Insurance & Homebirth

[wildflower18]

Just trying to gauge how often insurance will actually pay for homebirth.  If not, what was the out of pocket expense?

[kawa kamuri]

Everything but the birth is covered for me. The CNM practice I'm seeing charges $300 for hospital and $1000 plus supplies for home birth.

[L&K'smommie]

It's really going to depend on your insurance company. My last one was covered the same as a hospital birth would've been...they pay for 80%, I pay my 20% copay unless I've reached my out of pocket max and then they'd pay all after that. I expect this one will be covered the same.

I should add that there are things like the birth tub rental and homebirth supplies that would not be covered. My supplies cost between $50-100 and if I had gone with a birth tub rental that would've been $65.
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[wildflower18]

Thanks for the tips.   The midwife I spoke to says that she bills the visits and birth as "office" and sometimes it is covered.  I'm wondering if I can call my insurance company and ask.  But then I'm worried it will tip them off and then maybe they will question the billing.  I'm not sure how my insurance works as it's changed since my last birth.  I have a $1000 deductible this time, but Maternity visits are covered 100% after the first visit.  I'm assuming that any tests would be put towards the deductible.  Unfortunately, with my due date being early January, I may end up with a second $1000 deductible......figured that would be about the cost of a homebirth anyway.

[L&K'smommie]

Originally Posted by wildflower18 

Thanks for the tips. The midwife I spoke to says that she bills the visits and birth as "office" and sometimes it is covered. I'm wondering if I can call my insurance company and ask. But then I'm worried it will tip them off and then maybe they will question the billing. I'm not sure how my insurance works as it's changed since my last birth. I have a $1000 deductible this time, but Maternity visits are covered 100% after the first visit. I'm assuming that any tests would be put towards the deductible. Unfortunately, with my due date being early January, I may end up with a second $1000 deductible......figured that would be about the cost of a homebirth anyway.

My MW bills just like an ob office would with one big global billing after the birth. The only billing that occurs during the pregnancy is any labwork or ultrasounds. And yes if you deliver in January then you'll have that new deductible. It might be helpful to find out how maternity coverage is typically billed so that you can know how to have her bill your insurance. What company are you with?


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[wildflower18]

Originally Posted by L&K'smommie 

 What company are you with?


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Blue Cross.  I was afraid to call my insurance company and ask anything about a homebirth, but I guess just asking in general how maternity care is billed would be helpful.

[L&K'smommie]

Originally Posted by wildflower18 

Originally Posted by L&K'smommie

What company are you with?


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Blue Cross. I was afraid to call my insurance company and ask anything about a homebirth, but I guess just asking in general how maternity care is billed would be helpful.

I'm not sure where you live but bcbs was my insurance for half of my first homebirth and they paid like they would've for a hospital birth and my mw told me they typically had paid that way for other ladies that had bcbs.


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[pualum]

Our insurance does not cover any midwives in our area, we applied to have our CNM considered as in-network and they approved.  Theoretically, that meant they should pay 80%, but they only paid about 25%.  Better than nothing.

[AlexisT]

I'm not sure it's possible to get clear answers, to be honest. My insurer (Highmark BS) officially excludes non-nurse midwives from the eligible provider list--only nurse-midwives are covered. (I don't know about Capital--I think you're near me?) Yet, I know several people who say their CPMs successfully billed Highmark. I do know the CNMs around here are in-network.

[Lynann]

I'm with bcbs and I have managed to get my cnm approved as "in-network," although it is a huge pain as they would only pre-approve for 1 visit, then I called back and it was raised to 3 visits, and then finally after numerous calls it was raised to 9 visits, which takes me to 34 weeks. I spoke to one of the nurses who approves the out of network providers and she told me 9 is the limit they have but she did give me a phone number that isn't on my card to call back once I've had my 8th visit to extend the coverage for the rest of the prenatal/postpartum visits. The call center staff were next to useless, but once I got to speak to a nurse who had some authority it was a much easier task.

I have a high coverage PPO through my DH's work, and with a network OB we only have a $25 co-pay and $250 deductible. With the CNM it will probably be the out of network deductible that gets applied of $500 plus the $25 co-pay per visit. We're looking at probably paying $1000 towards the $4600 total cost, which is still a lot less than the straight out of network fees of 30% plus $500 deductible, which last time cost us $1600 for the LM we used who didn't qualify for the exemption.

I know that part of our coverage is because we live in Florida, and there is a State law that if there are no network providers within 30 miles for the type of birth we want the insurance company has to approve a properly qualified out of network provider that does. There are no home birth providers in network, so they had to approve our CNM, although it certainly has been anything but straight forward in getting the approval.