Insurance coverage for homebirth

[callieollie]

If your insurance does not cover homebirth (either as a general rule or because you're using a CPM that is not covered or illegal), does that mean they cover nothing related to your pregnancy, even if your insurance covers maternity? Would they just not cover the visits and birth provided by the midwife or would they not cover anything, including ultrasounds, any bloodwork, diagnostic tests, etc.?

[twead]

I want to know this too!

[OTMomma]

In my experience it depends on your insurance- mine paid for the ultrasound, labwork, etc at the rates they normally pay for those things- and I had to get them done at covered places (so my first choice for where to do the u/s was out). With my second child- I had an insurance policy that covered the midwives prenatal care as out of network, but wouldn't cover any of the birth- they didn't cover homebirth. With my third baby, we called them and got an out of network exemption, because there was no in network choice available, they had changed a lot of policies, and we got most of my pregnancy and birth covered at in network rates.

So my advice is to call and talk to your insurance company about how they do things, then call again when it is time to see a provider or get something done- just to be sure you understood exactly what and where they will cover.

HTH,

[IAMommy]

We switched insurance at the beginning of the year for this very reason. Our previous plan covered nothing that was done by a midwife (so they said, but they did cover labs and the initial ultrasound), but our current plan covers her as a regular provider.
You should call them and see what their policy is, because I have never seen this topic covered in the plan documents.
Either way, you will probably have to pay out-of-pocket for everything she does and wait to get reimbursed after the birth.

[nashvillemidwife]

Does your plan say it excludes home birth, or midwives? You should take that at face value. If midwives are excluded on your policy, they don't pay for anything. If it's just a home birth exclusion, they should pay for everything that was not done on the day of the birth.

[callieollie]

I'm not sure what the policy says actually. We're in the process of switching insurance so I don't have all the details of the plan right now. The insurance I have now does not cover maternity (except for pregnancy complications). If I get on the new plan my dh is joining, it would be covered. It's a highmark plan. I looked up providers on the website and they do cover several CNMs around here so unless they have different providers they cover on different plans, it appears they do cover midwives. But, they do not cover any of the midwives I would be considering using (one is a CNM and one is a CPM) when we get pregnant. I read somewhere on their website that they don't cover homebirth though. So, I'm not sure how it works if your provider is out of network for them but they provide maternity care. Insurance just confuses me!

[moonglowmama]

FWIW, our insurance covers CNMs at a birth center or hospital without mention of exclusion of home birth. We had to appeal the initial denial of coverage for a home birth, but our main point was that if they cover a certified birth center, it is only logical to also provide coverage for a CNM at a home birth, as the only difference is that she brings the supplies, etc, essentially the birth center, to us. It was the 3rd birth we've had to bring up this point with them, but again, they covered.

You'll need to get a copy of the coverage wording and work within it to get what you want. The first time we appealed, more than 6 years ago, we had to present research etc. that showed that not only was homebirth as safe as hospital birth with a qualified care provider, but that it was also more cost-efficient (no hospital fee, drugs, etc.) and that it was our legal right, so they really didn't have a reason to deny coverage.

[starrmama]

It really just depends on your insurance and your midwife. My midwife is a CPM (I'm actually not even sure if she has that!) in a state where direct entry midwives are alegal at best... but she happens to have a provider number with my insurance, even though she's not an officially licensed medical provider (don't ask me how she got it - I have no idea!). She does "global billing" for all care including prenatal stuff and the birth and postpartum visits. She gave me the forma to fill out and send in... she actually "bills" for more than we pay her so that with "out of network" we still got back almost all of what we had paid her up front. Any lab work, tests, etc are done through a supportive OB's office who was "in network" for me so of course all that was covered as usual, and that office handles those insurance claims. You may not be as lucky, but just wanted to post to say it CAN happen, even with insurance that might SAY they don't cover homebirth.