Wanting to Switch from Birth Center to Home Birth

[Herausgeber]

My MWs primarily do homebirths (90 percent), and but my insurance stupidly requires me to drive to their free-standing birth center, about 30 minutes away from my house in favorable traffic. It can take MUCH longer in rush hour.

I am actually closer to a hospital when I am at home than I would be at the center, in case of emergency.

What would happen if I switched to the home birth option at the very end? Would my insurance still pay the MWs for my prenatal care, but not the actual labor? Would they refuse to cover the whole thing (about $5K out of pocket, not counting labs), when they would otherwise have covered 100 percent?

I haven't decided if I want to stay home badly enough to have an "oops" UC. I really would prefer an attended home birth, and I don't understand why my insurance company thinks it's preferable for me to drive in traffic to the birth center in the middle of labor rather than have the MW and my doula just come to me.

DP would be supportive of the home birth, but would probably balk at paying the whole $5K on such short notice.

I definitely plan to just pay out of pocket for any subsequent births. But what to do about this one?!? It just all seems so arbitrary.

[mary3mama]

Not knowing any details of your insurance company, this is just a guess, but I'd contact a couple of potential MWs in the area that you might want to use. Find out what they know and whether they've dealt with your particular insurance company.

My midwives knew lots about my insurance carrier, and we left our interview with way more information about their typical coverage than I got from talking directly to a representative from the insurance company.

Good luck!

[boscopup]

My understanding about insurance billing is that the place of birth isn't part of the billing code, so the midwives should be billing the same (using the same codes), whether they attend the birth at home or at the birth center. Have you talked to your midwives about it? Don't mention homebirth to the insurance company. If the midwives bill the same way as they do for birth center births, the insurance company won't have any clue it was done at home. That's the route I'd pursue right now.

[HomeBirthMommy]

It depends on how they bill. There is something called the "global fee" that includes prenatal care, birth, care after birth. Most ob's and hosp or bc mw's use the global fee for billing.
They can seperate the fees and bill each thing individually. Prenatal care has one code, birth has a code, lab work, etc. Ask your midwives how they bill and if they would bill seperate for you. Also find out how much the actual birth part is, so you will know how much you might have to pay out of pocket.

Homebirth midwives are not legal here and my insurance flat out won't pay for homebirth, but my mw is licensed in another state and is filing for everything except the actual birth. She is also filing for more than I've already paid (I paid early and got a nice discount, but she's charging her acutal no discount fees). She is also filing for supplies, etc. We're really hoping to get some money back.

Also, do you or your dh have a flex account for medical expenses? Check into getting reimbursed from that for any birthing expenses.

[Briannasmom]

Originally Posted by boscopup

My understanding about insurance billing is that the place of birth isn't part of the billing code, so the midwives should be billing the same (using the same codes), whether they attend the birth at home or at the birth center. Have you talked to your midwives about it? Don't mention homebirth to the insurance company. If the midwives bill the same way as they do for birth center births, the insurance company won't have any clue it was done at home. That's the route I'd pursue right now.

This is my understanding too. Most experienced MWs know how to bill so you can get reimbursed.

[wombat]

What a crazy situation.

I know my insurance paid my MW for some of my prenatal stuff (with a CNM in solo practice) during my pregnancy. My insurance treated the prenatal visits separately from the birth I think. You'd need to check with the insurance co. Or talk to the billing person at the birth center, they should know this stuff. I don't think it'd matter to the insurance co. if and when you switched to homebirth. Your prenatal visits with this birthcenter that they cover are still valid.

Perhaps you could continue with the insurance paying for prenatals until the birth, but work out a deal with the birthcenter about just paying for the delivery out of pocket? Maybe that's what you're thinking already.

[Herausgeber]

Thanks for all your advice! My head is just reeling about this right now.

My next appointment is in 2 weeks, so I'm going to ask the midwife I'm scheduled to see, who is the one who founded the practice, for guidance. I can't be the first person to come in being just fine with my insurance's birth center restriction and wanting a home birth by the end of it all.

[MotheringHeart]

I also live in the DC area and go to a group of midwifes who deliver in a birth center and attend homebirths. My insurance also gives us less hassle if we deliver in a birth center, so last time the group just billed the insurance under "birth services". It didn't specify home vs birth center. I'm thinking we're talking about the same practice, so pm me if you want some more details!