Getting your insurance to pay for your home birth

6 December 2010 at 8:48 am 8 comments

In an ideal world, women would be able to make the decisions about birth setting, care provider, and type of care without thought of money. Of course, that’s an impossible unreality–the reality is that many women who have wanted natural, midwifery-model births and who have considered a home birth end up at birth centers or even at hospitals, fighting for the birth they want, pressured into interventions they don’t, because the out-of-pocket costs of a home birth were just too daunting for them.

What I always say is that first of all, most midwives use a sliding-scale, and next, many midwives also offer payment plans and even barter for part of their fee. It never hurts to investigate a home birth midwife and talk to her honestly about your financial pressure, if that’s a consideration for you. Ultimately, though, some women feel–rightly so!–that the health insurance they pay so much for every month should cover the costs of their birth; since getting most health insurance plans to cover a home birth is tough, they resort to a nearly “free” hospital birth experience with all sorts of other hidden costs to them and their babies.

Recently I passed along this link to some women on a parenting list-serv I’m a part of; maybe it’s helpful to some of you here, if you haven’t yet seen it. It goes into great detail about which insurance codes will make your claim for a home birth more likely to be approved by standard insurance companies. Good luck trying!

What have your experiences been? Did you just pay out-of-pocket for a home birth and not try for insurance reimbursement?



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8 Comments Add your own

  • 1. Christine  |  6 December 2010 at 1:32 pm

    In my situation, a hospital/birthing center birth would be completely free. My son was born, naturally, midwife attended at NWH. No issues, no pressure, no unnecessary interventions, no hidden costs (other than the gas it took us to drive there). Even with a home birth midwife’s sliding scale, it’s stressful on me and my family to be faced with the possible $1,000-3,500 medical expense at a time when the job market is tough and we’re adding to our family and the new expenses that will create. It’s hard to disregard free over pricey these days.

    Do I want to birth in a hospital again? No. Because my labor was fast and I’d much prefer to labor from the comfort of my home and see no benefit in being in a hospital.

    It’s frustrating: any hospital-based birth, regardless of interventions is billed the same way, “a global c” pricetag = $14,000. That’s how much my insurance company paid for the hour I spent at the hospital before my midwife caught my son. Covering my upcoming home birth would save them over $10,000 and still, it’s a matter of luck that it’s covered because Massachusetts law says only a midwife that is licensed and supervised by an OB counts (an antiquated, offensive law if ever there were one).

    Crazy system. But yes. I would rather fight my insurance company tooth and nail to get them to cover my home birth over paying for a model of care I don’t believe in or letting them take my monthly premium (and the salary loss that goes with it) and refuse to cover the more affordable, higher quality healthcare option. As consumers, we should all be demanding the best, most affordable options. But I still pray for the day when it’s not such a fight to have the right to decide for myself how I want to give birth and with whom! New moms have enough to worry about!

    • 2. Christina Michaud  |  6 December 2010 at 8:15 pm

      Yes, I agree–ideally we shouldn’t have to fight for this!

  • 3. heather  |  16 December 2010 at 1:10 pm

    This is our main issue about having a homebirth. I plan to write my insurance company a letter but with little hope.

  • 4. Abigail  |  6 January 2011 at 10:21 am

    Christina do you happen to know if commonwealth care covers any part of home birth midwives? Neat blog! (Abigail, jp moms and thebabywearer)

    • 5. Christina Michaud  |  6 January 2011 at 1:21 pm

      oh, hi, abigail! I don’t know about commonwealth care–I do know that if you ask most places about it ahead of time, they say no, but that’s sort of a knee-jerk reaction. 🙂

  • 6. Saoirse  |  18 February 2011 at 7:04 pm

    I am currently battling with Health New England to get my homebirth (could be any day now) covered. The midwives I’m working with have been really good about working with me on a payment plan as months of effort with the insurance co. have been for nothing so far. The homebirth midwives should not have to wait this long for their money. Here’s how it went: I called HNE and said that I didn’t see any homebirth midwives on their online provider list, was I looking in the wrong place. They said no, it’s not a covered benefit. I asked why on earth not, my plan is mandated to cover maternity per the state (which also mandates me having the plan in the first place). The rep offered to find out and get back to me. Took her two days but she did, saying that home birth was “not a standard of care” and not covered “becuause of the risks”. So I wrote them a letter with evidence that homebirth with CPM-level midwives IS a standard of care all over the world, not to mention a lot of this country, and that it is safe, and asked them to pre-approve coverage. I got a reply, literally the next day, saying that the request was denied, not because of any medical reason, but because (ready for the Catch-22?) homebirth was not a covered service. The letter also said I could appeal to the state, but that in my case I really couldn’t because the denial wasn’t personal to me, it was just “not a covered service”. Checking in with the state confirmed this. So I called the CEO of HNE, Peter Straley, who had the medical director, Dr. Donna O’Shea, call me back. She’s an obstetrician, and member of ACOG. Obviously someone with NO conflict of interest, but I decided to give her a chance. When she couldn’t get rid of me through specious arguments (my favorite: “of COURSE you have the right to do what you want to, it just won’t be covered”… as if that is a solution), she insisted that, for the homebirth to be covered, my midwives would have to apply to become in-network providers (which they did the extensive paperwork for, and are still waiting for a decision), and HNE would have to offer the service to everyone. Which is just not true, but she set up the hoops so we jumped. I provided her with medical journal studies and other research, films, etc. to educate her about homebirth, which I believe have been roundly ignored. To my knowledge, the company has never actually considered covering it. As time wore on and I continued to have a healthy, normal pregnancy, perfect for a homebirth, I asked HNE to approve the midwives as Out of Network Providers. The medical director agreed to review the request if my primary care doctor would write one. He is all for the homebirth, and did, and it was immediately (verbally) denied. Why? “Not a covered service.” When I called the medical director, all she talked about was money, trying to convince me that the homebirth would cost them more than a hospital birth (I’m pregnant, not brain-dead), and agreeing finally, at my insistence, to write a letter stating her reasons, since she was completely scattered during the last phone call. Two weeks or so later, no letter. I am continuing the effort both with the CEO, who needs to know how disrespectfully his subscriber is being treated, and to the extent I am able, with my elected officials and the Insurance Commissioner, and the Governor’s office. It’s just too much money NOT to fight about, and it skins me that I ALREADY PAY FOR THIS and can’t get the appropriate care covered. My new little family will be in heavy debt for our first year paying for what we already paid for, but I feel strontly that homebirth is what is right for us, and will not compromise our care. At this point I’d just be so furious at being forced down the cattle chute that it would probably mess up my birth. I’m going into this much detail to help others and because from some of the comments here, people think that writing one letter will change things for them. It won’t. You have to go all Churchill on them (never, never, never give up). For what it’s worth, my midwives say that Cigna routinely pays them. I can’t get that coverage as they aren’t selling to individuals/small businesses in Massachusetts.

    • 7. christinamichaud  |  18 February 2011 at 8:05 pm

      insanity! easy labor vibes to you, mama–good luck dealing with the state meanwhile!

    • 8. stacey mimnaugh  |  23 July 2012 at 11:47 am

      Hi Saoirse – not sure if you will see this comment, but I am about to start a battle with HNE to cover my recent homebirth. Wondering if you’d be willing to facebook message me directly so we could chat about your experience?


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