Home births cost more $$$?

[jmd5294]

This is my first biological child, and I've been looking for a midwife, and really thinking about a home birth.  I spoke with one midwife's office today, and they told me it was going to be an additional $1800 out of pocket for a home birth-- that's over and above whatever our insurance would pay.

It has nothing to do with our insurance (she is in our network), it's a flat rate she charges everyone who does a home birth.

Does this sound normal?  Is this typical for having a home birth?  That's a lot of money out of pocket when our insurance is already paying her.

[NishaG]

Well, my midwife likes to have been paid $2000 by the birth.  Even though my insurance will pay, it can sometimes take up to 6 months for them to get paid.  They usually will return the money minus whatever the insurance company didn't pay once they receive payment. 

Ask this midwife if this money is refundable upon payment from the insurance company.

[Lisa1970]

My insurance won't pay for a home birth. And I think the midwives cost about $5000 here. But it will pay for hospital birth, with a $100 copay.

[Jaimee]

It really depends on where you are and how the insurance is filed. HB mw's usually charge somewhere between $1500 and $5000 total and ask for that amount by 36ish weeks.  After the birth they file and the companies sometimes are quick and other times fight it.  It could take months for the mw to get reimbursed, but usually they will pay you back whatever they receive.   Ask if this is the case.  It's true you may owe a certain percentage or your deductible no matter what depending on your coverage.  We owed 20%.

And yes, my insurance would have covered a hospital birth (averaging $10K) for a minimal co-pay.  But that's just the way it is in this country.  And you really cannot at all compare the service and care you'll receive with a midwife to the care you would get with an OB and the hospital. It's a matter of what is important to you and if you find it worth the money.  I know that I absolutely find it worth it b/c I feel that how I birth my babies is extremely important.  And since I'll being doing it only a finite number of times I want to try and make each birth everything I want it to be.

There's another thread similar to this in the homebirth forum you might be interested in checking out.

[lactatinggirl]

My midwife charges 2400 for all prenatal care and the birth. She said insurances rarely end up paying her anything at all. I looked it up online though and the average you'd pay with co-pays and deductibles and what not for a hospital birth was like 1800, so really it's not much more expensive even if we can't get the insurance to pay. 

[MrsSurplus]

So, if I understand correctly, what you're asking is if it's normal to charge an additional fee (not covered by your insurance) for the homebirth - as opposed to a midwife-attended hospital birth?  I honestly don't know as all of my midwives have been homebirth midwives and charged a flat fee for the prenatal care, postpartum care, and birth.  I can see where a midwife could be justified to charge a bit more as there would be more for her to do at a homebirth (paperwork, all of the items she needs to bring that would otherwise be available at a hospital, etc...  My midwives clean up and are willing to cook a meal, etc - things that would be taken care of by hospital staff, etc...)  I guess the question is whether or not you think $1,800 is reasonable for the ability to birth at home.  My midwife charges $3k for everything (except lab...but we don't do labwork...and the birth kit that we order ahead of time).

[birdhappy85]

I am working with a CNM who only does outpatient births. She does mostly home births but there is a natural birthing center in the area so she'll work in conjunction with them if a client wants to birth there. She charges about $3000 for all prenatal visits, childbirth, and the standard postnatal visits combined. My insurance wouldn't cover her in-network but she has a billing company who specializes in working with insurance companies for natural prenatal care/childbirth through midwives, so I worked with them and my primary care physician to request a gap (in-network) exception with my insurance company and they approved it. It's going to help us out SO much! I would highly recommend that anyone who is working with a midwife and their insurance won't cover it, have your primary care physician call the insurance company and request a gap exception for an outpatient birth. It's worth a try.

So we'll have our $1000 deductible to meet and then 20% of the rest. My midwife also does bloodwork and submits that through insurance, so we'll handle that the same way. I'll also have to pay $250 for each RhoGAM shot (ouch!) which sucks but hey - it's worth it. At least my midwife doesn't administer the one after birth unless she has determined the baby actually has a positive blood type! I'm grateful for that. My prior ob/gyn's office didn't care, they would just administer it as a precaution no matter what. Not cool..... So then we'll have other random fees for our homebirthing supplies and if we choose to do a water birth. We might pay extra for a doula too.

I'm expecting this to be much less expensive than a hospital birth for sure. We won't be having unnecessary procedures done like I've heard such negative stories about, and I feel so secure and calm with our decision to birth at home naturally. Can't beat that kind of feeling!

[akind1]

Our insurance doesn't cover out of hospital birth at all, so we pay, all together, the maximum out of pocket which can be up to $2500 I think. for the OB (or hospital CNMs) part of that is our percentage of their global fee (all prenatal visits, testing, and attending the birth) which is between 300-600 dollars. The rest is the 10-20% of the hospital fees. Midwives in general around here, or at the local birth center, charge $3000+ for their global fee. And it has to be paid by a certain point in pregnancy. One of the sort of advantages, for us, of the hospital, is that we can do a payment plan for our part of the bill for as long as we need to after the birth, in the monthly amount that works in our budget. So alot of it isn't just the amount of the fee, but having a bit more control over how and when it's paid.

