To the moms who pay for midwife out of pocket:

[jess_paez]

I see a lot of you pay for midwives cash. Is this because your insurance doesn't cover one? Maybe you have health insurance, but you don't have added maternity coverage?
What happens when or if your midwife transfers you to the hospital because of a complication? Do you pay for the birth as if you didn't have any coverage? That could amount to thousands of dollars. I'm just curious.

[prancie]

We pay with cash because in our state midwifery is illegal. We transferred last time and I had an emergency c-section. Our insurance paid for every penny of the hospital bill. Once you get to a doc your insurance kicks in like normal. I imagine that for those who do not have insurance that they would have a big bill, but that is what they must be prepared to deal with.

[lyterae]

We will be paying cash for a midwife. Our insurance covers prenatal care/delivery, however it does not cover midwives. After the birth we will most likely attempt to get the insurance to pay for some of it. If we have to transfer for any reason our insurance will cover at least most of it.

[Thursday Girl]

we didn't have insurance through part of my 2nd pregnacy, so we payed some and bartered for most of it.


i was talking to one girl and she said the birth center reimbursed her for the birth portion of the bill b/c she ended up transfereing.

[WaitingForKiddos]

Hey Jess!

We pay our mw out of pocket. There's a chance that with dh's new job the new insurance will pay for 10-80%. It's out of network maternity care and we have no out of network coverage so I'll need to write a letter. With pregnancy #1 we had an HMO that we knew wouldn't cover mw, but would cover my ob. So I used mw for prenatals and planned to birth at her birth center. Labs, scans and other prenatals we through ob. I paid mw each time I saw her (as I do now). I pay towards the 4k fee so I try and make the payments 100-300 bucks. With pregnancy #1 I had paid $350-400 when I pprom'ed. It was made very clear at that time that I didn't owe anything more and mw was by my side for about 12-20 hours (can't remember much so this is dh's guess) at the hospital as my doula. After I pprom'ed but before I was in the hospital dh and I spent some time at the birthcenter relaxing and trying to gather information/keep it together. MW does offer doula services and she charges $1000 for them.

I've heard other loss mamas get complete refunds from their mw's after even a loss during labor/at term.

I think it would depend on why you transfered. If you get tired and want an epi I'd imagine you'll get your mw as doula/labor support but will be paying the cost of your agreed amount. If you transfer because something goes wrong...decels or prom or something not scary persay but better handled in a hospital I
imagine you'll pay for your mw that agreed amount.

In any case I've heard of, all insurance that is supplying maternity services will cover a transfer and you'll pay the % or copay your policy has.

My mw seems to have mostly ppo clients that pay the normal 20-60% of her fee.

[MyFillingQuiver]

We pay cash for a few reasons-

1) We have maternity coverage, but it has a 5k deductible and 20% coinsurance after that. Her fee is only $2400 if paid by 37 weeks, which is what we are doing.
2) Midwives are not covered by our plan as in network providers. So, in the end, we may get a couple hundred dollars kicked back if covered as an out of network provider, but maybe not.
3) If I end up needing a hospital birth, it's always more than the 5k, (particularly if it's for a c-section!) so we'll meet our deductible, then hopefully get some refunded for midwifery care as out of network.


My midwife has a pro-rated refund fee. So, if we end up deciding on another care provider, we'll pay only a portion of the agreed to fees up until that point. If it ends up in a hospital transfer, there is a discounted rate and she'll act as my doula/midwife in the hospital for that fee.

[AmyKT]

My insurance pays for midwife care "in a licensed healthcare facility," so that doesn't cover home births. If I had a home birth, I'd have to pay out of pocket, but if I got transferred to a hospital, I assume my regular coverage would kick in, which covers EVERYTHING except a $100 inpatient hospital fee.

BTW -- I'm not having a homebirth, but I am seeing a group of certified nurse midwives who deliver at a local hospital, and it is fully covered by my insurance.

[elmh23]

we paid up front, before the birth, in cash. after babe was born, she submitted a claim and we were reumbursed for what they would have covered if it had been a hospital birth (80%)

[Jelinifer]

Originally Posted by AmyKT

My insurance pays for midwife care "in a licensed healthcare facility," so that doesn't cover home births. If I had a home birth, I'd have to pay out of pocket, but if I got transferred to a hospital, I assume my regular coverage would kick in, which covers EVERYTHING except a $100 inpatient hospital fee.

BTW -- I'm not having a homebirth, but I am seeing a group of certified nurse midwives who deliver at a local hospital, and it is fully covered by my insurance.

We have the same clause- except it's only for midwives in hospitals, so my insurance is covering all the prenatal stuff and we are responsible for paying for the actual birth at the birth center. In the instance of a transfer, our midiwife will accompany us to the hospital and act as a doula- but we don't have the option of being reimbursed that money if I do have to transfer regardless of the reason.

[jennica]

We have full maternity coverage, with about a $1000.00 deductible. However, when I asked the insurance company if homebirth was covered, they said only if it is attended by a doctor. So, we set aside enough in Dh's cafeteria plan (where they take pre-taxed dollars out of his check and we get reimbursed for medical expenses) to cover the midwife, a doula (probably postpartum, not birth), a birth tub, etc. The cafeteria plan is much more flexible because it's our money, it's just pre-tax so we save quite a bit. We will give our midwife her first $500.00 payment out of our tax return, then we will just keep getting reimbursed for that and handing the reimbursment check right to her until she is payed off. Then, we keep the last reimbusement check (which was originally our tax return money).

