The good news is that sometimes your insurance will cover the cost of your home birth. Sometimes they don't. Basically, you pay your midwife's entire fee, and then you may or may not get reimbursed some or all of it from insurance. Your midwife should take care of submitting the paperwork to your insurance. Your job is to be really whiny and persistent to your insurance company. Your midwife may even have a pretty good idea of whether your insurance will reimburse you or not- she deals with a lot of insurances, and becomes pretty familiar with which ones are more willing to cut a check.
There's two good articles here and here about people's efforts to get reimbursed.
My first homebirth I got zip back from insurance. And I had arranged for a water tub (an additional $200ish) that I didn't get to use because my labor was too quick. But I still had to pay for the water tub. My second homebirth I paid my midwife's $3600 fee, and later got a check back for $500- which I promptly used to buy a Vitamix, which I had long been coveting.
This is my current midwife's financial agreement, I just copied and pasted so you can see the real deal. Though her fee is $4500, if I pay by 36 weeks I pay $3600. You can darn bet I'll be paid in full by 36 weeks. I am also planning on being a super annoying insurance customer and hope that it will pay off with a reimbursement check. If something did go awry and I ended up having to transport to a hospital, at that point the costs all go through my insurance, like any other hospital visit.
A few quick notes to help understand this: PN= prenatal, PP=postpartum. You'll also notice that I don't give up any essential tests or procedures by using a midwife: the group beta strep test, Rhogam injection if needed, postpartum care, and my baby still gets tested for PKU and other metabolic disorders. I will be passing on the Vitamin K shot for my wee one, though. More on why in another post.
I also want to point out that a midwife is at your labor and birth the entire time. That could be a two day affair, or perhaps a two hour affair. No waltzing in during the last 5 minutes to catch your baby, like many doctors do. Your midwife is there the whole time, day or night, plus at least 2-3 hours after. Then she comes to your home the next day to do any necessary stitching up, checks your uterus and the baby, sees how nursing is going, all that jazz. Then there's still two more postpartum visits for you and your baby after that. The final visit is usually at 6 weeks postpartum, and you get your PAP smear (yay! so exciting!) and make sure all is well, just like at any OB/GYN 6 week postpartum visit. At that point, your midwife care is finished, and your baby starts seeing your pediatrician.
UMBRELLA ALL INCLUSIVE CHARGES:
$4500.00
Global
Maternity Care: $3500.00
PN, PP, Birth
PN Homevisit
Group Beta
Strep Test
Initial Newborn Care: $300.00
Vitamin K $ 15.00
Metabolic Screening $ 85.00
Follow up Newborn Care: $600.00
Up to 4
routine visits
(2 home, 2
office)
All other services are billed on top of or outside of umbrella billing.
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The
midwifery fee does not include:
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It is the understood that you are paying us to be on
call day and night and for our skill and knowledge providing pregnancy and
birth care as well as in knowing if and when to refer to a medical doctor or
hospital.
- Non-Insured & Timely Payment Discount
The global fee is $4500. Clients will receive a 20%
discount, reducing the overall out of pocket fee to $3600 to those that pay in
full by 36 weeks. Balances due past the final postpartum visit will incur a 10%
annual interest charge.
- Non-refundable
Once labor has started and a midwife has been
notified fees will be considered earned in full. The midwives concern is for a
safe birth, whether in home or hospital, and midwifery care includes helping
you make the judgment for hospitalization, if necessary.
·
Transports: If a transport is required during labor, your midwife will
accompany you to the hospital to support you during the birth. Transports
usually involve the most intense care on the part of the midwife and birth
team. You will receive the same postpartum support and visits you would have
received if you had birthed at home. In the event of transport, no refund or
discount applies.
·
Early delivery: If your labor has started and progressed rapidly to
delivery before your midwife arrives, no refund will be made. The midwife must
still assist with the delivery of the placenta and maternal and newborn exams.
Postpartum watch and visits are also necessary.
- Payment Plans
In addition to the initial payment of $500 (which
includes a $200 initial prenatal fee) and the $125 office prenatal visit ($150
home visit prenatal) fee at each appointment, we encourage that regular monthly
installments be made. The $500 assistant fee will need to be paid in full by 36
weeks.
