homebirth and insurance [Archive] - MotheringDotCommunity Forums

veganf

03-16-2006, 12:46 PM

Does anyone have health insurance (in the U.S.) that actually DOES cover homebirth (not in a states that mandates all birth coverage, ie. Florida)? The one carrier who my midwife recommended no longer offers coverage in our state. We have no health insurance at the moment, and we've actually never had it while I've been pregnant. But I have no intention of paying $800/month for private insurance that won't cover my preferred method of birth and prenatal care. And we were dropped by state insurance because we no longer qualified.

- Krista

KC in KS

03-16-2006, 01:24 PM

I've got Aetna, and while they do cover midwives, apparently it's only through hospitals.

Policy

Aetna considers planned deliveries at home and associated services not medically appropriate.

Note: However, provision of home births will be considered when mandated by law.

See also CPB 127 - Home Uterine Activity Monitoring.

Background

According to the policy statement on home delivery of the American College of Obstetricians and Gynecologists, labor and delivery, while a physiological process, clearly presents hazards to both the mother and fetus before and after birth. These hazards require standards of safety which are provided in the hospital setting and cannot be matched in the home situation. The Guidelines for Perinatal Care published by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists state that the hospital, including a birthing center within the hospital complex, provides the safest setting for labor, delivery, and the postpartum period. The use of other settings is not encouraged. Further, any facility providing obstetrical care should have the services listed as essential components for a level I hospital. This includes the availability of blood and fresh-frozen plasma for transfusion; anesthesia, radiology, ultrasound, electronic fetal heart rate monitoring and laboratory services available on a 24-hour basis; resuscitation and stabilization of all inborn neonates; nursery; and other services that are not available in the home setting.

http://www.aetna.com/cpb/data/CPBA0329.html

peilover010202

03-16-2006, 01:49 PM

I would def check out the homebirth forum. I've read that some women have had success in appealing their case, though I don't know if you'd want to risk that and it end up being denied.

tatgurl

03-16-2006, 02:19 PM

We have Blue Cross Blue Shield of MA PPO. MY HB MW is not in-network and therefore they were only going to cover 80%. However, I have had a previous HB covered by them by my old MW who WAS in-network. And there are no HB MWs in my area who are in-network. So, I appealed (filed a grevance) with BCBS and they approved it!! They are covering my homebirth 100%!!!

autumnfaery

03-16-2006, 02:40 PM

I have Empire BCBS (NY plan, even though I live in MN). They could care less where I give birth. They're just concerned with who's attending. They will only cover CNM's. Last time, I had a CPM because CNM's don't do homebirths in this state. They said they wouldn't cover it because the provider is not an approved provider type. I filed the claim anyway and evidentally they didn't notice because they paid it at my out-of-network benefits level.

This time, there IS a CNM in my area that is doing homebirths (the only one in the Minneapolis area, and maybe the only in the state). That means that my insurance is covering my homebirth 100%. No deductible, no copays. Even birthing at the hospital wouldn't have coverage like that because I have both copays and a deductible as part of my in-patient hospital coverage. I'm so excited to have this covered this time without a fight! :D

SummerTwilight

03-16-2006, 08:50 PM

tatgurl

03-16-2006, 08:55 PM

WOW! tatgurl, that is AWESOME! You said this was in MA? I live in MA and the only reason I am not having a homebirth is because I can't afford $4000 to fund it myself so I am opting for a free standing birth center in NH (and am more than a bit nervous about the hour drive while in labor!).
Did you have to wait till after the birth to find out your grievance was won? I also have BCBS so I am ultra curious!

My insurance is through MA, cause DH's company is based there. We live in NY. My previous HB was covered 100% from day 1 cause my mw at the time was in-network. this time around was when I filed for the grievance and it came through a couple of weeks ago (I'm 20wks. now). I figured if I started now, it might save me all of the out of pocket to the MW before the insurance comes through. My next step is to ask BCBS to send me a letter in writing with the actual $ amt. the MW is billing, so that I don't have to do ANY more out of pocket!!

eleven

03-16-2006, 09:36 PM

You might want to check with state laws - in NYS all CNMs MUST be covered, regardless of where they practice.

We have HealthNet and homebirth is covered, but must have prior authorization. I haven't been able to find out what the actual coverage is (i.e., $$ or percentage). The first time I called, the customer service lady told me to go to the hospital for the "good drugs." :rolleyes

KarmaChameleon

03-17-2006, 07:16 AM

veganf

03-17-2006, 07:24 AM

I am opting for a free standing birth center in NH (and am more than a bit nervous about the hour drive while in labor!).

If it's you're first, you'll likely have plenty of time.
I could never do it, because I was pushing by the time my husband and midwife arrived last time. Crazy stuff. Labor started around 9:30pm, baby born at 11:08pm, everyone in bed by 1:30am. I'm afraid my 3 year old will be my "birth assistant" this time..very likely!!

- krista

**guest**

03-17-2006, 02:47 PM

I just saw this and had to post. Krista, if your dh is away when you go into labor, call me!!! I can get ds's father to come over while I go to your place!

