Insurance for Home Birth in New Jersey

[artist]

Please help me figure this out.

I am trying to navigate getting some coverage for a Homebirth in New Jersey. I currently have Horizon Direct Access which does provide coverage for out of network but only after the $7,500 deductible. My home birth will cost $6,500 (yes welcome to the high cost of  NJ!). My midwives told me that they have had success getting paid by Horizon, however, when I spoke to Horizon they said that they do not make out of network exceptions. The midwives also said that Oxford is really great about paying for home births so I am wondering if I should switch insurance at this point I am 5 months now. When I spoke to Oxford they also made it sounds like they would not cover home birth expenses.

Horizon told me that I may be able to get my primary care Physician to call them and ask permission for a Home Heath Program in which case it would be considered an in net work benefit. Does anyone have any experience with getting coverage for Home Birth in New Jersey?

Thank you!

[ralambert]

I am also planning a home birth in NJ.  My midwife fees are $5,500.  She uses a billing company which after you provide them with your insurance info they find out what is covered and then the billing company actually bills insurance for the midwife.  I have Blue Cross Blue Shield and when the billing company contacted them, they informed the billing company that they won't work with them, that I must file all claims myself and so on... Well that just sucks! lol  So I am preparing myself to do battle with the insurance company tomorrow.  My husband and I discussed it and if insurance won't cover the midwife, we don't care!  We will simply pay out of pocket.  The home birth is that important to us.  Also, I'm only 12 weeks so we have a lot more time than you do to save/make payments to our midwife.  As long as we have the full amount paid by 36 weeks, our midwife doesn't care when or how the money shows up.

I know this didn't really answer your questions or solve your problem but I wanted to share so you know you're not alone!

Good Luck!!!

[MissHeather]

I fought Aetna and lost. My husband and I ended up paying our midwife for our home birth $6000 out of pocket. $5500 for her fee, $300 for childbirth class, and $200 for a birth tub rental. Aetna has an official policy that home birth is "medically inappropriate." If I had out of network coverage I could have billed them for prenatal care, which may have covered her fee, but I don't.  During one of my many unpleasant phone conversations with them one of their phone reps actually asked me why I would consider having my child in an unsafe environment. A low risk hospital birth in New Jersey averages $18,000 (the highest in the nation). Too bad I can't bill Aetna for that. Anyway, to summarize I had no luck with my insurance and feel that I made the complete right decision to pay for my midwife. My husband and I feel very strongly that all of our children should be born at home.  I hope that you are able to work it out. Good luck to you with everything.

[Prettymormonmam]

I did a home birth in NJ 2 years ago.  We had Aetna and actually switched to them when I was 4 months pregnant.  We switched because I called ahead of time and asked if they would cover home birth.  I wrote down EVERY name, date, time that I spoke to someone.  I was told that the midwife was covered, but not the practice.  Weird, but they said they would cover 100%. I just had to pay first, then they would reimburse me.  Throughout the rest of my pregnancy, I continued phone calls to them to follow up (and kept all records).  At one point, the midwives told me to have the insurance company send a letter stating that they will cover.  They refused. . go figure.  When the time came to bill them, the midwives did the billing for me, made sure to bill with the midwife name and not the practice, and the insurance denied me.  I had another few weeks of phone calls to them, and they eventually sent me a check (the letter that came with it stated that they do not cover home births, but that someone on their end made a mistake, so here is a check.)  I don't get it because hospital births cost 3 times or more than a home birth.  

I suggest to call insurances, and speak to reps.  If you don't get the answer you are looking for, call and get someone else.  Usually you will get someone who can talk you through how to get it done through loopholes.  Or, at lease a part of it covered.  Home birth is the best ever!!!  I think we are done with kids, but if we had more, I would do home birth in a heartbeat, covered or not.  

Good luck!!

[artist]

Thanks for your responses everyone. I really have not made much headway in getting coverage and am kind of just hoping for the best when the midwives do the billing afterwards. I have decided that it is a worthwhile to me even if it is not covered, at least it will apply towards my deductible. I have rather large medical expenses due to treating RA so it is very likely I will eventually hit my deductible and the insurance company will have to pay for something. I wish is wasn't so hard especially considering that home birth is a great value for a low risk birth. Thanks again.