Will my insurance cover my homebirth?
Generally, yes. Your midwife is probably out of network with your insurance plan. If your plan has out of network benefits, chances are you will be able to use them. If your plan does not have out of network benefits, there may be an opportunity for a one-time, in-network exception. Talk to your midwife for more details.
Does Medicaid cover homebirth?
Again, generally yes. Since most Medicaid plans are run through an insurance company, and allows for midwifery/homebirth, the obvious roadblock is that Medicaid does not include out of network benefits. It depends on if your midwife is in-network, and whether we can work with the plan to get a one-time in-network exception. Because many of the midwives we work with are out of network, and because some plans can be difficult to work with, be sure to check with yours about your specific situation.
What’s the difference between ‘self-funded’ and ‘fully-funded’ plans? Which is better?
Neither is really ‘better’, since both have pros and cons.
Self-funded plans are employer governed and as such, can determine, privately, which services they will and will not cover. This is done to limit healthcare costs. An upside to this is that your employer may be willing to work with you directly to facilitate unique coverage for your unique situation. Then again, they may not.
Fully-funded plans are subject to state mandates – that means covered services may change from state to state. An upside to this is that state-specific legislation may compel the plan to approve services that self-funded plans specifically exclude. Again, there are benefits and drawbacks to both.
What is an “in-network exception”? Do I want one?
There seems to be a lot of buzz surrounding in-network exceptions. An in-network exception is when a plan offers a one-time, client-specific authorization, agreeing to treat/pay your out-of-network provider as an in-network one. This can be a good thing; but remember, pre-certifications and in-network exceptions add some clout to claims, but we want to be clear: they in no way guarantee payment. While they can be beneficial, they are not “golden tickets” that promise full reimbursement of your healthcare costs. If your midwife works with us, one of the services we offer is examining your plan benefits to see if this avenue is right for you.
My midwife says she’s out-of-network, but my insurance plan has her listed as being in-network – why?
Insurance companies may not always have the most up to date information in their systems. Defer to what your midwife tells you about her network status.
Can I use my HSA or FSA account to pay my midwife’s fees?
Yes and no. Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) and other forms of programs for applying pre-tax income towards your healthcare costs have very specific rules for releasing funds. The key issue here is that these accounts often require proof of services rendered, i.e. an insurance-issued EOB (explanation of benefits). If we bill ‘globally’ after you give birth, it may be some time before you can access these funds.
I had the same insurance and midwife a few years ago. Can I expect the same reimbursement with this pregnancy?
We wish we could say yes! The insurance landscape is continuously changing. While we’d love to tell you to count on an identical experience, we do not encourage you to rely on precedence; each claim is unique as the birth that prompted it.
CHOICES IN CHILDBIRTH
Information and advocacy for birthing women and their families
Comprehensive list of homebirth midwives in New York and New Jersey
Information on costs and issues facing maternity care
Largest organization of birth and postpartum doulas
NYC DOUA COLLECTIVE
Wonderful doula collective offering doulas at every practice level and I have been privileged to act as one of its mentors
INA BRANSOME, IBCLC, PCD (DONA), CLC
Board Certified Lactation Consultant, New Parent Mentor and all around Baby Whisperer
ELLEN SIDLES FARHI, CD (DONA), CLC
FAIR HEALTH CONSUMER
A catchall of insurance information
FAIR HEALTH CONSUMER LOOKUP
Helps estimate medical costs
Tutorial on Understanding your Medical Bill