do insurance companies pay for lay midwives?

[Maggi315]

hi, I knowthis has been asked before, but I can't find it in the archives. I am a lay midwife, planning on taking the CPM in February and work with a CPM. We would like to bill insurance companies, but I am not sure whether they pay in this state (pa) since we are not considered legal.

Anyone have success in non=legal states with this? Any hints or suggestions?

thanks,

[Midwife Kris]

I don't know of any insurance company who will pay for a unlicensed health care provider, regardless of the politics of midwifery in PA. A CPM isn't a license and wouldn't be enough for them to issue a reimbursement. If you turn in a claim without a license documented, they will kick it back until you provide them with one.

[Reha]

I do know a few unlicensed non-CPM midwives who have received payment from private insurance companies. One that I know says that she bills for all clients that have insurance, and gets payment about 50% of the time. This is in Oregon, however.

It's worth a try, right?

[cfiddlinmama]

My CPM bills insurance and Medicaid. Here in NH they just passed legislation that all insurance companies have to reimburse a licensed midwife wherever she is approved to practice. In this case it would definitely apply to homebirth. I'm pretty sure that the CPM counts as licensure in NH.

ETA: I will know more about the process soon, hopefully. I'm supposed to start apprenticing with her in a couple of weeks.

[shelleyd]

My insurance company paid my DEM in Michigan where midwives are not legislated. When I called the insurance company, they told me they'd pay for a liscensed midwife. But midwives aren't liscensed in MI. So we crossed our fingers and submitted it and they paid the out of network rate.

Shelley

[rajahkat]

I know of midwives who are unlicensed and have had success with billing insurance companies. (In Oregon, again) Can't hurt to submit the paperwork.

[Midwife Kris]

It has been said on other midwifery email groups that to submit a claim for insurance in a state where licensing is unavailable (illegal state since in reality alegal doesn't mean legal), it's an invitation for a potential investigation. Oregon is probably somewhere in the middle given it's status of voluntary licensing.

[rajahkat]

Do you think it would cause less problem then for the insurance holder to file for reimbursement? I know that my husband has clients who often ask for receipts so that they can be reimbursed by their insurance.....Or would this still be problematic for the midwife?

[babycatcher01]

It never hurts to try. I think that if enough people were to bill, insurances would notice that it is way cheeper and that there are better outcomes at home then in a hospital setting. I have had good luck with private insurance, but the trick is sometimes to have the client submit a paid infull invoice and then they remburse the client. Its always a shot in the dark.