Federal Insurance Programs Coverage of Out of Hospital Births?

cecilyandgautam · July 2011

I'm a federal employee and am interested in an out-of-hospital birth. Specifically, we'd like to use a birth center but the one we just toured yesterday said that generally, feredal insurance programs don't out-of-hospital births. Has any of you found an exception? I'm on the FEP Blue Cross plan which I'm generally quite happy with but for birthing options, it is rather limited. I can either pay $150 co-pay for a hospital birth or get no coverage for a non-hospital birth. Having to cover the whole thing ourselves would be thousands of dollars, which compared to $150, just seems extravagent.

Alternatively, INOVA hospitals run a "Birthing Inn." Have any of you delivered naturally here? How many staff were in & out during your labor? Did you feel rushed? Were they supportive of you forgoing medication? Were you free to move around, walk the halls, soak in a tub, and/or take a shower? Were you allowed to drink water/juice & have light snacks? Was an IV made necessary because they didn't let you drink fluids? Were you allowed to bond & hold baby before the cord was cut? Were you the one making the decisions about how much poking & proding you needed? Were you ever pressured or made to feel guilty about your approach?

My husband and I are new to the area and would appreciate hearing your stories. Thank you!

WinesNot Whines · July 2011

I don't know anything about the Birthing Inn, but I have the same insurance as you and I gave birth at a hospital. I can answer your questions with regard to my experiences with a hospital birth.

How many staff were in & out during your labor? One nurse and my OB. If anyone else came in, I didn't notice.

Did you feel rushed? Not at all.

Were they supportive of you forgoing medication? Very supportive.

Were you free to move around, walk the halls, soak in a tub, and/or take a shower? By the time I got to the hospital, I was beyond the point where I wanted to walk the halls. But I was free to move around in my room. I probably could've taken a shower if I'd wanted to, but I didn't want to. Getting in a tub wasn't an option, because they didn't have tubs.

Were you allowed to drink water/juice & have light snacks? Yes, I drank water and Gatorade (which I brought with me). I could've eaten "clear foods" like popsicles or jello, but I had no desire to eat anything at that point. No one tried to restrict my fluid intake at any time.

Was an IV made necessary because they didn't let you drink fluids? N/A - I had plenty of fluids and I didn't have an IV.

Were you allowed to bond & hold baby before the cord was cut? Yes.

Were you the one making the decisions about how much poking & proding you needed? Yes.

Were you ever pressured or made to feel guilty about your approach? No.

Mrs.Handy · July 2011

I would speak with your insurance company to make sure that you aren't covered. I just double checked our coverage for BCBS and it says they can recognize a birth center as freestanding ambulatory facilities.

I gave birth med-free at INOVA Alexandria which didn't have a "Birthing Inn." To answer your questions.

How many staff were in & out during your labor? 2 nurses and a midwife

Did you feel rushed? Nope, my midwife was awesome. I ended up pushing for almost 3 hours (not fun) but she was patient. Even our doula was impressed with how patient our midwife was

Were they supportive of you forgoing medication? Yep, all the nurses were very complementary

Were you free to move around, walk the halls, soak in a tub, and/or take a shower? My MW encouraged me to push on the toilet and I think I got in the shower for a little bit. No tubs were available. But like Whines I was too far along to feel like walking the halls (I arrived at 9.5 centimeters dilated.)

Were you allowed to drink water/juice & have light snacks? A little bit of water. I had puked earlier in the evening and at the hospital so I didn't feel like drinking anything.

Was an IV made necessary because they didn't let you drink fluids? No IV throughout the entire process

Were you allowed to bond & hold baby before the cord was cut? Yep

Were you the one making the decisions about how much poking & proding you needed? Umm..I assume whatever they were doing was useful

Were you ever pressured or made to feel guilty about your approach? Nope

Basically I trusted my midwife and the practice. They had a very low-intervention approach to things so I put myself in their hands with my birth plan as a guide for them. They encouraged me to write one.

