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Midwife Talks

Homebirth and Insurance

- Aug 29th, 2023

You’ve decided that you want to have a homebirth. You found the midwife that you want to join you for this ride. Congratulations! That is a big step… establishing care for your pregnancy, birth and postpartum journey. It is also a big investment of time, education, preparation and money.

Midwifery care, more specifically homebirth care, should be the standard of care or for “low risk”, healthy birthing people that would like access to this type of care. Yet, we do not have this option implemented in to our healthcare system and not as an open, accessible option offered to be covered by insurance companies.

On the contrary, you need to jump through hoops to get the reimbursement you deserve. Luckily there are homebirth midwives, billers who work specifically with homebirth midwives and people who have navigated the system that can help you navigate it yourself. Some insurance companies have been known to cover homebirth services 100% and others reimburse a different percentage.

In most of the cases that I’ve heard of, the initial claim was declined. That is why it is so crucial to go in to this with a game plan and know that persistence is key. And if you do get declined, you call back and ask to appeal the decision. You take the down names of every representative, manager you speak with and build your case.

Starting the conversation with your insurance carrier as soon as possible is super important as well. You can start gathering all the information you need, such as your deductibles and copays/coinsurance %. You can find out if the plan you have has gap exceptions and how you can access it. When the insurance company realizes that you did your homework and will not take NO for an answer they will respond.

You must remember that a large number of people are not aware that homebirth is an option. The people you speak with on the phone are not educated in the safety of this option. Less than 1% of people actually have a planned homebirth. As opposed to other countries where homebirth is accepted and integrated in to the system, that by the way have much much better maternity care and with much less morbidity and mortality in perinatal care, here in the US, homebirth is discouraged.

Why is this you wonder?

Well the evidence doesn’t point to it being the unsafe option, when it’s planned. But like many things, it is governed by organizations that seek more profit and control. If you search the evidence about the safety profile of homebirth, you will find that if you compare similar cohorts in planned hospital birth and planned homebirth the perinatal mortality is similar.

So as with everything in life, a certain choice is not the right one for everyone, but everyone should have a choice as to the care they would like to receive.

It cannot and should not be a “cookie cutter” policy.

When you navigate though the insurance reimbursement route, it is imperative that you see things through thier eyes, which follow the dollar signs. Insurance companies whould like to profitable and thus pay less for the services rendered. What you need to remind them is the rates paid to a homebirth midwife for an uncomplicated vaginal birth are significantly less that what the hospital will bill them for an uncomplicated vaginal birth. According to the Peterson-Kaiser Family Foundation, Health Sytem tracker, 2022, the average cost for prengancy, birht and postpartum care is just under $19,000.

If you’d like to receive a cheat sheet with questions and the information you need to gather from your insurance carrier, contact me and I’ll send it to you.

If you have any questions/comments, please don’t be shy and reach out. I hope you found this post informative and reassuring that …YOU CAN DO THIS ! Don’t let the lack of knowledge and misinformation of other people dictate that type of care you receive.

Another great resource on this topic was written by Mind Body Baby OC, that provides the ultimate guide to homebirth reimbursement.