Hugs,
Liz

SummerTwilight

03-17-2006, 02:51 PM

Karma: YES, Where do you live? I am in Paxton, which is one town north of Worcester, MA.
Tatgurl: Thanks! I will contact my insurance to find out!:D

veganf

03-17-2006, 03:03 PM

I just saw this and had to post. Krista, if your dh is away when you go into labor, call me!!! I can get ds's father to come over while I go to your place!

Hugs,
Liz

LOL, thanks Liz. I'll definitely put you on my "call" list.
Honestly I'm trying to make a list of people no more than a 10 minute drive away, figuring it would take them 5 minutes to get out the door, and another 5-10 to get here! Even if they have to bring their kid/s, I need people who can get here fast, even if it means popping in a Nemo DVD and feeding the boys snacks until Rob or the midwife arrive. I just need someone asap, since there's a good chance Rob will be away, and last time my water broke and I had transition contractions back to back immediately, and could barely make 1 phone call before I was out of it. I'm just going to keep the box of birth supplies ready in the dining room where Ryan can reach them!

- Krista

SummerTwilight

03-17-2006, 03:16 PM

Electra375

03-17-2006, 03:24 PM

I had UNICARE with my hb. I had to fight them for coverage and it came down to I'd been squeeking so long that they paid. They would have paid if the provider was licensed, she was a DEM and not licensed but there were no licensing requirements in this state at the time.
Generally speaking an insurance plan must cover licensed care providers based on your state's licensing. However, this is not true for self-funded plans, they do not have to abide by the law.
In VA there is a law that ins co must cover licensed care providers, CIGNA self-funded plan stated they did not have to abide by the law and would not cover a homebirth midwife who was licensed by the state. I believe it would have been fightable, but fortunately I didn't get pregnant while under that plan.
I told my dh that it didn't matter if the new ins covered hb or not b/c we would be having a hb regardless and my mw wasn't licensed nor wants to be licensed. At $2200 in 04, it isn't too expensive for us to just pay out of pocket.
I'm glad to see some ins co aren't putting up too many obstacles.

TurboClaudia

03-17-2006, 03:44 PM

saw your thread title and just wanted to share: we have insurance through a company called Lumenos and the particulars of our plan do cover homebirth under the "extras" category. prenatal and postnatal visits and any extra services (like resuscitation sp?, oxygen, probably anti-hemorrhage medications that my midwife carries, etc) at the actual birth are billed under specific codes so fall under the traditional health coverage part of the plan and not under extras.

~claudia

tatgurl

03-17-2006, 04:21 PM

AHHHHHHH! OH my GAWD! I just called my insurance BCBS and they DO cover homebirth 100% if the carrier is a provider and if not 80% just like you said Tat! I am SO excited and shocked! Now I am a bit confused cause I had ruled out homebirth from the get go thinking it would never be paid for and now maybe I have to rethink my entire birth plan...am I brave/daring enough to do a homebirth first time around?
:shrug
And my current midwives are not in network. :(

I say go for it!!! I would totally have a HB if you want to!! If you are at all interested in having a natural birth then I think that home would be better than a birth center. But a birth center is WAY better than a hospital any day!!!

Another thing to think about is that if you find a HB MW in your area, and she is not in-network, do your research and see if there are any others in the area that do HB's. If not, you could file a greivance and try to get it covered 100%. That's what I did this time around. NON of the HB MW's in my area are in-network.

KarmaChameleon

03-17-2006, 04:29 PM

Karma: YES, Where do you live? I am in Paxton, which is one town north of Worcester, MA.

Hey -- weird! I am in Leominster, and I am sure you already know that veganf is in Framingham. We will definitely have to get together at some point and compare bellies :)

I am loving the Birth Cottage...I am planning a homebirth but I just love the atmosphere there. My next appt is April 6 :D

veganf

03-17-2006, 05:05 PM

AHHHHHHH! OH my GAWD! I just called my insurance BCBS and they DO cover homebirth 100% if the carrier is a provider and if not 80% just like you said Tat!

I really hope they get back to me with something affordable, because I just requested info for family health insurance from BCBS. I'll keep my fingers crossed. Otherwise, it's another $3000 for the birth, but when you compare that to what the insurance costs, it's a drop in the bucket :angry .

- Krista

libbylu

03-18-2006, 07:36 PM

We had Medica with ds1, and their official policy is apparently not to cover homebirths unless hospitals not available, but they ended up covering it anyway! We got most of our midwife's fee back, I guess she has a really good insurance submitter. (our midwife has a state liscensure pending, and is a CMP, not a nurse-midwife)

It is kind of weird that they say there is no way they will cover it, but you just keep trying, and sometimes they just do! It was a wonderful suprise!

SummerTwilight

03-19-2006, 08:52 AM

Vegan: I didn't know Karma was in Framingham, both of you are about 40 minutes from me so we should DEFINATELY get together at some point!
It is very exciting to think about the possibility of a home birth now.
I think I will start a new thread on the subject so keep your eyes peeled so you can give me your opinion.

veganf

03-19-2006, 09:21 AM

I'd love to get together with local mamas. If we can actually find a time & place that we can all do!

