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homebirth insurance coverage

post #1 of 12
Thread Starter 

Hey friends... I am planning a homebirth with a CNM in NYS.   I just got off the phone with my insurance (BCBS of WNY) and they said I do not need prior authorization for homebirth (YAY).  There are only two out of network midwives that attend homebirth in my area, and so they said that for Out of Network Maternity Care, they pay 80% of the allowable amount after we pay a $1000 deductable.  My midwife's total fee is $4400.  So... looks like we have to pay around $1680 for our homebirth.  :(   (this seems crazy to me... considering my two hospital births were covered 100% and I didn't have to pay a dime for either one!)

 

Does this sound about right to you guys?   Any tips to get them to cover more?   My midwife was an in network provider but has taken herself out of network, because the in network reimbursement by the insurance companies was only about $1500.  Whereas now their 80% is equal to about $2700 that they pay.  It's all so dumb!  haha.   

 

Any ideas?  Or do I just need to pick up a lot more shifts at work?  Haha.  There goes all the cool extras like doula, photographer, fancy birth tub.... 

post #2 of 12
I can feel your pain. Our home birth midwives charge $4000 for everything, and after insurance pays there will be a $1300 out of pocket cost. We decided to pay them some every month to pay it off. Our midwives require its paid in full by 34 weeks. It does seem very silly considering a hospital birth would be fully covered, but will cost upwards of $13,000-15,000 depending of course on interventions used. It seems like a no-brainer for insurance companies to cover the lower costing providers. But I'm sure it's all politics!

Good luck! Sorry I can't be of more help.
post #3 of 12

I think it would be worth it for you to try and get them to pay more. Although, for me that deal would be great.

For my first homebirth, we fought a few rounds with our ins. to finally get them to pay out of network at 70%.

 

This time around, no insurance, so we will be paying in full.

post #4 of 12

It sounds like the issue is really that your midwife is an out of network provider? Have you checked to see whether there are any in-network midwives in your area? 

 

Since you're in New York, you may want to post to the NY state forum of this site. Moms there will be more informed on the specifics of insurance coverage in NY (because it does vary drastically by state). I used to live in NY and I do know that there is a law requiring insurance companies to cover the cost of homebirth. But I do not remember the details. I want to say that if there is no in-network homebirth CNM available to you, then the insurance company may be required to cover your chosen CNM as if she were in-network? (Don't quote me on this! I could be mistaken!!)

 

Of course, none of this will help you to avoid details of your particular insurance coverage (like the $1K deductable).

 

But at any rate, one thing that I would encourage you to do if you haven't already is to find out whether your CNM has a billing person on staff who works directly with insurance companies. If she does work with a billing person, then that person will probably be very skilled at speaking with your insurance company and getting them to pay as much as possible, which will help keep your out of pocket expenses down.

post #5 of 12

This is about what will happen with us, and since I mentally prepared myself years ago for the possibility we'd have to pay 100%, I am at peace with it.  THAT said, my MWs are great at "creative accounting" and have found that they sometimes get more covered.  (Like it's still 80% of "reasonable and customary," but if 80% of R&C ends up being more than 80% of what they actually charge, we pay less than 20%.)  Nothing unethical, but, for example, they're allowed to charge insurance more for labors that last more than 12 hours (or something).  So they do.  Basically, wherever they can legitimately charge more, they do, and I will benefit.

 

But yes, it's total BS on a philosophical level, considering how much more a hospital birth costs and how rare it is for the same insurance not to cover that 100% (or at least more fully).

post #6 of 12

I have BCBS of IL, and we are anticipating paying $2800 for giving birth at a birthing center (out of network). They would cover less for a homebirth. I have read people getting their out of network midwives covered as in network by repeated letters to their insurance company, if you want to try that. But I have heard that BCBS isn't too helpful in those situations.

post #7 of 12
Thread Starter 

Just found out that my insurance (which is the most expensive plan that they offer at my DH's work) will only pay $700 toward our home birth!  We will have to pay the remaining $3700!  YIKES!  I am so frustrated.  My two hospital births cost NOTHING.  just a $20 copay.  That's it!  What is wrong with this picture?!!

post #8 of 12
Thread Starter 

They said their "fee schedule" dictates that they will pay $1900 for the global maternity fee that the midwife bills.  She is out of network, so I have to pay $1000 deductible plus 20% of that 1900.  Her total fee is $4400.  I promised myself after a horrible experience with my first birth that I would never again choose a provider based on money.  I love my midwife, just wish she wasn't so much more expensive than the alternative.  Thanks for letting me complain!

post #9 of 12

Chapsie, this is what you call hypocrisy!! I have been reading Ina May Gaskins newest book A Midwives Manifesto, and she talks about this exact problem. It doesn't make any kind of logical sense, but the insurance companies are fully behind the demise of home birth and midwives. Whats really gonna get your knickers in a bunch is to know that we are the only 1st world country in the world that insurance doesn't pay for midwives and home birth. It's really nauseating to say the least. And also totally pisses me off! {{sorry for the language, but it does}}  

 

Have you talked to your midwife about all of this yet? The reason I ask, is because some states (Vermont just passed it last year) make it mandatory for insurance to pay for midwives (although they will deign it until faced with it). I am not sure if NY is a part of this, but you should really look into it.  And another thing, even though midwives are "out of network", sometimes they can bug the insurance companies enough so that they will pay more than they normally would if not bugged and bugged to do so. I also heard from a friend of mine a couple months ago, that she knew someone who called her insurance company and pushed so hard that she wound up talking to a head manager guy and they finally paid for almost 75% of her home birth. But she had to push and push like no tomorrow.  I hope that somehow you can figure this all out. 

post #10 of 12
Chapsie- this sounds awful. My in-network coverage is not that great, and OON is likewise horrendous. I lucked out and found an in network CNM, but we are paying a lot out of pocket. We have a $1000 deductible to pay (which is $500 for me $500 for baby). Then BCBS will pay 70% of what is left. Anyway, I will have my portion of the deductible met by the ultrasounds, so that "helps".
One thing that eases my mind: this plan I have would only pay 70% in a hospital, as well. So overall we are saving $.
I can sympathize that it would be very frustrating if a hospital birth were cheaper for you.

Has anyone read Baby Catcher? I just borrowed it from my midwife, I think the insurance companies don't pay well for our homebirths because they are helping keep the doctors in business.
post #11 of 12

I read babycatcher.  Good book!

 

Insurance is a scam... at least it started that way... Now it is a necessary evil here. :(  (<  And that is probably the most controversial I will ever be on this board. lol)

post #12 of 12

Ours will cover CNM's but I didn't see any in our area that do homebirths, so we are paying our midwife out of pocket. I'm pretty sure the ins. won't pay anything. We have a high deductable anyways...not looking forward to the out of pocket bill but really I'd much rather pay for it and have a homebirth than deal with a hospital.

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