BlueCross BlueShield Pregnancy & Postpartum Coverage

If you are newly pregnant, amidst the celebrations, it’s normal to be concerned about the financial implications that come with growing your family. Luckily for the 115 million Americans covered by BlueCross BlueShield (BCBS), extensive prenatal and postpartum care coverage is available.

In this article, we’ll break down what’s covered, how to access services, and additional benefits that may be available under your BlueCross BlueShield insurance. By learning early in pregnancy what your BCBS plan covers, you can make informed healthcare decisions for your pregnancy and postpartum recovery.  

BlueCross BlueShield Pregnancy Care Coverage

All BCBS plans must provide prenatal care coverage as an essential health benefit, regardless of whether your plan is offered through the health insurance marketplace, your employer, or Medicaid. 

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Under the Affordable Care Act (ACA), pregnancy cannot be considered a preexisting condition, and BlueCross BlueShield cannot deny coverage or charge higher premiums based on pregnancy status. This means that even if you become pregnant before you enroll in a BCBS plan, you are still eligible for full prenatal care coverage.

However, it’s important to note that the extent and specifics of prenatal care coverage vary depending on your BlueCross BlueShield plan. We recommend that you review the details of your plan through your Explanation of Benefits (EOB), which is typically provided upon enrollment and is available online through the BCBS Members Portal, or contact BCBS customer service by calling the number on the back of your insurance card. 

Pregnancy Care BlueCross BlueShield Covers

BlueCross BlueShield covers preventive and routine prenatal services for expectant mothers. It’s important to verify coverage under your specific plan by contacting the insurance company directly. 

Some common types of prenatal care covered by BlueCross BlueShield 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, 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: In addition to gestational diabetes testings, many plans cover nutrition counseling with a low to no copay. 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 baby arrives.

Some BCBS plans, such as FEB Blue also offer incentive programs for completing prenatal visits, in the form of pregnancy care kits and wellness rewards. Other plans, including Blue Cross MA offer reimbursement for childbirth education classes.

Pregnancy Care BlueCross BlueShield Does Not Cover

Some types of prenatal care are not covered by BlueCross BlueShield, or require out-of-pocket costs when they are deemed not medically necessary. These services include: 

• Non-medically necessary ultrasounds: 3D/4D ultrasounds for keepsake purchases are typically not covered by insurance.
• Non-medically necessary genetic testing: While some parents opt for genetic testing early to find out a baby’s gender, this service is generally not covered by insurance.
• Alternative therapies: Treatments like chiropractic care or massage therapy can help to manage the aches and pains that come with pregnancy, but they typically have limited insurance coverage.
• Over-the-counter vitamins: Prenatal vitamins may be covered when they are prescribed by your doctor; however, over-the-counter vitamins generally are not covered by insurance. Their purchase may be FSA/HSA eligible, which can help offset the cost.
• Out-of-network care: Visits to providers or birth centers that do not participate in your BCBS network may result in higher costs or denial of coverage.

Because coverage varies by state and plan type, it is important to review your specific BCBS policy to understand any exclusions or limitations on prenatal care services.

BlueCross BlueShield Labor & Delivery Coverage

While the cost to give birth varies by your specific policy, state, and hospital, BlueCross BlueShield generally covers labor and delivery at in-network hospitals.

Covered services typically include:

• Hospital admission: Coverage includes hospital room & board for vaginal births (typically 24-48 hours) and C-section deliveries (typically 48-96 hours). Private rooms may be covered, but some plans only cover shared rooms. 
• Delivery services: BCBS covers vaginal birth and medically necessary cesarean sections (C-sections), including medical staff fees and emergency interventions, when needed. Pain management during labor and delivery, including epidurals and anesthesia services, are typically covered, though may have cost-sharing requirements.
• Newborn care: BCBS provides coverage for newborn care immediately after birth, including standard screenings, vaccinations. NICU services are also covered, though typically with cost-sharing. 
• In-hospital lactation support: If offered by your hospital, most BCBS plans cover lactation consultations during your stay. 

