Homebirth & Insurance

Parent Q&A

  • I have insurance to have prenatal tests/check ups at Sutter Berkeley but plan to have a home birth. Can anyone recommend a great OB to work with? Also open to East Bay home birth midwife recommendations. Thank you! 

    When I asked Dr. Madhavan at Sutter Milvia about concurrent care, she said they require you to leave their practice if you're planning a homebirth. When I did get pregnant, I had to sign a form attesting that I was not getting care elsewhere and not planning a homebirth. I thought it was so ridiculous, patronizing and completely focused on Sutter's liability not on actually helping moms and babies. I left the practice.

Archived Q&A and Reviews


Questions

Insurance that covers Homebirth?

Dec 2009

I'm wondering if you all could help me identify what insurance companies cover homebirth. I currently have Kaiser, but am thinking I'll need to change that as I'd like to have another child within the next couple of years and just can't imagine doing it anywhere but at home. (I realize that one can have a wonderful experience at a hospital, but this is one of my personal desires and priorities for birth.) Advice on what insurance companies to look at? Thanks so much! homebirth loving mama


i was told not to ask if they cover a homebirth specifically because the answer is always no. i have blue cross anthem & it covered my homebirth midwife as an ''out of network provider''. i used my midwife's insurance billing service which took a percent but overall got me reimbursed more then i thought i could get. my birth was 4000 & I received 2300 back. good luck!


I recently had a homebirth, July 2009. I was three months pregnant before making the decision to have a homebirth. I did allot of research to find out what insurance companies might cover homebirths.

At the time I was with Pacificare on an individual HMO plan, paying about $300 a month, for the plan for my age group, to find out they didn't cover homebirth. I was with Hills Physician's Medical Group for my primary care. Pacificare would cover my prenatal coverage, and birth if I had the baby at the hospital with an in network OBGYN or midwife CNM. Pacificare covered a prior birth in 2006. I had Lindy Johnson, CNM as my midwife. They covered my visits. Out of pocket I paid Lindy about $400, the rest the insurance covered. My bill at Alta Bates for a half hour birth and 1 day stay cost, $11,500. Pacificare covered $1500 of that, and Alta Bates had to write off the rest. Due to how Pacifcare and Alta Bates are contracted with each other.

With that I decided to look into other plans. There are only 5 medical insurance companies in California. None cover homebirth. Blue Shield said it WOULD cover homebirth if I was on a group plan, not individual plan. If I was trying to have covered on a group health insurance plan, I cannot change plans whilst pregnant. It has to be 10 months before you get pregnant. Hopefully your employment offer's a Blue Shield group health insurance plan. BUT please call to double check as this might have changed.

With that I decided to be responsible for the entire cost of my care. I chose Judy Luce has my midwife. She was great! And worth every penny! As I was having my third child and I was not a high risk pregnancy, Judy and I kept extra costs to a minimum; blood work, testing etc. I was able to cover 1 procedure with the help of Lindy on my plan. One procedure was a lost for Judy, as it was too much work to fight Pacificare to cover the cost. I paid Pacificare more over the last 4 years than what my homebirth cost. I was very disappointed at how much money I have given them only to find out they don't cover homebirth's. Disgrace on their part, because homebirth's are cheaper than a vaginal birth at the hospital or C- Section.

I have since changed my plan. I no longer have maternity coverage. I have decided that if I have a baby again, it would be at home, and I will find a way to financially make it happen.

I did recently found out that Doula's are now covered under health insurance. Companies will cover a doula but not a homebirth midwife.

I hope this information helps. I'm interested to see other replies on this issue/topic. hb


Homebirth in Berkeley & Insurance

Nov 2009

I'm about 12 weeks pregnant with my first baby and considering going the homebirth route. I am currently seeing Dr. Amy Huibonhoa in Berkeley for prenatal care and I like her a lot, but think I would feel more comfortable laboring in a home environment if I remain low-risk. We are right around the corner from Alta Bates so I'm confident that we'd be able to get to the hospital quickly should anything go wrong.

I'm wondering if anyone has done this recently and if so how your insurance handled it. We have Anthem Blue Cross HMO which covers 100% of hospital/doctor costs but I haven't been able to figure out if they'll reimburse homebirth/midwife costs. There do not seem to be any midwives in our medical group (Alta Bates Medical Group) but the woman I spoke with at Blue Cross seemed to think I might be able to get a referral. I also still have SHIP insurance coverage so it is possible that I can get a referral through that plan instead. I haven't really started looking at midwives so any recommendations (preferably in Berkeley or East Oakland) would be welcome. Thanks! J


I just did some research on this though from what I understand it all depends on the contract you have w/ your insurance company. For mine (UC), Blue Cross will not reimburse homebirths. It will only reimburse costs if your midwife is a CNM, or if you birth in a birth center. Most CNMs I know don't do homebirths. You can try Hsio Li Chen or Lindy Johnson if you want to use a CNM. You will have to switch your Medical Group (Hills Physicians) but I don't see why that would be an issue unless you have to see other doctors who are not in that group. Many around here take both. I believe they both take Blue Cross. anone


We had a homebirth last year (our daughter is 12 months old), and we found it pretty difficult to get any of it reimbursed. As I understand, Blue Cross used to reimburse for all midwives (LM, CMP, and CNM), but has since changed its language to only reimburse for CNMs (certified nurse midwife). You can check in the details of your plan, it will have a ''definitions'' section where it lists what they consider a care provider.

