One of the top questions we answer is "will my insurance cover home birth?" The answer is not nearly as simple as the question so we thought it is about time someone broke it down clearly for families! In this explanation please know that we are speaking solely to our community here in Florida and things change region by region. Something else important to note is that we are Licensed Midwives who are licensed and regulated by the state of Florida. We are legally recognized and able to accept state insurance/Medicaid.
In the state of Florida, private insurance companies are required by statue 627.6574 (sec. 7) to cover the services of Licensed midwives. An important note though is that if your policy is self funded, then they DO NOT HAVE TO FOLLOW THIS STATUE. Yes, we have a statute that says insurance MUST cover the services of a Licensed Midwife however at which rate is completely up to the insurance companies themselves. Insurance companies love to use the phrase "reasonable and customary." That essentially means they can decide what they feel is reasonable and customary fee for a provider to be paid for their services. Some companies are honest and fair and they reimburse close to a provider's cash pay rate, while others think the Medicare/Medicaid reimbursement rate (less than 20% of our normal cash pay fee) is just dandy.
What many private insurance policyholders don't understand is exactly how their insurance works. HMO, PPO, WTF....we KNOW! It is all very confusing! Policies can vary widely on deductibles (we have seen some policies with $8,000 deductibles!), coinsurance, and in-network/out-of-network allowances. Some providers have contracted with these companies making them "in-network" which means they have a negotiated rate with the insurance company (which is usually much less than their cash rates)usually in exchange for a higher volume of that company's members. This is why it is so hard sometimes to go outside of your "network" with your insurance company to use a provider of your choice. This 'volume' exchange is also why MOST independent homebirth midwives cannot participate in network- we don't work in large corporate practices and move clients through like cattle.
There is a whole other side of politics to the private insurance industry we could probably write a novel on, but I am sure those novels exist and you can hear someone on a soap box about the corruption of our healthcare system elsewhere. The bottom line is - maybe your insurance will cover a homebirth, or maybe they won't. The second part of that statement is why many midwives and birth centers collect their entire cash pay fee up front.....because probably they won't- or maybe they will but for only half of what your midwife deserves to be paid. Or maybe they will, but you have to personally call Don in Member Services every Monday at 4pm until he is annoyed enough to just push your claim through so you will just GO AWAY ALREADY!
There are lots of great alternatives for normal healthy families like health-share programs, HSAs, catastrophe policies, etc.. What we have seen work well for many families is taking the $400-800 you'd usually spend on a private insurance policy and sink that in to a savings account. Just some other options to consider if you find yourself sinking lots of money into a policy that you never use.
Some great ways to help afford a home birth that clients have used in the past:
+Plan ahead! Know what your policy covers and what it doesn't. Know what your in and out of network benefits are, read the fine print, and SHOP AROUND for a policy that works for you. Maybe your right answer is not a private insurance policy after all but instead one of the aforementioned alternatives.
+Know what your policy might actually pay! Sit down with a professional- a 3rd party billing company or someone from your HR dept who can tell you in black in white what your policy may cover in the hospital vs at home. You may find out you will be spending the same amount out of pocket regardless.
+Set up a registry for your birth! Ask for family members to contribute to your fund vs buying items from a baby registry that- let's be honest- you will likely rarely use.
+Cut costs! Seems simple but it can make a huge difference in making a monthly payment to your midwife vs paying for that annual Disney pass. Cut back on eating out, luxury items, and unnecessary spending. You can save hundreds by making little changes where you won't feel them too much.
+Barter! Many midwives are willing to barter some or all of their fee for goods or services. Maybe your midwife just bought a new house and your partner happens to be a carpenter. Maybe you can sew and your midwife needs some alterations? Maybe you have other skills that are of great service and would be an even trade. Many midwives still consider barters so don't be afraid to ask!
At Barefoot Birth our global fee for comprehensive care is $6000. That includes concierge prenatal visits in the comfort of your home, tailored childbirth education classes throughout your pregnancy, all routine lab work, delivery, and postpartum care. The only other out of pocket expenses families can expect is their 20 week anatomy ultrasound and ordering our $30 custom birth kit. We also work with Medicaid if you are assigned to an HMO and it is your only coverage.
At the end of the day remember that ultimately you get what you pay for. I cannot even begin to tell you how many people have told me over the years that they planned a hospital birth, used a birthing center or another midwife because the cost was "cheaper" or covered by insurance only to be sorely disappointed they did not go with their first choice. Your prenatal care and care during your birth are so very important. Don't let price tags or lack of coverage stop you for choosing your best birth team.