Homebirth and Insurance HELP! - Mothering Forums

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#1 of 3 Old 01-11-2010, 05:50 PM - Thread Starter
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Ok, so I'm due in Sept, and am glad that I am starting all this now, as I get the feeling it can take a while.

I called my insurance company and asked them if midwives are covered. They said yes, under and employed by an OB in a hospital setting. We have one group in our area that has an OB who employs midwives. I asked them then to look up midwives that are covered and in-network. They did, and there was one. Strangely enough, this midwife wasn't under an OB, or worked in hospital setting. So I was confused. She then looked up my midwife and said she is covered and registered, but is out-of-network. Really, I'm fine with that. That means we pay 1800 for the birth with out of network coverage, which is about 1/3 of what we would pay if we went the hospital route.

She said she would get back to be before the 14th, and tell me the information on all the senerios. One being a midwife in the hospital, two being the midwife at home, and three being a midwife in a birthing center. I have heard that if the MW doesn't list the "place" of birth, than coverage can be different.

So, I"m kinda stuck, they said I need to "pre-certify", and I'm worried that I am a VBAC, and some see this as "non homebirth worthy". So......has anyone delt with this, what has been your experience? I hear some women get the birth covered 100% after going through multiple calls, etc. I'm surprisingly willing to do that, I just need to know where and who to call and what to say.....HELP!
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#2 of 3 Old 01-12-2010, 01:38 AM
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Unfortunately, all insurance is different, so I have no advice on that.

But being a VBAC client, you might want to just call and talk to the 3 mw's to see if they'll take a VBAC client. Where I live you have a better chance with a homebirth mw for a VBAC. The birth center mws will attends you at the hospital but not the birth center -- I believe. Hospitals mw's, it'll depend on their policies, I'm sure.

Karen happily married mother of 3 great children (19, 6, 5), in my last semester for my Masters in Nutrition and started a six-month internship.
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#3 of 3 Old 01-13-2010, 08:31 PM
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Hi Austin Mom!

I work at a health insurance company (Blue Shield) in Washington State, and having done customer service for three years, I feel I can give a little inside advice.

First of all, every insurance company is different, and they can choose to cover or not cover a birth done at home based on your particular benefit plan. What I would recommend is that you take the time to call (perhaps more than once) until you find a Customer Service representative who is clear with you and talks to you like a real person. I would try saying it to them like this, "I would love to have a home birth, and I know it is safe for myself and my baby, as the pregnancy has been normal and healthy. If you were me, how would you go about getting this birth covered by my plan at the highest possible level?"

Any information given to you, ask for it in writing, ask for reference numbers for your calls, and possibly even the printed portion of your benefits that refers to home birth or birth places. If you need to have the home birth pre-authorized or pre-certified, make sure you are given copies of all of the documentation sent back and forth about it. Keep all of this in a safe place, in case you have to use it as grounds for an appeal after the fact. Also make note of every person you speak with and the dates you speak with them. Just think of it like being a detective on your own case, only in advance. Take notes on everything, and don't give up asking until you understand everything they are telling you.

Some insurance companies don't make it hard for you to figure this stuff out, but others do. Just cover your bases in case you have one that will make it tough.

I hope this helps, and I wish you the best of luck!
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