My HB dilemma....

[Jojo F.]

My insurance is sadly through the state, the only insurance we can get.

My first birth was a hospital birth for 1) my ignorance about birth and 2) I had pre-e.

This time around I am low risk, although I am being monitored closely for any changes, but everything is peachy and my diet is DRASTICALLY different, more TF.

I just talked to my insurance and they said that a "planned" HB is not covered but if it is "accidental" they will not deny me coverage. My heart is really set on a H2O HB.

Soooooo, I figure my options are 1) talk to MWs in my area and see if they can bill my insurance for seperate "services" or 2) have an "accidental" HB.

I have no problem calling around but if I have an "accidental" HB I would definitely want a MW present, I am not comfortable with a UC.

Anyone in RI BTDT? Any advice is much appreciated.

[GrrlyElizabeth]

Suggestion #1 might be a good route, if it'll work. I'm confused about "accidental" homebirth being an option; it doesn't seem like an insurance company would pay for a midwife's services if she just "happened" to be there when you "happened" to go into labor, know what I mean? I would have interpreted what your insurance company told you to mean that if you had a surprise homebirth and transferred that they would cover that. Am I mistaken?

Anyway, the first thing I'd do is find out what the laws in your state are concerning coverage of a licensed care provider during pregnancy. Just because the insurance company *says* they don't cover HB doesn't mean you can't make it happen. (It might, however, require some effort.) This would be an excellent question to ask a midwife when you interview.

My other suggestion is to contact the midwives in your area and find out how much they charge, whether they'll barter, etc. I'm guessing that paying out of pocket is a concern for you (isn't it for everyone?!), but many midwives will be happy to set up a payment plan with you, offer a sliding scale, etc. Of course I'm biased (see signature), but I think the money you spend on a midwife is the most important money you can spend on yourself and your baby. Have your friends throw you a midwife fundraiser instead of a baby shower!

I hope you find a great midwife and have a fabulous birth! Good luck!

[~Megan~]

You should clarify if that means they will pay a homebirth midwife or if they are saying they will still cover postpartum hospital costs if your baby is born at home.

Insurance deos not pay a place but rather a provider. Find out if they pay CNMs or liscensed midwives, where you have your baby doesn't matter to the insurance.

[robynlyn80]

i know everyone's insurance is different, by i don't think mine (bcbs) had any idea where i gave birth (except that they never got a bill from a hospital). after ds was born, my midwife just billed for global maternity care- so she really billed for all my prenatal and not the delivery. i had a check for 60% (out of network coverage) within a week. i never asked my insurance if they covered homebirth- i asked about midwives.

[nashvillemidwife]

Your midwives can indeed bill for just prenatal and postpartum care. I also don't get the "accidental" home birth. If it's accidental, that means you didn't have time to get to the hospital, which means there is no care provider to pay for.

Two things in response to the posts above:

1. "Any willing provider" laws only apply to having to cover the provider, it does not require companies to pay for procedures, which is what we're talking about. She may live in state that requires payment for midwives, but they still don't have to pay for home birth, just like they don't have to pay for cosmetic surgery.

2. Yes, insurance companies DO know where the birth took place, though I think sometimes they miss it. That information is contained in the "diagnosis code" that is submitted on the insurance claim.

[Emmeline II]

Originally Posted by robynlyn80

i know everyone's insurance is different, by i don't think mine (bcbs) had any idea where i gave birth (except that they never got a bill from a hospital). after ds was born, my midwife just billed for global maternity care- so she really billed for all my prenatal and not the delivery. i had a check for 60% (out of network coverage) within a week. i never asked my insurance if they covered homebirth- i asked about midwives.

Me too. They called about 6 weeks after the birth to find out what hospital I delivered at so the bill got paid. I had a nice chat with the nurse about my baby being born in my bath tub .

[Emmeline II]

Originally Posted by nashvillemidwife

Two things in response to the posts above:

1. "Any willing provider" laws only apply to having to cover the provider, it does not require companies to pay for procedures, which is what we're talking about. She may live in state that requires payment for midwives, but they still don't have to pay for home birth, just like they don't have to pay for cosmetic surgery.

The "willing provider" law is Federal and states that you cannot be required to give birth in a hospital and they must pay any provider that is legal in your state. But it seems that if an ins co. states in their manual that they will not cover homebirth they do not have to pay for it; but if they do not have that provision, they do.

My ins co said they'd pay for hb only with a cnw or a doctor, but since cpm's can be licensed in my state they could not deny payment; if they say they cover hb they cannot restrict the provider.

[nashvillemidwife]

"Any willing provider" laws are not federal. NCSL has a good explanation: "Almost half the states have laws prohibiting health insurers from excluding participation of willing and qualified health care providers in their geographic coverage areas."