Anyone win the battle with insurance for home birth?

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Marite13's picture
Joined: 08/07/09
Posts: 3368
Anyone win the battle with insurance for home birth?

Anyone have any experience with this?

I've just started discussions with my insurance company, and things are not looking good right now. Sad

Advice? Encouragement? Please?

Joined: 05/31/06
Posts: 4780

My insurance had a strict "we don't cover homebirth" policy, but my Midwife told me that they were actually one of the best at reimbursing a percentage (I did have out of network coverage to the tune of 70%, we have Aetna and a generally excellent policy). We had to pay the $3,900 for the prenatal care and birth out of pocket (but luckily could use our FSA for that so were able to pay using pre tax money). We got a check back for a portion (maybe $1700 if I remember right?) about 4 months after the birth as things simply don't move quickly in the world of insurance reimbursement. I probably could have spent hours trying to eek out a little bit more, but at that point we had paid the money OOP so long ago and I was so busy with a newborn and two other kids that it just didn't seem worth it. I know that it varies by state and by insurance provider, but at least here in PA they do not have to cover it, and none that I know of would pay for it pre birth/billing.

The only advice I can give you is to go to Mothering.com or your local LLL or anywhere where they may have a message board where you could find other homebirthers in your state who may have your insurance, and find out what their experience was. That worked well for me, beyond just what my midwife said it was encouraging to hear from other Aetna homebirthing Moms and to hear how much or how little had been covered.

I saw your post elsewhere and I know I have a hugely strong bias, but would urge you to reconsider dropping health insurance entirely, especially as you are birthing and traveling in cars and what not while you are here. Medical debt can literally cripple a family, and especially with a child, it is just a huge huge gamble to take (IMO). I know I'm preachy about that, but I just truly believe that if you have any way to avoid dropping insurance, particularily when pregnant or a parent, you should take it.

Marite13's picture
Joined: 08/07/09
Posts: 3368

Melissa, I don't plan on dropping insurance. At this point, it looks like we will literally be paying at least 1 month's wages to KEEP our insurance, but we will. Our savings is not deep, but it's deep enough to keep us safe, and I am hugely grateful for that. This is basically what I said in an email to my insurance rep, that they have us "by the balls" (no, I didn't say it exactly, I used polite language), because we are responsible and able, so we will not ultimately choose to drop the insurance, even if it does cut into our savings.

That said, I am still going to fight tooth and nail to get most of this birth paid. With me not working and DH's salary being what it is, I'm going to fight for every cent. Not really looking forward to it, but, as I said, our savings is not so deep that paying for it fully OOP wouldn't be a big deal.

Spacers's picture
Joined: 12/29/03
Posts: 4099

I have HMO coverage so they aren't obligated to pay for anything out-of-network, so I paid $4000 OOP both times. Definitely use a medical savings account if you can, that saves you whatever tax rate you're in! There was a long discussion about this on my local homebirth listserve. Most of the midwives around here are very adept at billing things the right way to get it covered by insurance; they use a billing service which takes a small percentage of what they can recover for you, but most people find it's worth it to get back 70% or even 50% instead of nothing because they don't know which codes to use & all that.

If you will be billing the company yourself, the thing to remember is that they aren't covering a person or a place, but a service. They cover birth and a licensed professional to attend, and the details of doctor/midwife/hospital/home really aren't important. What's important is what your out-of-network coverage will pay for, whether your annual deductible has been covered yet, and whether you have a "maternity co-payment."

So if your birth costs $4000, and your co-pay is $500, the amount the insurance has to cover is $3500. If your OOP coverage is 70%, the insurance should pick up $2450. But if you still have to meet a deductible, let's say $500, then the total you'll get will be $1950. In the same scenario, if your OOP coverage is 50%, you'll get $1750 back before your deductible. Also, one thing that a few moms on my listserve have noticed is that insurance companies have stopped paying for post-partum followup visits. It's worth appealling, some of those who appealled got their money back. And if your insurance company denies you flat-out, appeal it. Send a letter showing how they would *save* money by covering your homebirth. Also check your state laws, most states that have licensed midwives require insurance companies to pay for them as out-of-network providers. Good luck!

CamelNoodle's picture
Joined: 07/28/04
Posts: 908

Also for insurance, check your max "out of pocket" expense (for us, in-network is $500, out of network is $2000) plus our deductible ($250 in network, $500 out of network). Beyond that, our insurance has to cover billed expenses. So if a HB midwife was billing out of network, my MAX I would have to pay is $2500. Everything else would have to be covered.

The max out of pocket might have a different name, but it should be there on your policy.

(This is why when people have had large expenses in one year (insurance years may start a a different month than January) , they try to squeeze in additional procedures that same year, because then they are covered 100%

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

In my state (WA), insurance is pretty good about paying for it. I think this is partly because we have high standards for midwifery training in this state. We had to pay most of the fee upfront and wait for reimbursement, though. My midwives work with a biller who handles filing everything. We have a PPO, so they should reimburse us at the out-of-network rate. We haven't been reimbursed yet, but I am expecting to get a decent amount of it back...we will see!

Joined: 12/10/05
Posts: 1681

I don't have any experience dealing with insurance, but good luck! I hope you get all sort of money back Smile

jolly11sd's picture
Joined: 02/02/05
Posts: 3327

With DS2 the insurance company initally said 'no way'. So I kept calling back over and over. Turns out that our rep. didn't really understand all that was involved with a homebirth and prenatal care with that MW. She just figured it was out of network (PPO) and was a big no way. I think she even thought that we were asking for some random, untrained, person to be payed by them...lol. So after being that annoying repeat caller, explaining everything to her, and getting her to talk with those 'higher up' we were told that they would actually be able to cover 60% of the total cost. In hospital, in network, would have been covered at 90%. So we payed $4500 out of pocket for our prenatal care and birth in the months prior to delivery and got a refund check about 3 months after baby arrived.

My lesson learned was that sometimes persistance pays off and that if the insurance rep. has no idea what a homebirth is or involves that they are totally likely to say no without educating themselves. Totaly worth educating them if it helps get them to pay!

boilermaker's picture
Joined: 08/21/02
Posts: 1984

We have Anthem BCBS-- and they will cover ours as "out of network"-- so 70%. My MW works with a billing company to code everything....and she gets creative to try and eek out as much as possible. Last time, it cost us less than $1K, so I expect it to be similar this time, too.

Good luck!

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