[laohaire]

In my state (MA), CNMs are barred from attending homebirths. However, there is a loophole - lay midwives are not barred. So you can only have a homebirth with a lay midwife. (EDIT: Or with an OB, but good luck finding one who will do it.)

My insurance only covers maternity services from OBs and CNMs. So, basically they don't cover home birth.

So we paid for our DEM upfront, paid by 38 weeks.

I did not transfer to the hospital but if I had, the insurance would have kicked in. I'm sure they would have charged for the full birth. As it was, DD did get admitted to the hospital 3 days PP for jaundice. We were of course not charged for the birth (obviously) but for the medical care she did receive.

[xixstar]

We have insurance with maternity benefits, but my midwife is out-of-network and DH's work just dropped ALL out-of-network benefits. Of course, our deductible when we still had OON benefits was so high, we'd still be paying out of pocket -- so that change hasn't affected us much. With our old insurance, they covered part of her fee, but we didn't have high deductibles then (we now have an HSA account).

There is another homebirth midwife that I believe my insurance would have covered as in-network... but I like my mw and wasn't willing to change. It's worth it to us to have the birth we want in the place we want, with who we want.

If we transfer, then we will be paying both our midwife's fee and the part of the in-network deductible we need to meet before our insurance kicks in to cover the hospital fees. That will really suck, but emergencies tend to suck in general so we'll survive if that happens.

[Monarchgrrl]

We are paying cash for our homebirth. Our insurance won't remiburse anything and our midwife can't bill them for anything. We have an HMO that won't cover anything outside their network (or outside their hospitals) but it does cover all maternity in their network. We could have a hospital birth for a grand total (no matter what type of birth) of $250. Or we can pay our midwife $4500 for a homebirth. Homebirth is that important to us. If we have to transfer then it'll only add $250 to the birth cost, anyway.

[Peace+Hope]

cash to HB midwives: in NC, CPMs and lay midwives are not licensed, so they are not practicing legally.

insurance: to get maternity coverage (and probably not covering HB but i'll never know), we'd have to have added it on an anniversary date, and pay for a year at a time, making it probable we'd have had to pay 2 yrs of premiums. this would have been an extra $186 PER. MONTH. my (private) policy covers emergencies related to labor and delivery, so emergency c-sections, hemmhoraging, etc. and the baby is covered as soon as it is born under all the same coverages as i have.

enter HSA: since it's a federal program, it's above my state's rules. my MWs were ok giving us a receipt to save for our federal taxes, so even though we are paying them out of pocket, at least it is money we were able to put aside pre-taxable income. awesome.

[lunarlady]

I'm paying my MW cash because my insurance basically won't do it. She is "out of network", and I have no out of network coverage. So I'm paying her fee ($2900) with my tax refund. If something goes wrong and I end up transferring, then my insurance will kick in and cover the birth, minus our copay of $1000. However, I will hit my deductable before that as the out of network pay that I'm giving my MW does count toward my deductable. So if I end up transferring, we actually will only owe about $600 before the insurance kicks in 100%. It's enough to make your head spin! I'm all for health care reform if only to make things more straight forward!

[MiaMama]

I am in Alabama. Midwives are not licenced here, so I am driving across state lines to TN to deliver at my midwife's clinic.

My insurance is blue cross blue shield of Alabama. Since there are no licenced midwives here, they do not cover midwives. My midwives have had some luck billing BCBS of TN, and having them pass the bill to BCBS of AL and getting some money, but we are not counting on it, so I paid cash.

However, my insurance DOES cover hospital births, so if that ends up happening (with my midwife's backup OB), then it will be paid for.

[CallMeMommy]

I have insurance but they will not cover out-of-hospital midwives. If for some reason we have to transfer during the birth I still pay the midwife her fee plus I'd have to pay the hospital (20% plus the $5000 deductible). If we transfer care during the pregnancy because of a complication I think I might get some of her fee back but I'm not sure.

[emnic77]

My insurance claims that they cover homebirth but only with a CNM or OB attending. CNMs are not allowed to attend homebirths in my state so essentially no, they DON'T cover homebirth.
I will pay my midwife out of pocket and submit it to insurance to see if we can get reimbursed for any of it. If I end up transferring, what I pay the midwife will not change (I feel she still would deserve it) and our insurance would cover whatever hospital bill save for a $20 copay.

[MacKinnon]

We are paying our midwives (freestanding birth center) out of pocket. They will then give us a super bill to submit to our insurance. My insurance will cover 100% prenatal, labor and delivery at a hospital or birth center that is attached to a hospital, and post-natal, as well as any hospital stay and labs, etc.. So, my insurance stipulates they will pay for pre-natal and post-natal care with a midwife attending out of a hospital setting, but they won't pay for the actual delivery. I don't know what I'll get back, but I'm hoping for 50% at least. Which, would be about equivalent to our out of pocket co-pay and deductible on our old insurance with DS's hospital birth. Should I be admitted to the hospital, my insurance would kick in and be covered at that 100% rate (or 90% if it's an out of network hospital but the hospital the midwives transfer to is covered). Honestly, I don't know what happens to the midwifery fees if I transfer care ahead of time for delivery, for medical cause. I'll need to ask that question!

[dannic]

We pay out of pocket for MW care. If paid for before 37 wks i's a flat 3000. If we transfer care, it's prorated. If we transfer during labor, we still pay for both. Our midwife comes with us in transfer as a doula/support/ect and still does all pp care if wanted. If we transferred we'd be paying out of pocket for the hospital birth as we are self employed. It's a chance I'm willing to take...IMO, my midwife is worth it either way--both in prenatal care and advocating/comforting/supporting in an emergency hospital birth.