Insurance and Homebirths

[~Kristina~]

Does anyone know if insurance companies cover homebirth midwives? I completely doubt it, but I figure it wouldn't hurt to ask. Oh, I have a PPOM. TIA

[MamaJenese]

My insurance covered all the supplies and 70% of the midwife fee.

[pamamidwife]

I think rather than asking specifically about 'homebirth' when you talk to your insurance, ask about the credentials of the provider doing the homebirth.

Most insurance companies deal with providers, not place of birth and there could be a reflex to just say NO when homebirth is brought up.

What is a PPOM??

[kalisis]

You should also check your state law, b/c here in NY, it is required that insurance companies cover homebirth the same as hospital birth.

They sometimes try to say that midwives don't get to be covered as the same rate as MD's, but that's just a bunch of hooey. I fought it (not even that hard) and was able to get 100% reimbursement.

So, check your state law and see what it says. You might get a better response if you post in the "Finding Your Tribe" area for your specific area. Usually those mamas know what the scoop is.

Good luck.

[alegna]

Mine was covered 100%

-Angela

[Kidzaplenty]

It does all depend on your state laws regarding care providers. In many places if MWs are legally allowed to deliver babies at home, then many insurances will cover it (even if it is "out of network"), in somecases even government insurance covers it (medicaid or low income assistance insurance). But if MWs are not legally allowed to deliver at home in your state, I doubt your insurance will.

[Emmeline II]

Originally Posted by ~Kristina~

Does anyone know if insurance companies cover homebirth midwives? I completely doubt it, but I figure it wouldn't hurt to ask. Oh, I have a PPOM. TIA

http://www.cfmidwifery.org/states/states.asp?ST=30

CNMs may legally attend home births in Missouri. Midwives are currently practicing in both home and hospital birth settings.

Midwifery is defined as part of the practice of medicine according to state law. Therefore, anyone other than CNM's can be (and some have been) prosecuted for the practice of medicine without a license, which is a felony.

Private health insurance that pays for maternity care has to pay for birth regardless of where it occurs (though it may be at an out of network rate). At the bottom is a link for gentlebirth; there is a lot of information on that site to help with billing.

http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

http://www.gentlebirth.org/cgi-bin/q...&maxresults=40

http://www.gentlebirth.org/archives/money.html#HMO

[~Kristina~]

I'm in Michigan, but thanks for the link!!

[~Megan~]

If you insurance is like mine they don't care where the birth takes place just who they are reimbursing. So they would pay for a doctor or a nurse but not a CPM or LM. Perhaps you can find a CNM that does homebirths.

[mom2five]

Does anyone know anything about insurance covering in Texas... or know of a thread that discusses it.

thanks

[alegna]

I'm in TX. Didn't have any problems. They covered it. (took a few phone calls of course, but I think that's pretty standard)

-Angela

[Emmeline II]

Originally Posted by ~Kristina~

I'm in Michigan, but thanks for the link!!

All the better:

Direct entry midwifery is currently legal through judicial interpretation or statutory inference. This means that direct entry midwives are free to practice, but are not regulated by the state government.

Your insurance company can't say boo! to you; well, they can, but the final boo! is yours.

[Emmeline II]

Originally Posted by mom2five

Does anyone know anything about insurance covering in Texas... or know of a thread that discusses it.

thanks

This is a post I wrote for a Texas poster with an HMO, though most of it applies to a PPO also:

Private health insurance that pays for maternity care has to pay for birth regardless of where it occurs (though it may be at an out of network rate). At the bottom is a link for gentlebirth; there is a lot of information on that site to help with billing. I'm in San Antonio/Converse; CPMs and DEMs are legal to practice in Texas.

http://frwebgate.access.gpo.gov/cgi-...1999&TYPE=TEXT
Code of Federal Regulations Title 45, Volume 1:

(iii) Attending provider defined. For purposes of this section, attending provider means an individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing maternity or pediatric care to a mother or newborn child.

c) Construction. With respect to this section, the following rules of construction apply:

(1) Hospital stays not mandatory. This section does not require a mother to--

(i) Give birth in a hospital; or

(ii) Stay in the hospital for a fixed period of time following the birth of her child.

(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.

http://www.gentlebirth.org/cgi-bin/q...&maxresults=40

http://www.gentlebirth.org/archives/money.html#HMO

http://www.texasmidwives.com/

From gentle birth:

To get payment from an HMO, I would have the mother call her insurance carrier and request an "in-network midwife." They will
probably tell her that there is none in network, but they have plenty of other options. She will have to stipulate to them that she has researched
the treatment plan and decided that the midwifery model is her preferred treatment plan. Then she will need to say since there are no "in-network," providers I want a "transfer of care (TOC) exception number, or waiver for the services." (different terms for the same thing.) Many company insurance specialists will have the form. If they refuse to consider a TOC you can file for a review for the denial at that point, then appeal, and finally arbitration or State Insurance Board.

And here is the state board site:
http://www.tdi.state.tx.us/consumer/doctors.html

Notice to HMO Patients
Texas law protects your access to medical care.
If you are not satisfied that your HMO is providing you with the medical services
you need, you should write or call your HMO to complain. If your complaint is not
resolved to your satisfaction, you have the right to request that your complaint be
reviewed by a panel that is made up of members who have not been previously
involved with your case. THE HMO MUST MAKE THIS PANEL AVAILABLE TO
YOU.
If you want to know if you have other rights, call your HMO.
For more information call:
Texas Department of Insurance
HMO Complaint Helpline
1-800-252-3439
In Austin, Call 463-6515

For definition of midwfery care and other good info:
http://www.cfmidwifery.org/midwifery/faq.aspx#1

Definition of OB:

"An obstetrician is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth)."