I hope this helps.

tomandcourt · July 2011

I'm interested in this as well. My friend recently gave birth at the Family Health and Birth Center, and their payment options are here. It seems like they take Carefirst Blue Cross Blue Shield PPO, but I'm not sure if that includes the FEP or not.

As to your other questions, I delivered at Holy Cross in Silver Spring, but these were my experiences:

How many staff were in & out during your labor? My doula, and one nurse while I was in triage and then one while I was in the delivery room. Then my doctor during the actual deliver.

Did you feel rushed? No.

Were they supportive of you forgoing medication? Yes.

Were you free to move around, walk the halls, soak in a tub, and/or take a shower? No. I wanted only intermittent monitoring, but they never let me get off the monitor because they thought DS' heart rate was decelerating. This meant I was changed to the bed once I got there.

Were you allowed to drink water/juice & have light snacks? Was an IV made necessary because they didn't let you drink fluids? My labor was really quick (I was at the hospital less than two hours before DS was born). I ate when I was at home - a lot - and had only ice chips at the hospital. Contractions were making me nauseated at that point though so I wasn't hungry. I *almost* got an IV, at the end when I chickened out and asked for the epidural (they have to give you the IV for that) but they couldn't get it in and I didn't end up getting the epidural anyway (I went all natural).

Were you allowed to bond & hold baby before the cord was cut? No. He was pretty blue when he was born so they took him right away. In retrospect I should have asked to hold him sooner - he was fine, but they ended up cleaning him and everything before I got to hold him.

Were you the one making the decisions about how much poking & proding you needed? Yes. After delivering, my doctor wanted to give me pitocin to help deliver the placenta (apparently this is pretty common) and I said no, so she didn't. No big deal. There was very little poking and proding during labor aside from two cervix checks.

Were you ever pressured or made to feel guilty about your approach? No. Actually, they tried really hard to get me to stick to my birth plan even when I freaked out at the last minute and wanted the epidural.

But next time I'm interested in a home birth or birth center so I'm curious to see responses!

cecilyandgautam · July 2011

Whines, where did you deliver? Sounds like your hospital was very respectful.

cecilyandgautam · July 2011

Thank you ladies for sharing your stories! My friend just gave birth in Alexandria and had like 8 hospital staffers present at the final push moment and was tied to an IV so she couldn't get off the bed, which is the opposite of what I want. So it's good to hear your experiences and know that not every hospital birth is like that.

I know many factors are out of our control and even with a plan, there might need to be adjustments but I just want to go somewhere where I know the staff will do their best to facilitate a natural, largely undisturbed birth. From your experiences, sounds like that is possible at a hospital. Thank you! More stories welcome of course.

victoria1212 · July 2011

I had a great experience at Sibley. I never had any interest in a med-free birth but I also never felt pressured to get an epidural or anything. The doctors and nurses kept me informed of everything that was going on and were really supportive of what I wanted. When I first arrived, I was asked if I had any requests and the nurses seemed genuinely interested. I did have to be monitored because of some blood pressure issues and I ended up having a lot of complications that were only picked up by the monitoring. Things got really crazy at the end (at the time I did not realize how serious things had gotten in a very short period of time) and the hospital, nurses and doctors were all great, very calm and moved very, very fast. I really appreciated that fact that a neo-natal team was there to help DD.

WinesNot Whines · July 2011

I delivered at Holy Cross in Silver Spring. I also had a doula, which I highly recommend if you end up with a hospital birth.

rels09 · July 2011

BirthCare in Alexandria is in-network for Federal BCBS. In fact, I switched to BCBS for just this reason. They're also in-network on one or two other federal plans.

Mama Angelina · July 2011

Yes, Birthcare.org is in-network so is mostly covered. When I gave birth, I think Fed BCBS covered 60-70% of the total cost. Not sure exactly what it is now. They have a great center with wonderful midwives. Good luck in your search!

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