Some services have more variable coverage, such as: 

• Midwife-assisted births: Some states only recognize Certified Nurse-Midwives (CNMs) as licensed practitioners with covered services, and may not cover Certified Professional Midwives (CPMs) or lay midwives.
• Elective C-sections: BCBS covers medically necessary C-sections, but elective C-sections may not be fully covered.
• Labor & delivery at freestanding birth centers: Similar to a hospital birth, BCBS generally covers the cost of labor & delivery at in-network freestanding birth centers when births are attended by Certified Nurse-Midwives. However, there are important exceptions to understand, such as if medical complications arise and the birth center does not have hospital privileges.
• Home births: Some BCBS plans cover home births under specific conditions, including that it is a low-risk pregnancy and the birth is attended by a licensed midwife who has collaborative relationships with physicians and hospitals to transfer if necessary. Home-birth specific supplies, such as birthing tubs, are generally not covered.
• Doula services: Select BCBS Medicaid plans now cover doula support before, during, and after childbirth.

Regardless of where and how you choose to give birth, it’s important to contact BCBS directly to verify coverage details. 

How To Find A BlueCross BlueShield Labor & Delivery Hospital 

To find an in-network BlueCross BlueShield hospital for labor and delivery, follow these steps:

1. Check online: On your plan’s BlueCross BlueShield official website, look for a “Find a Doctor” or “Find a Provider” tool. Then, select “Hospitals & Facilities” as the provider type, and enter your zip code to find an in-network BlueCross BlueShield hospital near you. Be sure to filter the results for maternity care, labor and delivery, or OB/GYN services.
2. Call BCBS: Call the number on the back of your insurance card and speak to a customer service representative to verify the in-network status of a specific hospital.
3. Ask your OB/GYN or midwife: Your OB/GYN or midwife will need to have delivery privileges at the hospital where you want to give birth. To minimize out-of-pocket expenses, both the hospital and the provider need to be in-network.

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Choosing the hospital where you will give birth is an important decision, and even among in-network hospitals, plans cover labor and delivery differently, so it’s important to have a clear picture of the costs associated, including deductibles, copays, and out-of-pocket expenses related to your hospital stay. 

BlueCross BlueShield Postpartum Care Coverage

Giving birth is a qualifying life event, which means you can enroll in a new health insurance plan or make changes to your existing plan, including BlueCross BlueShield, through a Special Enrollment Period (SEP). 

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The Special Enrollment Period typically lasts 60 days from when you give birth, allowing you to add your newborn to your existing BCBS plan, enroll in a new plan, or make changes to your coverage. If you do not enroll your baby within this 60-day period, you may have to wait until the next Open Enrollment period, which would leave your newborn temporarily uninsured and potentially facing higher healthcare costs, including for pediatric visits.

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If you were previously uninsured, giving birth allows you to sign up for a new health insurance plan, including BlueCross BlueShield Medicaid, if eligible. To take advantage of this qualifying life event, it’s important to contact BCBS as soon as possible after your baby is born and provide any required documentation, such as a birth certificate or hospital records, to ensure uninterrupted insurance coverage.

Postpartum Care BlueCross BlueShield Covers

BlueCross BlueShield covers a range of postpartum care services to support physical recovery and emotional wellbeing 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 to address urinary incontinence and diastasis recti. Some BCBS policies allow direct access to a physical therapist, which means you can go see a physical therapist without a doctor’s referral, while others require a prescription for continued coverage.
• Mental health & postpartum depression support: BCBS covers sessions with licensed therapists for postpartum depression and anxiety, including via teletherapy. Many plans include free mental health screenings for perinatal mood disorders. 

• Acupuncture: Certain BCBS plans cover sessions with licensed acupuncture providers for pain management and postpartum healing.

For the most affordable care, it’s important to find a provider who is in-network with BlueCross BlueShield and your specific plan.

Postpartum Care BlueCross BlueShield Does Not Cover

While BlueCross BlueShield covers many essential postpartum services, there are certain treatments and services that are not included or require out-of-pocket costs when deemed not medically necessary.

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Postpartum care services that are not typically covered include: 

• Cosmetic procedures: Elective cosmetic procedures after childbirth, such as abdominoplasty or stretch mark treatment, are generally not covered.
• Alternative therapies: Services like postnatal massage and placenta encapsulation are not covered by insurance, unless under a specific plan’s wellness program.
• Out-of-network care: Visits to providers that are not in-network with your BCBS plan  may result in higher costs or denial of coverage.

Some plans also place limits on the number of sessions that can occur for a covered service, such as pelvic floor therapy and mental health therapy; prior authorization or a doctor’s referral may be required for continued coverage.

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Final Thoughts

Understanding the coverage and costs associated with BlueCross BlueShield for prenatal and postpartum care is crucial to make informed decisions about your medical care. 

Your health during pregnancy and postpartum matters, BCBS has resources available to help members access care. If you’re pregnant or trying to conceive, contact BCBS today to confirm your benefits and take advantage of available programs. 

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