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Why do insurance companies exclude home birth and/or CPMs from coverage if out of hospital birth would be more profitable for them? I have heard vague answers like "insurers are in bed with doctors" but nothing specific about whether doctors have lobbied insurance companies on this issue or what. Does anyone with experience trying to become a preferred provider or get reimbursement know the answer to this question?
 

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I'm sure you'll get lots of great responses, but I just wanted to recommend some reading for you that can help you. 2 books that answered this very question for me (and more!) are Born in the USA and Pursuing the Birth Machine. Both by Marsden Wagner!
 

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There are two realistic and valid explanations. One is liability. They cite faulty studies that indicate home birth is dangerous, and they are obviously not in the business of endorsing dangerous elective procedures. It doesn't matter that the overwhelming majority of evidence shows that it is safe, the parents of live and healthy babies that didn't get insurance coverage for home births aren't the ones that are going to bring lawsuits that bankrupt the companies.<br><br>
The second reason is the lack of licensure for midwives and/or that the CPM credential does not meet their standards of a quality practitioner. I think the licensure issue is understandable; why should a medical insurance company be expected to cover the services of an unlicensed practitioner?<br><br>
I think doctors do have a hand in it. They have much more power to persuade the insurance companies that home birth is dangerous and CPM are inadequately trained than the midwives have to persuade them otherwise.<br><br>
There is also the issue of home birth and midwifery care not being excluded outright, but a defacto denial of benefits because midwives are not network providers. Often either your out-of-network benefits are so low that you don't see any benefits, or you have an HMO that does not allow you to see an out-of-network provider. The problem there is two-fold; one is that CPMs are often not eligible to become network providers because they don't meet the standards, namely they do not have malpractice insurance. Second, the reimbursement rate is too low for midwives to have any incentive to become network providers. Personally, I will never agree to be an in-network provider for any insurance company for that reason.
 

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I am an in-network provider for several insurance companies, as an LM and soon to be CPM. I had to provide a consultation plan (the local unversity hospital has a 24 hour consulation line for all comers), a transfer plan (local hospital and EMS) and my malpractice coverage contract. They also wanted information about any lawsuits, claims, state actions, felonies, etc. They also wanted my clinic to pass inspection for wheelchairs, locked up meds, good recordkeeping, privacy, etc. In exchange, they pay me a lot less. But my clients pay a lot less out of pocket, too.
 
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