers a range of postpartum care services to support physical recovery and emotional well-being after childbirth. Coverage details vary by plan, but most plans include:
- Postpartum checkups: Plans cover at least one OB/GYN visit, typically at 6 weeks postpartum. Some plans cover multiple postpartum visits, especially for those with high-risk conditions such as high blood pressure.
- Lactation consultations: BCBS covers virtual or in-person lactation support with a board-certified lactation consultant for breastfeeding challenges.
- Breast pumps: Eligible members can receive one breast pump per calendar year at no cost, and some plans cover hospital-grade pump rentals when medically necessary.
- Pelvic floor physical therapy: Many BCBS plans cover pelvic floor physical therapy to aid in postpartum recovery, including addressing urinary incontinence and diastasis recti. Prior authorization or a doctor’s referral may be required for continued coverage.
- Mental health therapy: Coverage for mental health therapy is available, though prior authorization or a doctor’s referral may be required for continued coverage.
Important Considerations and Actions
To ensure uninterrupted insurance coverage, it is important to contact BCBS as soon as possible after the baby’s born to take advantage of the qualifying life event for adding a newborn to the plan. Required documentation, such as a birth certificate or hospital records, may need to be provided.
Understanding the coverage and costs associated with BlueCross BlueShield for prenatal and postpartum care is crucial for making informed healthcare decisions. BCBS has resources available to help members access care, and health during pregnancy and postpartum matters.
Conclusion
BlueCross BlueShield offers extensive prenatal and postpartum care coverage as an essential health benefit, with specific details varying by plan. Members have access to routine visits, screenings, nutritional counseling, lactation support, and postpartum services such as checkups, breast pumps, and physical therapy. Programs like Special Beginnings® in Texas provide additional support. To maximize benefits, members should review their specific plan details, utilize available resources, and promptly contact BCBS after childbirth to add a newborn to their coverage.