So, for actual out-of-pocket expense, sure, a hospital birth actually might be less expensive. And if you have a good local hospital that will honor your birth plan (they do exist! I have read several MDC mama's stories of excellent vaginal hospital births) it might be an option for you. I'd love a homebirth, but as a VBAC I don't live close enough to any midwives willing to attend one, and the risks are too much for me to consider going UC. It is worth the extra out-of-pocket money, for me, if I could do a homebirth.

I know one thing that bothers DH is if you end up being a transfer, and those cases to happen, you are paying both the midwife and the hospital, and that just bothers him to pieces.

[MarineWife]

By federal mandate, no HCP can charge more than 15% above the normal and customary charge for anything. Normal and customary is usually established by what other practitioners charge and what the insurance companies will pay. $1800 above what your insurance pays seems excessive to me.

[Mommel]

I'm about 31 weeks now. I have paid $1250 out of pocket and Medicaid will pay my midwife an additional $2000. I called and interviewed seven or so midwives until I got one with the combination of flexibility and experience that I needed. I was lucky that we clicked. I have also bought all of my home birth supplies (about $500 total) and also paid out of pocket for about $200 in lab work and $150 for an ultrasound from our nearby naturopath. My entire income is about $2000/mo (including student financial aid, which is mostly loans - I also work part-time for the remainder of my income). I sold my car, moved to a cheaper apartment and work on a very tight budget. This is my first, and will likely be my only little miracle (I am 38, have one fallopian tube and my partner left in March), so I guess it just depends on what you think a home birth is worth to you. 

[cat13]

My homebirth midwife charges $2000 for birth, plus $60 for each pre-natal visit. I don't know how much she charges for testing, as I have been doing all of that through my HMO.  The sad thing is that my HMO would pay 100% of my birth costs with only a $100/night charge for hospital if I had the baby at the hospital (regardless of what type of treatment/interventions I need) but they won't pay a single penny to cover my homebirth. Seems like a waste of money on their part if you ask me!

[Chloe'sMama]

We paid much more for our HB, but it was worth it.  Most likely, we would have paid less than $1000 total for a Hospital birth and prenatal care.  We paid over $4000, but were reimbursed about $1500.  Like people above said, we paid it all, then we were reimbursed by the insurance company.

[jeninejessica]

Originally Posted by jmd5294 

This is my first biological child, and I've been looking for a midwife, and really thinking about a home birth.  I spoke with one midwife's office today, and they told me it was going to be an additional $1800 out of pocket for a home birth-- that's over and above whatever our insurance would pay.

It has nothing to do with our insurance (she is in our network), it's a flat rate she charges everyone who does a home birth.

Does this sound normal?  Is this typical for having a home birth?  That's a lot of money out of pocket when our insurance is already paying her.

I'm not from the states, so take this with a grain of salt, but it's the wording of what you asked that worries me... It sounds like regardless of whatever your insurance would cover, she is still automatically going to charge you $1800 extra? IE if her fee is $3000, and insurance pays the whole $3000, she's still going to charge you $1800? If I'm understanding correctly, then yes, that's a little fishy. 

I could see her homebirth fee being a little bit extra than a hospital birth fee because her duties IMO are increased (there's no nurses, she probably spend more time with you, paperwork, etc). But to automatically charge you an additional amount, without billing it to insurance (or at least trying!) seems... odd. 

Am I misunderstanding?

[emmaegbert]

I had one HB where the MW fee was $3900 for everything (prenatal, birth, pp), plus extra for the Rhogam shots and blood tests that she did (I went to a clinic covered at 100% by my insurance for some of those things). She charged me those extras upfront (she had to pay for them) and the gloabl fee had to be paid by 36 weeks, and then after the birth she billed my insurance. They covered 60% less copays, and then she reembursed that to me once she got the payment. That was when my baby was about 4mo. 

I am planning another HB now, different state, different insurance. MW customary fee is $10,000. I have medicaid which will cover $7000 through a particular HMO plan. They will provide me the care for that fee and I pay nothing upfront. I will only be responsible for the extras (like Rhogam, which for some reason medicaid doesn't cover) and a birth assistant who comes to assist the MW at the birth (fee is a set $300). They work with a professional biller who already has me pre-approved (all the midwives I talked to in my area work with this same woman, she is like the insurance whisperer) and she has explained everything very clearly to me. The only way I might get stuck with charges is if I transfer and Medicaid refuses some or all of their fee. In that case they will work out a payment plan with me for the care that they did provide.

I would ask for more explanation if you aren't getting a clear answer from your prospective MW, or call around to some other MWs to find out what they charge and how folks do it there. IME in both cities, though the fees and procedures were really different, the various HBMWs pretty much charged the same thing and worked the same way, though I think there are some who don't take insurance at all. Also, every MW I have ever talked with has a specific customary fee and a proceedure she can clearly explain. To be fair, this MW could just be telling you that in her experience, $1800 is about what the PPOs do not cover of her fee (is it about 40% of her fee?)

And yes- hospital for my previous HB would have been cheaper, with copays etc less than $1000. But it was totally "worth it" to me, and I have no regrets whatsoever. I got much better and more consistent care from my HBMW. And she worked for me, not for the hospital.

[MarineWife]

I wanted to add that if your MW is in-network with your insurance that means that she has agreed to accept the amount paid by your insurance company as her full fee. If that is the case, she cannot legally charge you any more above that. The only thing she could charge you out of pocket would be any deductible and/or copay that you may have. I would check with your insurance company about that sort of thing.