paying for a homebirth if there are no homebirth midwives in network

[Nightswimming]

Hi,

Does anyone have any experience with this?  I have the federal Blue Cross Blue Shield plan and there are no homebirth midwives in network (there are hospital birthing midwives in network and they are who I am with right now).  Is my insurance company required to provide me with an in network Homebirth midwife?  I had heard somewhere in the past 3 years or so that they were but I cannot remember where (and maybe I am totally wrong).

If I birth at the hospital with the hospital midwives I pay $0 but unless they are required to provide me an in network homebirthing option I will have to pay a % of the homebirth cost because the provider would be out of network.

I will not be basing my decision (to homebirth or not) on this but it would be nice to know what my rights are! 

Thanks!

--Katie

[nicolian]

I'm am wondering the same thing for myself. I don't even see any CNM's in my insurance's network (Tufts HMO). So far, from the reading I have done her and elsewhere on the interwebs, you can ask that your insurance cover a homebirth midwife as an in-network (or maybe out?). Seems some people have had good luck with this. Keep us posted on what you find out! I'm anxious to find these answers myself and I'm not even pregnant yet.

[alyssatuininga]

It depends on the laws of the state you are in. For me in NH they technically have to pay for any certified midwife. They get around it though by making midwives jump through countless hoops and requiring them to carry really high liability insurance. The only homebirth midwife they will pay for is an hour and a half from me. We will most likely go with someone closer.

[Kedrosami]

I found this site with lots of helpful info: http://www.homebirth-usa.org/choosing/insurance.html

For the homebirth of my son we had a Kaiser HMO and it was horrible. It did not cover my midwife or my homebirth at all, basically only labs and ultrasounds. So we ended up paying around $3000 out of pocket. It made me so angry but I paid it anyway so I could have the provider/birth I needed. It was totally worth it.

But in retrospect, I wish I'd have fought harder with Kaiser to get them to cover it. Apparently it can be done even if your midwife is out-of-network, but you have to be persistent. Pointing out how much cheaper it is for them if they don't have to pay for your hospital birth is a good tack. Lots of people have managed to get homebirths covered just by talking to their insurance companies.

This time around we have Aetna and I haven't figured out yet what our situation is with homebirth/midwife coverage. But if they won't cover my midwife I plan to fight them on it this time!

[mama_daba]

i have kaiser hmo and so pay out of pocket and i generally choose to have ultra sound and labs done elsewhere because i hate how i get treated at kaiser and get better care other places. it gets really expensive but for my family and for me it is worth it.

[HawaiianBlesing]

You can try to apply for what is called a "gap extension."  I've read several threads on here with really good examples of letters both requesting coverage and appealing their denial of coverage.  From what I've read, it's better to ask and get permission ahead of time then try and recoup your expenses later.

My insurance will only pay for a CNM but she does not do home births so I am going to apply to my insurance company for a gap extension and be really persistent.  I really need to figure out what the laws are in my state but can't seem to find a good source.

The best information I have found is to stick to the facts.  Most insurance companies don't care about our feelings of why we believe a home birth would be a better option.

[jraohc]

My understanding is that it depends what state you live in.  I believe when I was in MA I'd have had to pay entirely out of pocket because CPM's aren't covered by insurance and CNM's don't do homebirth.  I'm in PA and finding that my insurance will cover the midwife and prenatal fees but not the facility fee (they charge the facility fee for birth center and for homebirth because they bring the equipment to the homebirth).  This is amusing because the reason they won't cover the facility fee is that the facility is considered a "standalone surgical center".  Yes, for the sake of our insurance my house is a surgical center!

[alireb]

I think it depends on if your policy covers homebirths.  If it doesn't, you might have to pay for out of network.