Never was there a more complicated question.
In an attempt to explain how insurance reimbursement works for home birth, I have updated my Services and Fees page. But I thought it would be a good idea to repost that information here on the blog:
In some cases, a portion of the fee may be reimbursable by a private insurance company. Whether you can expect any reimbursement after the birth depends more upon your particular plan than the company itself (in other words, you can’t say with any certainty that Company X will cover your birth but company Y will not–it all depends on your specific plan). The best way to determine this is by doing a Verification of Benefits through my biller for a fee of $20. When your Verification of Benefits indicates that you can expect some reimbursement, we can submit a claim through my biller. Insurance claims can only submitted after the birth, but the fee is due by 34 weeks. Therefore, my fee must be paid in full before you would get any reimbursement from your insurance company.
My services are usually out-of-network, though occasionally you may request an in-network exception that is approved. In either case, your deductible would need to be lower than $3000 and your co-insurance would need to be favorable in order to justify submitting a claim. If no reimbursement is expected but you want to bill insurance in order to meet your deductible, I can give you a super bill to submit to your insurance on your own. As well, if you participate in a Christian health sharing program, I will provide a super bill for you to submit to your insurance company.
If you are curious about whether any of my fee will be reimbursable by your insurance company, you can call them and ask the following questions if you aren’t ready to commit to doing a Verification of Benefits:
- Are midwives covered?
- Are CPMs covered? If yes, at the in-network or out-of-network rate?
- Is home birth covered? If not, are office visits covered?
- What is my deductible (either in-network or out-of-network as applicable)?
- What is my co-insurance obligation (usually 90/10, 80/20, 70/30, etc.)?
I am not contracted by Medicaid or CHP+ at this time. (Medicaid/CHP+ contracts for Registered Midwives in Colorado is an important issue. If you would like to be active in changing this state law, please consider contacting your state representative and senator and telling them that you believe direct entry midwives should be covered provider types in Colorado.)
On another note, I just want to say that the decision to take charge of your birth and plan the home birth you desire is one that really transcends a calculation of reimbursement. There are value-added elements of planning a home birth: feeling more comfortable, being one-on-one with a provider you trust, better outcomes for mom, and better start for baby…the list goes on and on. Yes, it is important to make a wise financial decision, but that can’t be the only factor you calculate. When people make the decision NOT to have a home birth for financial reasons only, they are nearly always regretful (the same is true for choosing a home birth for financial reasons only). You MUST birth where you feel safest and most supported. As I often joke, kids are expensive…the birth is just the beginning.