Home birth and insurance

ABeautifulMind

Did anyone do a home birth and then submit it to their insurance for reimbursement?  Both sets of midwives we interviewed suggested we do this.  One midwife said depending on our ins., may get reimbursed up to 65%. That would be wonderful, of course.

Honestly, it doesn't matter how much or how little they reimburse b/c we really only want to deliver at home.  I know all ins. companies are different and cover different things but I'm just wondering for those of you who did have a home birth and submitted to insurance, was the process long (I've read it can be a pain) and did you even get reimbursed enough to make it worth the effort?  

chiromommyMichelle

If your plan covers homebirth, do the paperwork and submit it!  I've been submitting our visits as services are rendered, and have been getting reimbursed right along.  If you have a flex plan or HSA claims will be processed through them as well.

CTri17

my m/w submitted it after our DD was born, we got nothing covered. But that was what we were expecting

srmmm09

We got $1500 covered, even though not a single bit of the actual birth was covered, just the prenatal and postpartum care. So, I say do it! Our whole birth cost $2100. That's a pretty cheap way to have a baby!

ABeautifulMind

srmmm09:

We got $1500 covered, even though not a single bit of the actual birth was covered, just the prenatal and postpartum care. So, I say do it! Our whole birth cost $2100. That's a pretty cheap way to have a baby!

Wow!  That is awesome!  I'm not expecting anything (like PP), but 2/3 covered would be amazing!  Do you mind me asking, did you just submit at the end or were you submitting the entire time?

iris427

My insurance originally said they would cover our prenatal care and birth as out of network.  Then when we billed them, they refused to cover anything.  We have horrible insurance (they have also since refused to cover our baby's well child visits--not because he was born at home, just because they are as$holes) so this was not shocking.  We went into the HB prepared to pay the full cost OOP, because we figured our insurance most likely would not cover it.

flyer23

Short story: I did submit. It was a HUGE pain. It was worth the effort.

Long story: I switched to homebirth late (36 weeks), so I had to pay my midwife's cash rate upfront. It was $2500.

After the birth, she submitted a bunch of different claims. Six, I think. Four on my insurance and two on DS's. That covered prenatal care, day-of-birth stuff, and postpartum care up till 6 weeks. Totaling around $6000 -- her insurance rate.

The largest claim was for about $4500. It was my prenatal care plus most of the day-of-birth stuff. That one was only reimbursed for about $1500. I appealed it, twice, and was told that was the maximum reimbursement for homebirth. Period.

The other claims were not reimbursed initially, but I called my insurance company and they resubmitted them and surprise! They came back fully reimbursed, no more hassle.

So, in the end, I did get reimbursed for pretty much the entire $2500 I had paid upfront, since even though the big claim didn't get fully reimbursed, the difference between the cash and insurance rates was big enough that it didn't matter.

But yeah, it took HOURS on the phone with my insurance company to get all the claims through. DS was nearly six months old by the time that all five smaller claims got reimbursed, and I didn't get the final appeal rejection for the big claim until after his first birthday, I think.

I should note, though, that most of this hassle had to do with my midwife being out-of-network, not with the homebirth thing. I know others on my insurance whose homebirth midwives have been in-network, and then it's been a very smooth process. Unfortunately, there are no in-network homebirth midwives in my area, and my insurance doesn't do gap exceptions... sigh.

wnk1029

Check your coverage first... Our BCBS insurance has a specific exclusion for home births and prenatal/postpartum care done by a CPM.  (A CNM would be covered for prenatal/postpartum care, but there are none in our area that do homebirths).

We paid $2000 for all of our prenatal, L&D, and postpartum care.  It's been worth every penny!

wifeofadam

My plan originally said they wouldn't cover it when I called during pregnancy.  After I had the baby my MW submitted the paperwork and I was pleasantly surprised to receive a check in the mail a few months later.  They ended up only covering about 25%, but it was better than nothing!!

ABeautifulMind

wnk1029:

Check your coverage first... Our BCBS insurance has a specific exclusion for home births and prenatal/postpartum care done by a CPM.  (A CNM would be covered for prenatal/postpartum care, but there are none in our area that do homebirths).

We paid $2000 for all of our prenatal, L&D, and postpartum care.  It's been worth every penny!

This is what my ins. says too.  Like you, there are no CNMs that do home birth in my area.  Depending on the CPM we use it will cost between 3-4K, which is fine and WELL worth it IMO, but of course I'd rather be reimbursed for some if possible!