- Krista

JenMidwife

03-19-2006, 11:04 AM

I have Aetna POS & while they don't cover homebirth, my midwives have an AWESOME (creative!) billing service that aparently knows how to squeeze every last penny out of Aetna! But the midwives are still considered out-of-network, so we still have to come up w/ $500 deductible & then I think insurance covers 60% after that?

There are no in-network midwives that do hb in my area, so I wonder if I should file a grievance? On the otherhand, w/ Aetna's anti-hb policy, maybe I should just keep my mouth shut & be thankful for anything we are going to get. Any advice?

JenMidwife

03-19-2006, 11:15 AM

am I brave/daring enough to do a homebirth first time around?

That's so great that you have choices!!! :thumb I am planning a hb ESPECIALLY because it's my first time, knowing that first time mamas are more likely to be induced, have a c/s, etc. Even though birthcenters have more lienient (sp?) protocol than hospitals, I would rather be able to make decisions in partnership w/ my midwives rather than get booted out of the birth center because I'm in labor too long, go too far past my due date, etc.

I know this birth experience will significantly impact my future birthing options, so I guess I look at planning a hb this time around (& paying much more out of pocket than I would in hospital or maybe bc) as my best chance of having a spontaneous vaginal birth.

I'll get off my soap box now! :love Good luck making a decision that you're most comfortable w/.

Jen

P.S. I wanna join the MA tribe!!! :)

KarmaChameleon

03-19-2006, 01:25 PM

It is very exciting to think about the possibility of a home birth now.
I think I will start a new thread on the subject so keep your eyes peeled so you can give me your opinion.

Be very careful when you ask for my opinion. You'll get it :) Those who know me best only ask me for opinions when they want and can handle the truth (as I see it, of course :lol )

JenMidwife

03-19-2006, 10:19 PM

Be very careful when you ask for my opinion. You'll get it :) Those who know me best only ask me for opinions when they want and can handle the truth (as I see it, of course :lol )

Hehehe, oops, I guess nobody asked for my opinion!!!:lol

veganf

03-20-2006, 06:33 AM

Be very careful when you ask for my opinion. You'll get it :) Those who know me best only ask me for opinions when they want and can handle the truth (as I see it, of course :lol )

heh heh, you sound a lot like me!

SummerTwilight

03-20-2006, 01:58 PM

Ok, that's it. Off to start a new thread. And don't worry. I like opinions, am not easily offended and btw DO want to get together with MA people, the more the merrier. And I don't mind driving to Framingham (used to live in Ashland) OR Leominster (AWESOME coffee/sandwich shop in the Victory Market Plaza, Moosetracks, that I host an open mic at and have been for a few years- they are the BEST!) You guys name the place and date.

Robynee

03-21-2006, 06:41 AM

All you MA BCBS ladies- Do you have PPO? I have HMO and I am doubting they will cover anything but you all have my hopes up. I have an excellent homebirth midwife that lives about 10 min from me.

veganf

03-21-2006, 06:58 AM

Right now we have nothing. We HAD MassHealth, but they cover nothing!

- Krista

KarmaChameleon

03-21-2006, 07:05 AM

All you MA BCBS ladies- Do you have PPO? I have HMO and I am doubting they will cover anything but you all have my hopes up. I have an excellent homebirth midwife that lives about 10 min from me.

I have BCBS HMO and so far I am holding my breath but it looks like they are going to cover it....It is sort of backhanded though because I am seeing an out-of-network BCBS provider (a midwife at The Birth Cottage in NH), and they just so happen to do homebirths in addition to Birth Center births. So it wasn't like I had the freedom to just choose a homebirth midwife and get it covered. But I went about it through the backdoor :mischief

Paying out of pocket was not an option for us, so this was the way it needed to be done. It would've been nice to find a real local midwife who had that mother nature demeanor, but I had to go with the place I mentioned because it's paid for, and they are really nice and will do quite nicely I am sure:love

KarmaChameleon

03-21-2006, 08:02 PM

Leominster (AWESOME coffee/sandwich shop in the Victory Market Plaza, Moosetracks, that I host an open mic at and have been for a few years- they are the BEST!) You guys name the place and date.

When is the open mic?!?!?!?! I am a folksinger, thats how I met hubby (he was a drummer in a band -- they're actually playing at Tammany Hall in Worcester this Sat. but I can't go :() -- I haven't played out since we moved to Mass -- unless you count my weekly stint doing music time at my daughter's preschool:innocent but Iwould love to come hear local live music and drink coffe :) Tell tell......

SummerTwilight

03-22-2006, 09:18 PM

Karma: WOOHOO! That is AWESOME! I am also a folk gal myself, singer, songwriter, guitarist...more the former than the latter.
It used to be once a month but with the pregnancy I have slowed down. I am definately doing one either the last Saturday of April or the first one of May (depending on the schedule of a visiting friend) so that gives you time to plan to play something! You can ask me again about it or just check in with Moosetracks- they will add it to their schedule. And it always starts @7. I'll be the one with the belly.:D