Oh and OP again - you asked about getting an exception for coverage for Sarah if there weren't any midwives...
The thing is, insurance covers by provider type, not service location. So your plan would have to cover ZERO midwives within 30 miles of your address for you to get that coverage in place. And even then it's tricky to get. It's called a "gap exception" fyi.
My insurance that starts July 1 has no midwives within 30 miles of my home, but they offer midwives in other states, and it's a national plan, so technically I'd qualify for the gap coverage. However, because I'll be within 3 months of my EDD, I qualify for a different type of coverage that lets me keep my current provider.
So if you were to ask for the gap coverage, BCBS will tell you to go birth in a hospital with a midwife. There are a ton of midwives all over the area practicing in hospitals that take BCBS.
Sometimes it's worth planning on an out-of-network provider, if that's what it'll take to have a birth at home. The reimb. rate is 60-80% depending on your PPO plan, and midwives are around $4000 right now, so the out of pocket expense is worth figuring into your budget imo.
We deliberately switched from PPO to HMO for July because the $ difference in premiums that we'd spend each paycheck is more than the out of pocket difference for using an out-of-network provider or just paying cash, after 1 year of the new insurance.