Insurance coverage for homebirth in MN?

[babymango]

I had my first son in a free standing birthing center back home in Canada. Now that Im pregnant with my second one, Im pretty reluctant to go to a hospital to deliver. I'd love to do a homebirth or a birthing center birth, but im getting conflicting information regarding insurance coverage. Heck, even my insurance company is giving me conflicted information. I had called when we were TTCing and they said they would cover (non-nurse) midwives at the out of network rate. Then I called again last week to get a few details clarified, and the guy said no way a homebirth would be covered.
I thought there was a law in the US that said it had to be covered (at least in part)? Did I dream that?
Anybody else in the same situation? Im with Medica if that matters

[Tine]

Medica covered my homebirth in 2006. I believe it had a lot to do with my savvy midwife (a CNM) coding all her claims "properly" and not asking ahead of time whether the ins. co. would cover a homebirth. The customer service folks will almost invariably answer that question "no" (even if it's the wrong answer) because they are completely and utterly clueless about homebirth.

[cheenya]

Medica also covered my homebirth in 2006, mostly because the billing for the prenatal appointments covered almost the entire birth fee. Whether you will get anything depends a lot on your plan and the way it is billed. The things that will make a difference include - what your out of network deductible is and what is covered out of network - not specific to midwives, but what would be covered if you saw an OB out of network.
Another factor to consider is what is your in-network deductible and maximum out of pocket. With many insurance plans your yearly deductible may be more than the midwives fees, and with even more plans, your actual cost for an in hospital birth will add up over the midwives fees because you pay more even than just the deductible because there is not necessarily full coverage for many hospital services even after the deductible until you reach your maximum out of pocket. Just a few things to think about

[babymango]

Tine,
Were you with Clare (If so, how did you like her)? She seems to be currently one of the only CNM who does HBs? She's pretty high on my list right now.

Cheenya
Good points, I hadn't even thought about that. Im so new to this private healthcare system, Im getting really overwhelmed by all those details. I never thought it would be so complicated!

[Tine]

Originally Posted by babymango

Tine,
Were you with Clare (If so, how did you like her)? She seems to be currently one of the only CNM who does HBs? She's pretty high on my list right now.

Sort of. My midwife was Janet Schwab (http://www.2eachherown.com), who has since moved to Colorado. When Janet was practicing here, Clare was in the discernment process. While she was deciding whether to start her own practice, she accompanied Janet to many prenatals and births to see what it would be like to be a HB CNM.

Clare was at my birth (as well as a couple of prenatal appts.). Honestly, I loved her. She was a wonderfully peaceful presence, and I loved her outlook and her sense of humor. Though she wasn't a part of my original birth plan, I'm *really* glad she ended up in it.

A close friend of mine who chose Clare after she started up Trillium Midwifery was also very pleased with her experience. My friend is an MDC mama, and if you want to ask her more about it, I could PM you her info.

[Vaske]

I had a homebirth under Medica last year. All they actually paid for was the lab work, for various reasons. The best thing to do is read the fine print in your Certificate of Coverage (make them send you the print version) over and over until you understand it. Ours actually says that Medica won't pay for homebirth. But they're still supposed to pay for prenatal care (state law), if only out-of-network after deductibles have been met.

But what we learned from sad experience was that Medica wouldn't count a lot of things towards our deductibles or out-of-pocket totals. Our midwife submitted lots of creatively coded claims, and they kept blowing them off as being far in excess of their usual and customary charges for such services. We ended up far below our high deductibles. I personally think that Medica owes me some kickbacks for saving them so much money by giving birth at home!

[ammiga]

My insurance (Health Partners) won't cover any part of a home birth. But, it will cover a portion of the prenatal care.

We are using Clare for our home birth in July! I LOVE HER!!! I can't speak to delivering with her, but I have really enjoyed my prenatal time with her. I can't imagine thinking anything other than perfect things about my delivery with her.

[heymama1plus1]

I used Janet Schwab, CNM, in 2007 and all I paid OOP was $100. I believe Clare is using the same billing company and picked up on her clever billing practices I think I also had Medica at the time.

Her fee at the time was $3500. Medica claimed they'd reimburse 80% for prenatals (since she was out of network) and 0% of the homebirth. What I think Janet did was bill my insurance company at the "standard" rate one could bill for in a clinic/ hospital (obviously way more than $3500!) and they paid 80% of that (and probably none of the birth) but that still ended up being $3400 paid back to me. Whatever happened, it worked! I would've paid it all OOP, though... it was a great experience.

I also met Clare and really liked her; if there was a 3rd baby for me I'd definately use Trillium!

Good luck!

[babymango]

Originally Posted by heymama1+1

I used Janet Schwab, CNM, in 2007 and all I paid OOP was $100. I believe Clare is using the same billing company and picked up on her clever billing practices I think I also had Medica at the time.

Her fee at the time was $3500. Medica claimed they'd reimburse 80% for prenatals (since she was out of network) and 0% of the homebirth. What I think Janet did was bill my insurance company at the "standard" rate one could bill for in a clinic/ hospital (obviously way more than $3500!) and they paid 80% of that (and probably none of the birth) but that still ended up being $3400 paid back to me. Whatever happened, it worked! I would've paid it all OOP, though... it was a great experience.

I also met Clare and really liked her; if there was a 3rd baby for me I'd definately use Trillium!

Good luck!

Thanks
I met with Clare and Emme yesterday and really liked them. I also went to the birthing center, but it felt too much like a business to me (well, it IS a business! But after sitting on the floor with Clare, playing with my 9 month old as we were discussing her views on birthing, the center with its group visit and perfectly designed rooms felt a lot more "business-like")
Im meeting one more midwife, then we'll decide. DH still feels the birthing center might be "safer", which I don't believe... But I'd be more than happy to deliver there if it was the only way DH was on board for a out of hospital birth!

[heymama1plus1]

I don't think birth centers have any different equipment or skills than a HB midwife would have (other than more backup available and perhaps it's closer to a hospital, depending on where you live). It just seems more "legit" to those people who are on the fence.

[homebirthing]

The only difference between a free standing birth center (in Minnesota) and a homebirth midwife, is at a birth center, the oxygen might be mounted on a wall. We carry ours in a bag! Otherwise it is exactly the same, except you don't have to go anywhere, your midwife comes to you!

[sashag]

OOh, I just started a new thread about Medica and HB. Should have looked before I lept. Thanks for all the info, it seems to me that my take away is that Medica has gotten cleaver about not paying for HB. I am willing to pay the whole cost out of pocket and still feel like it may be better than the hospital as they would also charge for the baby and the combined cost I am sure would be over the fee for a HB.

I had my second son at a free standing birthing center in MD. It was better than my first experience at Woodwinds, but the ride to the center when you have been in labor for hours was not pleasant. Much rather be at my house!

[homebirthing]

Sashag - We have so many wonderful  midwives!! Have fun interviewing!