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Prenatal Care
Prenatal appointments with Blue Cross Blue Shield (BCBS) PPO providers are covered in full, without copayments.
The number of prenatal appointments you have depends on your personal medical condition and whether your pregnancy is without complications. A standard schedule of appointments may be the following:
- One visit per month from week one through your 28th week of pregnancy
- Every two weeks from the 29th week through your 36th week of pregnancy
- Weekly visits from the 37th week until you deliver
Genetic Testing
Depending on your family history, your obstetrics provider may recommend that you have genetic testing.
Not all genetic tests are covered. Please make sure that your doctor obtains prior authorization for any genetic test that they recommend before you have the test done. When you use an in-network provider and receive approved prior-authorization,genetic testing is covered in-full, without copayments.
Ultrasounds
Your obstetrics provider may recommend that you have ultrasounds as part of your pregnancy care.
You are covered for three routine ultrasounds during your pregnancy as outlined:
- One routine ultrasound during the first trimester to determine the presence of an intrauterine pregnancy and to estimate gestational age
- One routine ultrasound during the second trimester to survey fetal anatomy and generate an accurate estimation of gestational age
- One routine ultrasound during the third trimester to determine fetal presentation and to evaluate fetal condition in late registrants for prenatal care
Your provider may order additional ultrasounds; however, additional ultrasounds must be medically necessary and cannot be ordered for routine purposes.
Delivery and Inpatient Admission
Your inpatient stay following delivery will be no less than 48 hours for a vaginal delivery and 96 hours for a Caesarian section unless you and your attending doctor decide otherwise.
Your cost for the inpatient stay will be lower when you use providers that are in the BCBS PPO network.
When using providers in Massachusetts, you should also confirm if the provider is affiliated with a lower cost sharing hospital as that will impact how much you pay for your inpatient admission. This is known as Hospital Choice Cost Share (learn more about hospital choice cost sharing).
Lactation Counseling
Lactation counseling is covered in full, without copayments, when performed by a doctor, nurse practitioner, or an IBLCE (International Board of Lactation Consultant Examiners) licensed lactation counselor.
At this time there isn’t a network of participating licensed lactation counselors available. Most members will be asked to pay out-of-pocket and file for reimbursement for services. If you pay out-of-pocket, you need to submit a subscriber claim form and receipt to be reimbursed. Note: some providers in Massachusetts have agreed to submit claims on behalf of our members.
Other Services
Reimbursement for childbirth classes
Pregnant members can be reimbursed up to $90 for one childbirth class and up to $45 for each refresher childbirth course.
Enrolling Your Newborn
When having a baby or adopting a child, be sure to add them to your health plan within 45 days of the date of birth or adoption/placement. This plan does not cover the newborn under the mom’s enrollment; therefore, you must add the child to the plan as of the date of birth/adoption date to avoid costly bills.
Breast Pumps
Pregnant members can be covered for the rental or purchase of one manual or one electric breast pump per birth. The pump must be purchased from a durable medical equipment supplier in our network.
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