Introduction and a question

[jetta91806]

Hi Gals --

Brand new here! My name is Andrea and I'm about 11 weeks pregnant with my second child. My son, Simeon, is two and we're just so thrilled to have a new little one join the clan. I had a homebirth with Simeon and it was wonderful. I'm planning on doing the same for this birth as well.

My question is...I have called a couple doctors around my area to line up prenatal care and have been informed that they combine prenatal and delivery fees as a package now. So that means I can't separate out just prenatal care. Since I'm birthing at home, I obviously don't need to pay for all the hospital fees. I would like a doctor's care for some lab stuff and the ultrasound mid-way through. So I guess what I'm asking is if this is standard? If so, what happens to ladies that move mid-way through and have to switch doctors/hospitals? Also, I have been pretty upfront about my home birth plans. Is this why they're telling me I can't just get prenatal care?

Any advise is greatly appreciated! I look forward to getting to know you all!
Thanks in advance,
Andrea

[Romana]

I think that's pretty standard. Does your homebirth HCP not do prenatal care? My midwife did all my prenatal care, including arranging for the lab stuff and ordering an ultrasound.

Usually, if you switch HCPs in the middle, they just bill for what they've done.

[jetta91806]

My first home birth I only had attended by a doula so I did prenatal care with a doctor. So, honestly, this is the first time I'm actually using a midwife and I haven't made contact with her yet. I plan to next week. She may be able to do all the prenatal stuff including a sonogram. I'm just not sure. That will be my next avenue to pursue. I was just surprised to learn that I couldn't just pay my office co-pay for prenatal care. Last time, I was able to just do that and not have to pay for the hospital stuff. The doctor I saw last time no longer does prenatal as he was pushed out of the system due to being so home birth friendly...grrrr.

Thanks for your feedback! I'll be getting in touch with my mid-wife-to-be and will go from there.

[Full Heart]

There are no drs in my area that will see hb patients because of their liability insurance. So if you tell them upfront you may not be able to get care. You might just not want to say anything. However my mw does all my prenatal care and can do a referall for an u/s. She does all the labs but if a mw doesn't I know there are several places around that people go to get labs done. My mother shopped around when she needed some specific labs done that her natropath wanted. So I know here its not really a big deal that drs don't take hb patients.

[JosieAK]

My midwife has a tiny little office over a coffee shop in a tiny town in Alaska. Through her I have gotten all of my needed urine tests (one per visit and an official one through the lab), blood tests, and my RhoGAM shot. She would have scheduled an ultrasound if I wanted it and would refer me to a very midwife-friendly husband and wife doctor team who work with breeches, twins, etc. if needed. I really don't think that having a doctor is necessary for an uncomplicated pregnancy and it sure is cheaper and cozier to work with someone that I've become good friends with over the past few months.

[jetta91806]

Yeah, I pretty much decline most of the testing anyway, but I would like a sonogram just to make sure I'm not having twins or anything wild like that and to make sure everything looks good from that vantage point for a home birth.

So when you say your midwife referred you for an ultrasound, did you have to pay out of pocket for that or did your insurance cover it?

[DahliaRW]

Most midwives can send you to an u/s tech and a lab for bloodwork (if they don't do it themself) just like an OB would. When I had a viability u/s with my 2nd, my insurance covered it 100%. Just like they do when my doctor sends me to a lab for bloodwork or to radiology for an xray or MRI.

[Mainstream Hippie]

I see an OB my first trimester, when I am high risk, and then transfer care to my midwife. I do have to pay my midwife's full global fee, but my OB, who is the doctor my midwife risks patients out to, completely understood the situation, and broke down their global fee into what portion the weeks I was seen by them were worth.

My midwife can order labs and ultrasound, both of which are done through independent labs. When my OB ordered bloodwork, I had to go to an independent lab for that, too.

I think the real trick is just finding an OB who is home birth friendly, which can be tricky. You midwife should have a good bead on that kind of thing. But they are all blowing smoke up your rear if they tell you they can ONLY charge you a global, and you have to pay the whole thing or no service. I mean, what if you were seeing an OB, and then decided to change doctors? You wouldn't be allowed or they would both charge you? No- you would be billed for the services you used from the first, nothing more, and then would be billed a global from the doctor who delivered you. Oh, and you would also be billed by the hospital- the doctor's global only covers his services- prenatal and at the delivery- not the actual hospital fees.

[jetta91806]

Mainstream Hippie -- First off, I love your screen name! And, secondly, that makes a lot of sense that I would only have to pay for what services I used. I'm sure that a for-profit doctor's office would prefer me to pay the global fee, but yeah, people switch doctors all the time and don't have to double pay.

I know my insurance would normally cover a sonogram and whatever lab work I want done. I just wasn't sure if they would cover if I'm using a midwife instead of a doctor. I know they won't cover a midwife.

Thanks again, for all the feedback on this. I sure this will all fall into place when the time comes. I just don't enjoy dealing with insurance companies and the medical community. It's such a drag on an otherwise joyous life event.

[alegna]

Originally Posted by jetta91806

I know they won't cover a midwife.

How do you know this/ are you sure?

In areas where midwives are legal and licensed, they have to cover midwives (unless you have an HMO- that can be a PITA)

-Angela

[L&K'smommie]

I was going to say what alegna did...where do you live? In AK insurances(most of them including Medicaid) cover midwives of all kinds. My m/w does all my bloodwork and ordered my 20 week u/s which insurance covered at its normal percentage(80%). So I would talk with your m/w and find out what she can do and call or look online and see what your insurance will and will not cover.

[jetta91806]

I'm in Kansas City, MO. They just legalized home birth midwives a few months ago. I haven't called my insurance since that change. Perhaps they do reimburse now. I hadn't thought about that. You ladies are instilling high hopes in me!

[Evergreen]

I am in NC. I have a friend who used a midwife for her homebirth, but had backup prenatal care with an OB in town. After she had the baby at home, she called the OB and he returned the birth fee.

I used the same midwife (no OB backup,though) and was a hospital transfer with my second. She didn't return any of the money I paid her, which was in her contract and I was fine with it. So, I thought that was pretty cool of the OB.