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Home Birth and Flex Spending Accounts...

post #1 of 12
Thread Starter 

The last post I see for this topic is back in 2009...


Is anyone familiar with the newest rules...


If they'll cover midwives/homebirths...


And, how to get them to cover it?


I feel like I'm climbing an uphill battle...  I can't seem to get a straight answer and don't know where to turn...


I've been contacting both flex and insurance representatives since before I ever actually got pregnant...


Now, we've put a bunch of money on our Flex card for the planned pregnancy for 2012, and I'm concerned we may not have access to the money now..


Any guidance or help or direction is appreciated!

post #2 of 12

is it a flex or hsa?

post #3 of 12

Here is a link I found to a listing for approved flexible spending expenses:



It lists "childbirth (doctor/midwife)" as an expense that is approved and does not specify that the child needs to be born in a facility. The most important thing is to have a receipt that backs up this expense to show you had the right to pull the money from your account.


For an HSA I found a list that put "midwife therapy" as a covered expense.... not sure what midwife "therapy" exactly is, but midwives are covered and it does not specify CPM/CNM/DEM, etc. Also, the list of approved HSA expenses lists prenatal care and postnatal care as well as childbirth as approved expenses.


It seems to me that you would be quite safe in using your account to pay your midwife as long as you get those receipts and as long as they are the ones providing your maternity care.

post #4 of 12
Thread Starter 

Thank you so much!


It is a Flex spending account... I couldn't find a generic one (pdf) that listed all of the covered costs... They were all affiliated with companies and I could not find one that was affiliated with my husband's company in particular...


I called my insurance company and they told me that it was not going to be approved on the list produced (from some sort of act) by the IRS... She said it wasn't a required expense and so the flex card could not be approved... Then, I was reading on most of the pdf's (from other companies) that midwifery IS indeed covered... And, it left me with the most obvious question...  Why would the IRS say it's not okay, and all of these companies say it IS okay...


I think I'll take my chances... The actual insurance company covers a midwife as an out of network cost... I don't see why flex would deny it...  Makes no sense...


The midwife I'm considering advised me to let the office of whomever I should decide to go with call the insurance company... Less of a hassle, it seems.


It all seems more confusing than it should be.  I feel better about our decision to put so much $$ on the card! I appreciate the helpful links also!  Thanks so much.  =)



post #5 of 12
Originally Posted by Bryton View Post

I think I'll take my chances... The actual insurance company covers a midwife as an out of network cost... I don't see why flex would deny it...  Makes no sense...


Yes, I had no problem getting reimb from my FSA.  Basically, you take your insurances 'explanation of benefits' from the midwife's billing, and send that to your FSA.  It's not that the services aren't covered because they're not allowed, it's that the services are simply out of network.  It's not like you're submitting request for a boob job or something ;) 


I even used my FSA to buy some of the birth supplies.


post #6 of 12
Thread Starter 

Thank you!!!!  Made life much easier today!



post #7 of 12

I am totally using my HSA to pay for our midwife..... so long as this baby waits until at least Jan 1st to be born, so after our HSA has been started. In reality, we will have already paid for our midwife in full by then, but it is nice to know that we can put the money away pre-tax and then pull it out to recover the expense we took on. The health insurance I have will not cover midwives who work outside a facility or who work without the direct supervision of a physician nor will it cover any midwives who are out-of-network. However, that doesn't mean that it isn't an acceptable HSA expense :)


I have had plenty of clients pull the funds from a FSA or HSA to pay me and I just am sure to provide them with a good receipt showing dates of service, CPT codes, etc so that if they ever get audited then they can show that it was a justified expense as the services I provided were covered services.

post #8 of 12

IRS Publication 502 lists what are allowable and nonallowable medical expenses to be reimbursed from a FSA or similar account.  It is remarkably uninformative about childbirth outside of a hospital, but I think you can safely assume that the costs of prenatal care, birth attendance, and postnatal care from a midwife are indeed medical expenses. It doesn't specifically say that they are reimbursable--maybe that is why you were told that they weren't--but it doesn't say that they are not, either.

post #9 of 12
Thread Starter 

So, I got to the bottom of it all yesterday...


It is NOT written there, where you've cited, Vaske...  HOWEVER, because it is covered under my medical insurance, it is considered a medical expense...  This all seems way more confusing than it has to be, and it really reinforces the feeling that they are not too fond of coloring outside of the lines...  Frustrating...


The insurance lady was incredibly helpful and would not let me off the phone until she had a for sure answer - because my husband had already agreed to put that money into the FSA, and she didn't want me being mis or ill-informed. 


It's crazy how I called 5 times and this is the only lady that invested this much time to get me a straight answer.  Just takes the right person...


The other thing that bothers me is I can't pull the money without getting a list of things from her and submitting it... If I have the receipts to show that I used it for medical purposes, then I'll be safe.  It is just a lot more regulated now than it was 2 years ago...  Also, I won't have access to the money until after the baby is born - when an itemized receipt can be produced. 


Thanks again, everyone.  I am really digging this site and I'm so glad I found it!

post #10 of 12

I don't have any more links or resources to give you, but I just wanted to say that I got my homebirth costs covered, as well as my lamaze class (they wouldn't cover my doula costs). Like you, I kept getting wishy-washy answers from the folks on the phone, so I eventually got an email confirmation so I could have it in writing.



post #11 of 12

My Flex spending account will not cover homebirth costs because CPMs are not considered licensed providers by the state and insurance company.  They will cover the cost of some supplies in birthing kit, though.

post #12 of 12

Our flex spending account will cover the cost of the midwife.  It also covered the pharmacy expenses (for Pitocin, Newman's Nipple Cream, stuff like that) and lab work that the midwife ran, as well as the GBS test.  We drained the account for this year, so we aren't going to attempt to get the stuff from the birth kit covered, but I imagine they would be as well.


My midwife bills after the baby is born, so we haven't paid her anything out of pocket yet, but we were told we needed an itemized receipt if we want any of her expenses covered under flex spending.  I'm due 1/2, so if baby is born this year, we get the tax deduction for the year, but can't use any of next year's flex spending on the midwife.  What a rough spot for the poor kid to be in!  :)

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