Pacifica Maternity & Blue Shield of CA

I have an out-of-state PPO BCBS plan through my employer. I got prenatal and postpartum care through Pacifica (would have birthed there, but had complications and needed to be induced at Alta Bates). Pacifica ended up offering us a $500 refund because they couldn't support us at AltaBates because of COVID restrictions. 

In the end, only about $2,000 (maybe slightly less, I don't remember the exact amount) of the $6,500 was reimbursed through our insurance. It took a long time to get the reimbursements (maybe 4 months?) and it was a somewhat frustrating process in that Pacifica used a billing service, which wasn't very responsive. I loved the care I received through Pacifica, especially as a first-time mom. I probably won't do that for the next kid, but highly recommend Pacifica for first-time parents!

Honestly, I would say that you should be prepared to pay full price because the insurance piece is so unpredictable. I had PPO coverage that said very clearly that it would cover 60% out of network, but in the end I only got some of it, I think a little less than half. I got bounced around between a bunch of different people, all of whom said I *should* get the rest of the money, but after about a year and many phone calls (and of course having a newborn!) I gave up. I think if I had actually birthed at Pacifica it would have been ok, but I had to transfer - which is very common, and was totally fine otherwise - and the insurance company just couldn't figure it out. And so on top of that I also had to pay for the hospital birth (20% for in network, but that's still a lot!). I loved the care I got at Pacifica, and the community, and I know people who choose it with no insurance coverage. I hope you have better luck with your insurance than I did but it's worth being prepared for your insurance not coming through.

Have you contacted your provider directly?  That will be your safe bet in getting all your questions answered particularly around coverage.  Or your HR resource depending on if the coverage is through your employer or your partners.

You can also work with an admissions director from Pacific- they should be able to explain exactly what BS will and won't cover including addressing whatever your out of network deductible might be.  

I wasn't going to respond origionly, as we had Cigna when I birthed at Pacifica, but since others had bad experiences with their various PPOs and Pacific, I thought I'd chip in my more positive one. So we paid Pacifica upfront and then waited for our reimbursement from the Cigna PPO. We had figured we'd pay our 60% out-of-network and get 40% back of what we had paid. But Pacifica bills at a much higher rate to insurance companies than what they bill families. My insurance then said they would only pay a portion of that bill. But even with that lower payment, we got back much more than we were expecting. I think we probably got about 60-75% back of what we paid Pacifica upfront. It was really unpredictable though and the biller, like others mentioned, was not super responsive to my question about whether the first check was the final check or if we would get more (I think we got the reimbursement in 3 installments in the end over several months after the birth).

As others suggested, I'd try and talk to someone at your PPO, but it all seems very murky even after the reimbursement checks start coming.