If you decide to challege your insurance company to pay for your midife, remember to talk to their wallet and not their ear :smile:. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top with hb safety info and check out the WHO because they have a lot of good things to say about midwives.. Call up the hospital where they think you are delivering and find out (in detail) what a hopital birth (w/anest., vag and c-sec) costs. Home birth saves them money, and HMOs exist to save money. There is a stickey at the top of thi board with hb safety info.

[CEG]

My understanding is that the provider bills as a maternity provider. As long as they are on your network, it shouldn't matter if they are a homebirth or hospital provider. Then there is just never a hospital bill added on. Insurance providers should be happy That's how it works with mine, anyway. In Illinois.

[Slingin'Momto4]

Does anyone know how the insurance works in MA with a lay midwife? I am wondering if maybe, just maybe our ins will cover our homebirth...

[Emmeline II]

Originally Posted by Slingin'Momto4

Does anyone know how the insurance works in MA with a lay midwife? I am wondering if maybe, just maybe our ins will cover our homebirth...

Code of Federal Regulations Title 45, Volume 1 applies to all states.

Direct entry midwifery is legal in the state of Massachusetts.

Currently (October 2001), direct entry midwives practice legally, without regulation but also without official recognition, as per a 1985 Supreme Judicial Court decision. CNMs practice legally, under the supervision of the Board of Nursing, as per statute.

Legislation is pending before the Massachusetts legislature to create a Board of Midwifery that would govern CPMs, CNMs and CMs. The bill has been designated as Senate 569. Additional information can be obtained from the Massachusetts Coalition for Midwifery web site, which is accessible from the MFOM web site.


Masachusetts Friends of Midwives, Inc.

Beth Volkman, President
55 Washington Avenue
Northampton, Massachusetts 01060
USA
Email: [e-mail]
Website: http://www.mfom.org

[Defenestrator]

Hi --

I'm a homebirth midwife in Ann Arbor:

Billing insurance as a non-nurse midwife in Michigan can be a tricky business. I have had excellent luck with United and Good Samaritan. I used to have a lot of trouble with Blue Cross but have had excellent luck with them lately as well.

Most homebirth midwives in Michigan do not "take" insurance per se because of the erratic payment from the insurance companies. We ask for payment up front and then will give you insurance forms (filled out by us) for reimbursement. I have considered taking insurance from the aforementioned companies because of my positive history with them, but the clients I work with would have to understand that we would need to set up a payment plan if the claim is denied.

A lot of times whether or not your claim gets paid depends on your own persistence and flexibility. There have been a lot of claims that are just denied with no explanation and when the client makes a call the ins. co. says that one code was wrong or that one date was wrong, etc.

Even though traditional midwifery is legal in Michigan, we are not licensed. Some insurance companies can shut us down pretty quickly by saying that they only cover licensed midwives. Also the lack of licensing makes it pretty near impossible to get malpractice insurance and many insurers want their in-network providers to have $1 million of malpractice insurance.

I know this post is a little convoluted, but the jist of what I am saying is that most homebirth midwives will be covered as out-of-network providers, if they are covered at all. Most homebirth midwives will also ask that you pay up front and seek reimbursement yourself (though a few, like me, are either taking insurance from a small handful or companies or considering doing so).

Hope this makes things clearer, not more confusing!

Stacia

[~Kristina~]

Originally Posted by Defenestrator

Hi --

I'm a homebirth midwife in Ann Arbor:

Billing insurance as a non-nurse midwife in Michigan can be a tricky business. I have had excellent luck with United and Good Samaritan. I used to have a lot of trouble with Blue Cross but have had excellent luck with them lately as well.

Most homebirth midwives in Michigan do not "take" insurance per se because of the erratic payment from the insurance companies. We ask for payment up front and then will give you insurance forms (filled out by us) for reimbursement. I have considered taking insurance from the aforementioned companies because of my positive history with them, but the clients I work with would have to understand that we would need to set up a payment plan if the claim is denied.

A lot of times whether or not your claim gets paid depends on your own persistence and flexibility. There have been a lot of claims that are just denied with no explanation and when the client makes a call the ins. co. says that one code was wrong or that one date was wrong, etc.

Even though traditional midwifery is legal in Michigan, we are not licensed. Some insurance companies can shut us down pretty quickly by saying that they only cover licensed midwives. Also the lack of licensing makes it pretty near impossible to get malpractice insurance and many insurers want their in-network providers to have $1 million of malpractice insurance.

I know this post is a little convoluted, but the jist of what I am saying is that most homebirth midwives will be covered as out-of-network providers, if they are covered at all. Most homebirth midwives will also ask that you pay up front and seek reimbursement yourself (though a few, like me, are either taking insurance from a small handful or companies or considering doing so).

Hope this makes things clearer, not more confusing!

Stacia

Thanks Stacia! My dh is going to check into his insurance but he thinks it's covered. I don't mind paying up front and getting reimburst for it. But would be nice to not have to pay in the long run. Are you with New Moon or someone else?

[Defenestrator]

Hi --

I run a practice called Trillium Birth Services -- it used to be a group practice, but the midwives who started it have retired and now it is just me (though I contract with other independent midwives to be second attendants at my births)

[starry_mama]

What about if your insurance specifically says "Will not cover planned home births" in the policy? Has anyone ever had a company that said that, and then convinced them to change their mind, or at least pay for part? Our last birth was in a hospital because we couldn't afford to pay a midwife. We're thinking of a UC next time, or maybe start saving now