homebirth and insurance

[mom2allynben]

I was wondering if homebirth was covered by most insurance companies or what you have to do to get them to cover it. Also, how much they generally cost. Thanks for any info!

[alegna]

It will depend on your state and your insurance company. I got ours covered at 100% It just took a lot of talking back and forth to explain the situation and get all the codes right.

Homebirth seems to vary a lot by area. In Houston it ranges from $2400-$4500+

hope that helps!

-Angela

[WinterBaby]

I'm no expert on it, so maybe someone else will chime in - but I see people paying anywhere from $1500 to $5500. My PPO bluecross blueshield covers homebirth, and so does the military's tricare, so I'm going to hazard that many insurance companies cover the service, but obviously this may vary according to your company and plan. Also some types of providers may be covered while others not. If your company doesn't cover it, you can always try to discuss it with them in advance presenting it as a cheaper option, but I don't have experience with insurance companies ever actually budging over these things, heh. When interviewing midwives, it may be worthwhile to ask them about how they work with insurance, and barring that, what payment arrangements they're willing to make.

[cheeseRjedi]

In the denver area, we paid $2900 (which included all prenatals, birth and 6 weeks pp). My united healthcare insurance paid 60% (would have been 80% if we used midwives in their 'network').

[Rockies5]

Aetna EPO

it's not covered. we've had two HB already with them and paid out of pocket 1200-1800)

THEN with this last pg, I decided they HAD to cover it. I worked for several months (4) and it is now covered, despite supposedly not having ANY out of network coverage...we have a "deficiency" supposedly because MWS are offered everywhere by my county (no CPM are covered AT ALL, but I didn't go into details about what KIND of mw I'd want

so anyhow, covered! 100%

[jplain]

HMOs generally won't cover planned homebirths. The two largest HMOs in my area specifically state that there is no coverage for homebirths or out-of-network prenatal care providers in their Certificate of Coverage.

PPOs may or may not cover homebirth. It may help not to mention that your birth will be out of hospital, and have your midwife help you submit receipts with appropriate billing codes. The codes are no different for a homebirth vs. a hospital or birth center birth. When interviewing midwives, you can ask if they have experience with helping their clients get reimbursed.

If a PPO won't cover the birth, often they will cover prenatal and postpartum care if receipts with appropriate billing codes are submitted. I suppose it is up to you and your midwife to determine how much the prenatal/postpartum care costs relative to the actual birth (wink wink).

I have an HMO, so we'll be paying $2800 out-of-pocket. I considered switching to a PPO during this pregnancy to get more of our costs covered. Looking at the PPOs available to us, I realized that with the deductible and higher charges for out-of-network care providers, and factoring in our typical yearly health care needs, the costs wouldn't be significantly lower with the PPO. In fact, if I ended up transferring to hospital-based care for medical reasons, we could end up paying more.

If you have the option of switching to an insurer who will cover homebirth, you'll need to do those calculations for yourself to decide if it is worth changing.

Good luck!
Carolyn

[Spark]

Most insurances won't cover "homebirth" but they will cover out-of-network providers (unless HMO, then it takes a bit more work, but can be done). So, you just bill them as an out-of-network birth.

To submit a claim to an insurance company, you need:
Name of provider
their ID/Liscence # (this helps if they have it, if not, not the end of the world)
Name of practice (fine to just call it NAME Midwifery)
Address
Phone number

Then, your name.
Birth Date
Insurance ID
Group ID
Spouse (if it's through their work)
Employer

For the knitty gritty you need:
Date of service
Dx Code (V222 is for prenatal care)
Procedure (59426 is for prenatal care)
Service Provided (write Prenatal Care)
Fee (Typically $100 will be covered by your insurance, so don't over bill)
Balance due

I won't be following this thread, but if you have any specific questions, I'm more than happy to help. Just send me a PM. I've gotten 3 different insurance companies to cover my homebirths FULLY and one of them was an HMO.

[applejuice]

I had four homebirths.

I paid out of pocket for three and one was covered by Travelers, $200.00 down and 80/20 after that.

My last home birth was 1992, cost $2,500.00. Lab tests were not included in that price and neither was the birth kit.

[indie]

Originally Posted by WinterBaby

My PPO bluecross blueshield covers homebirth

Are they covering it as in network or out of network? I know it varies from state to state with BCBS. They are only willing to pay part of my prenatal and none of the birth but it is out of network. I have a very high out of network deductable which is more than my midwife charges. Homebirth still ends up being less expensive since the cost of hospital birth is so much higher (unless I have to transfer).

[WinterBaby]

Originally Posted by indie

Are they covering it as in network or out of network?

Out of network coverage is what I used, however my plan didn't have a deductible prior to the 80-20 coverage.

[mom2allynben]

Thanks for all the info! You've all really been a great help. We have a PPO plan, so hopefully they'll cover at least part of it. Thanks again!