Homebirth/Insurance Question...

[redpajama]

My question about "when to go to the hospital" elicited a comment to the effect of "if your client wants to stay home so long, why doesn't she just plan a homebirth?" And I think this is a valid question. The answer--and the answer that I'm hearing from woman after woman lately--is money. They can pay $4,000-$6,000 out-of-pocket for a homebirth, or they can "endure" a more-or-less "free" hospital birth, because insurance FULLY (or nearly-fully) covers their hospital birth, and won't touch the homebirth.

I don't know why the absolutely ridiculousness of all of this (or of the word "ridiculousness," for that matter) just occured to me, but it did. Insurance companies, unwilling (if I understand the matter correctly) to cover a homebirth waste THOUSANDS of dollars (and drive up health care costs all around) paying for the expensive hospital births (some of) their clients didn't want anyway.

So my question is...where should I begin sending letters? To the insurance companies? To the state? Washington? God?

[Defenestrator]

Is your client in Ann Arbor too? No way is a homebirth $4-6k here. Most homebirth midwives charge less than $3000 -- my sliding scale is between $1800 and $2800 and I can often get insurance reimbursement if a client does not have an HMO. I also have several clients on loong payment plans and will sometimes cut my fee further or barter for a family in true need.

I would say that about 1/3 of my families have medicaid and can expect no reimbursement for my services, about 1/3 have HMOs and can expect no reimbursement, and about 1/3 will have insurance pay between 50-80% of my bill. As a non-licensed midwife, it is hard for me to get malpractice insurance and most insurance companies will only allow providers to be preferred providers if they are licensed and have malpractice. So, I have to bill as an out of network provider. But, I have an insurance biller and so far, so good. There is a new national provider identity program that might muck things up for me a bit, but we shall see.

Just wanted you to have more accurate info -- hope you can help your client have a great birth!

Take care,

Stacia

[Defenestrator]

To answer your question, probably the best thing that you could do would be to help support a licensing bill for homebirth midwives in the state of Michigan. One organization that might help with this effort if the midwives decide to try for licensing is the Friends of Michigan Midwives.

Here is a thread about that organization:

http://www.mothering.com/discussions...d.php?t=642425

Also, you can support legislation that is beneficial to CNMs because the easier it is for them to work independently and bill a variety of providers (including Medicaid) for reasonable reimbursement, the more of them will work in homebirth.

Good luck!

[Reha]

Just wanted to interject that having midwives licensed does NOT in any way ensure insurance coverage. In Oregon, while there are a handful of companies who will cover a portion of licensed midwifery services, it seems to me that majority of insurance companies do not, and many of our clients with insurance end up paying out of pocket.

[Defenestrator]

But there are federal laws which should trump state laws if insurance companies are providing reimbursement for one category of midwives (like CNMs) and not another (like a licensed traditional midwife).

I am not saying that insurance companies do not set up policies ALL THE TIME that are in violation of state or federal laws, but that when you are fighting a claim denial all the way up the ladder to the state insurance commisioner, you will get a lot further as a licensed provider than you will as an unlicensed provider. Legally, insurance companies can refuse to reimburse unlicensed providers. It is the #1 obstacle I run into with claim denials as a midwife in an unregulated state. #2 would be the "we don't cover homebirth" argument, but in that case I can often get at least the prenatal and postnatal care covered and because my fees are so far below the reasonable and customary charges for my area, I can often bill almost my whole fee as prenatal and postnatal care without the insurance company batting an eyelash.

At least in Michigan, the insurance companies are required to open their enrollment once per year and to publish the requirements for becoming a preferred provider. It is very common for them to require licensure and also a $1million malpractice policy. Some of them require physician supervision. While being part of an HMO is still quite uncommon in other states for homebirth midwives, even CNMs, I do know quite a few midwives in states with licensure who are preferred providers or who have very good luck with insurance reimbursement.