I am about 8 weeks pregnant with my second baby and would love to do a home birth but we have an HMO insurance plan and I think we have to pay out of pocket. Obviously I will have to talk to my insurance but I was wondering if any Moms had success in having at least a part coverage of a home birth. My last birth at the hospital was billed with 12 000$ even though I labored all at home and just spend 90 minutes in the LDR with no interventions!!! The midwife I like would charge 4500$ (I live in LA county, I think everything is more expensive). That would be less than half the cost though for the insurance. Thanks for any thoughts and insight. Maren
I was able to get my insurance company to cover my upcoming home birth as in-network. It was a little tough but doable. But I think I have a PPO. My sister lives in Orange County and has an HMO plan like you. I've heard a lot about her difficulties just even getting simple referrals to specialists as required by her insurance, among other annoyances, so I do imagine it might be harder to get an HMO to approve covering a home birth? I hope not for your sake, though!
Basically what I had to do was have my primary care physician call my insurance company, approving and requesting a "gap exception" for my midwife to be covered in-network for my outpatient birth. One of the reasons insurance will often deny these things is because they have a list of clinical midwives who are covered in-network in your area and they can argue that you have them available to see and should just choose one of them for care. But the difference between them and your midwife is that they cannot perform outpatient births, which is what your midwife is doing. So my primary care doctor specifically stated to the insurance company that I had been under my midwife's care for 5 months of pregnancy already (at the time I had her submit her request) and that it would be best for me to continue my care with her, along with the fact that there are no in-network midwives in my area who perform outpatient births. I thought my insurance company would take a while to decide and maybe fight it, but surprisingly they didn't! They initially coded everything wrong, which caused a problem, but once that was fixed they sent me a letter right away approving my home birth!
My midwife has a billing company who handles her practice's billing and they specialize in working with midwives in this capacity, so that helped make this process smoother too since they find out ahead of time what a client's insurance company would need to get approval. Clients in her practice pay out of pocket during the entire length of prenatal appointments and then her billing company bills the insurance company after the birth, at which point insurance reimburses the client. I'll be getting back 80% everything I paid less my deductible. It sucks and is backwards with how it works, but hey - I'll take it. I'm looking forward to getting a few thousand $$ back a month or two after my birth!
Thanks for your reply. You are right I am dealing with the same problems like your sister. I don't know why I was even thinking they would partially support a home birth. I talked to them yesterday and for us a home birth would be completely out of pocket. We have been talking about it a lot but I might not be able to do it out of financial reasons. I am very frustrated at the moment. I am still early in my pregnancy so hopefully we can figure something out that works for us. I wish you all the best. You are so close :) Happy Birthing!!
Many, many midwives will work with you on payment. They say payment is x amount by x weeks, but usually they will be flexible. I've heard of them waiting for tax returns to come in, for example. Or, trade homegrown beef/chickens/produce for part of the payment. Or, put you on a different payment plan, less per month for much longer.
Don't let the cost immediately stop you from trying. Be honest with the midwives, and see if they can help you.
"If you keep doing the same things you've always done, you'll keep getting the same results you've always gotten."