6. Discontinuation of Services
Should a decision be made to discontinue service
before 36 weeks or it becomes medically necessary to transfer care before 36
weeks, the $500 initial payment plus $125 per each prenatal office visit ($150
home visit) will be retained. If you would like one of our team members to
continue to assist you in a hospital birth in the capacity of a doula, your
total fee will include, the $500 initial payment, $125/150 per each prenatal
visit, and a $1250 doula fee.
7. Private Insurance
If you have private insurance or health care
coverage, we will bill your insurance company or health carrier for you. By entering
into this contract, you authorize Aspiring Birth Midwifery & Doula Services
to release information to your insurance company or health care carrier for the
purpose of processing your claims.
We may bill your insurance company or health carrier
for the following services related to your and your baby’s care, including, but
not limited to:
Initial visit, lab work, OB global fee including
prenatal visits, intrapartum care, delivery, birth assistance, supplies, IV
therapy and medications, newborn exam, newborn metabolic screen (PKU), and
postpartum visits.
When we bill clients directly, we standardized all
services into a $4500 package fee. However, when we bill insurance and health
carriers, we itemize services in accordance with the insurer’s claims payment
structure, which may require billing the payor in excess of the standard $4500
fee. Due to repeated claims processing and tracking expenses, it is more costly
to bill insurance than to collect directly from clients. The reimbursement
amounts are variable and based on what the insurance company considers “usual
and customary”. Thus the amount we bill the insurance company may exceed the
package amount of $4500.00 to account for these discrepancies. We have the
right to accept reimbursement from insurance that exceeds the package fee of
$4500.
If your insurance denies your claims, you are
responsible for paying us the entire package fee of $4500. Verification of benefits does not guarantee
payment.
If, upon verification of benefits, your insurance company is likely to
pay, we may agree to only collect the deposit, your deductibles for you and
your baby, and approximate coinsurance amounts (patient responsibility or PR)
up front, rather than collecting the entire $4500. If your insurance company pays,
and we find that we have overcharged you, we will refund you accordingly. If
the insurance assigns PR that exceeds what we have collected from you, we will
bill you for the deficit.
If you have insurance and you’ve paid the entire
amount in advance, and if your insurance company pays us directly, we will send
you a refund. Your refund cannot exceed the amount you prepaid. Your refund
amount will be affected by your assigned PR amounts and any deductibles (for
you and your baby) applied to our claims independently of reimbursement amounts
we receive.
So, that's a lot of boring money talk! If you've had a homebirth, leave a comment and let us know your success in getting any reimbursement. In the meantime, here's something on the lighter side; comedian Jim Gaffigan on homebirth:
Next Post:
What If Something Goes Wrong?
We've paid for six homebirths. We had different insurance for many of them. Most of our births were reimbursed - one around 120%, a few at 80%, a couple at 60%, and one with no reimbursement. I love how my husband put it one time when we were paying the midwife a big bill - "You get what you pay for." Sure, with some of our insurances, we could have had a cheaper hospital birth (hoping that nothing went wrong and we needed no interventions) but that wasn't what I wanted. I felt like the care I received from my midwives was FAR superior to care I received from the OBGYN I was seeing during my first pregnancy. When it came right down to it, we wanted exceptional care, and I feel like we got what we paid for.
ReplyDeleteI had to really fight to get my insurance company to reimburse us for our home birth costs. They had a clause that stated that if there were no preferred providers within a 50 mile radius of where we lived we could appeal for an out-of-network inclusion to get in-network benefits. Since there were no in-network home birthing midwives on my plan I used that clause to argue my case. I was denied THREE times but after I talked to our manager and asked him to speak to the insurance coordinator (the person that sold the company our insurance) I finally got a reimbursement check for a very large portion of the cost. I can't remember the exact numbers but I know I paid somewhere in the range of $3000 for my midwife and I received over $2000 from the insurance. It was definitely a lot of whining and annoying calls to the insurance company but in the end it was definitely worth my time.
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