Question about insurance coverage in case of a transfer

[Jennemiah]

So, my insurance plan specifically excludes home birth. Therefore, I'm trying to figure out how much planning a home birth could potentially cost. For my first I had a hospital birth with a group of CNMs, and the one I saw for most of my pregnancy has a home birth practice, so I would LOVE to have a home birth with her. Here are my 2 scenarios:

1. (ideal) Home birth with my MW, prenatal (and maybe postpartum?) care would be covered at the in network rate because it's in their office, and I would end up paying the birth fee completely out of pocket (still a lot of money, but totally worth it).

2. (not ideal) Plan a home birth with my MW, but have to transfer to hospital. In this case, how does the billing work. I know my MW would still charge the full fee, but how does it usually get billed - they can't bill it as a birth fee, so does it get billed as labor support? Or do they just bill the entire fee as prenatal/PP care? Also, in this case, are there issues with if my insurance company finds out I had planned for a HB? They can't refuse to cover the hospital services just because I had planned to birth at home, can they? I would think that that information would come out at the hospital, especially if I am transferring to the hospital where my MW is on staff...

Not pregnant yet, but planning ahead...

Thanks!

[GoldmanBaby09]

I would speak to your midwife as to how she would bill for a hospital transfer. In terms of your health insurance, if you transferred, you would likely be admitted throught the ER and you would be resposible for your ER co-pay and then your coverage would kick in after that. Again, if your midwife is on staff with the hospital you would be transferring to, I would ask her about it. I'm sure she has had to deal with transports before and could probably provide more specific information. Good luck!

[Full Heart]

It should still be covered even if they knew you were planning a hb. Its not like its gonna be in the bill to them from the hospital. If someone goes to the hospital for stitches because they were the assistant to a knife thrower who missed his mark its not like thats in the bill. Just that the patient needed stitches. KWIM?

As far as how your mw gets paid, she would bill for the prenatal, insurance doesn't cover labor support (do doulas wish!). And they would probably cover pp follow up but the birth fee would go to the mw/dr who attended the birth. So you would still be responsible for the fee to your mw for the birth if thats how she breaks it out.

[Jennemiah]

Thanks for the replies! I will definitely check with my mw about how she does it specifically, but these answers really helped clarify things for me.

[nashvillemidwife]

Generally, your midwife would bill the prenatal and postpartum (assuming she does the postpartum) as she was planning, and the doctor will bill for the birth. If you don't have the baby at home, they may pay your midwife for labor support where ordinarily they wouldn't. Whether or not you were planning a home birth should not matter, that is not related to the procedure or diagnosis being billed for.