When we had our homebirth, our insurance language was unclear (they did not exclude homebirth but didn't specifically state that they'd cover a LM) and we had to fight to get it covered. We are planning for #2 and assuming that we won't be able to get it covered again and that we'll pay out of pocket for the whole thing. I know that sometimes midwives will try to bill for the prenatal care and you can pay out of pocket for the birth itself. You should ask about it when you're interviewing.

We used Judy Luce, and loved her. She is an encyclopedia of knowledge, supportive, calm, and has a great sense of humor. We loved her so much that we're not going to look for a CNM for our next birth, we'd rather pay for her despite that it will be financially difficult for us. But, I think Beah Haber is a CNM and we have friends who had wonderful experiences with her. Congrats and good luck! jisun


I used Leopi Sanderson Edmunds for my homebirth in August & she is absolutely wonderful. Lots of experience & great clinical judgement. I used the billing service she reccomended & they were very successful in getting me partially reimbursed, about 60%. I have blue cross anthem PPO.


I had a wonderful homebirth with Beah Haber & Michelle Edgar on SHIP, and had no problems getting reimbursed at the out of network rate. I recommend them highly. happy former student


Health Net PPO billing for Home Birth

April 2009

I'm seeking recommendations/advice on how to have a home birth covered by insurance (at least partially!) Speacifically, do you have any experience with billing using a Health Net PPO for a midwife attended home birth? How did you receive coverage? After speaking with a Health Net rep on the phone I'm left feeling disappointed and frustrated. I was told on the phone that no home births were covered at all, but I'm hoping there might be a way to work around this. Most midwives I've spoken to say they will bill me at the end in a flat rate and it is my responsibility to seek reimbursement. If you've had experience with Health Net PPO I'd really love to hear from you. Thank you!! Laura


We had HealthNet and did get our homebirth covered after quite a bit of hassle, but our insurance ''rents'' the HealtNet network, so I'm not quite sure if it is the same. Read your booklet. If homebirth is specifically stated not to be covered, there's not much you can do. If it doesn't mention homebirth either way, it is possible that it would be covered, or that you could win a fight to get it covered if they denied it. Also look at what they define as a covered care provider. Some insurance will accept LMs, some only CNMs, some leave it open. Either way, if you are really set on homebirthing, you might want to be financially prepared to pay for it all. Many people have problems with insurance, even if the insurance company said that they'd cover it. Also, you may be able to get the prenatal care covered but have to pay for the birth. Get everything in writing! Hates Insurance Companies


Homebirth and post-partum on SHIP?

March 2009

Thanks everyone for being such a great resource! I have a couple of queries for the group. Any experiences or advice on how to get maximally reimbursed for a home birth while on SHIP at Berkeley? My husband and I are both graduate students and hoping to have a home birth. We've got a great team of midwives already and would like to know how to best navigate the bureaucracy that is SHIP. Also, any advice on whether grad students are eligible for disability or paid parental leave? Any other suggestions for financial post-partum resources? Thanks! expectant grad student


Be careful. I just lost a baby to a home birth. The baby died because we could not get to the hospital quickly enough. I am blaming myself - I, too, had a team of midwives and a doula. (This was not a breech birth). I now believe that homebirth is a ridiculous and selfish act. KM


I had a homebirth on SHIP, with no difficulties. SHIP paid my certified-nurse-midwife as an out-of-network provider (60%), without a hitch. Officially, they didn't cover home births, but there was nothing on the paperwork that identified my birth as such, so it went through. But there was a risk that they would decide not to pay.

As for leave, I had my baby before the new policy took place. I just had an understanding with my adviser that I would come back when I could, and stayed on my GSR-ship ''working at home'' for three months--but didn't fill in any time sheets. My school fees were paid, but no salary. Now, i think you are entitled to 6 weeks paid leave.

My heart goes out to the previous poster who lost her baby. I can't imagine feeling I could have prevented my baby's death if I had only been in a hospital. When I planned my second child's birth, though, I looked at the data and decided that I would feel equally horrible if I lost my baby to a hospital-acquired infection or a complication of an intervention that would not have occurred outside a hospital as if I lost a baby at home. So, knowing that, horribly, some babies die at home and that some babies die in the hospital, I decided that with an experienced midwife, the risks for me and my baby were actually lower at home while the benefits were greater. In no way to I want to minimize what the poster went through; it's absolutely awful. But looking at the literature and the data as a whole, i came to a different conclusion. Good luck, and all the best.


I just posted, signed as ''Good luck, and all the best.'' Rereading the message, I wanted to make sure it was clear when I wrote ''I can't imagine feeling I could have prevented my baby's death if I had only been in a hospital,'' I meant that it's the kind of awful emotion nobody can imagine unless they're in that situation--unimaginable. In no way did I want to say that the feelings aren't justified. Again, my heart goes out to the poster. good luck, again


Getting Blue Shield to pay for home birth with midwife

Feb 2008

Hi! Just curious if any other moms have succesfully filed a claim with Blue Shield HMO through John Muir Medical Group for a homebirth with a midwife? I was told John Muir does not ''recommend'' midwives- although Blue Shield will cover the costs. Any advice for an expectant mom?


For effective strategies for getting homebirth coverage check out: http://www.gentlebirth.org/archives/preApproval.html#Overview After a lot of phone calls, I just got my home birth covered at in-network (!) rates. I have United Health Care, not Blue Shield, but I'm guessing the process is similar. When I got pregnant, I called United to ask for an in-network midwife who does home births. (Of course they don't have one). Then I said since they don't have one, then my out-of-network midwife should be covered at in-network rates. They agreed to this, and even sent me a letter saying so. After the birth when our midwife submitted the claims, the amount United initially proposed to cover was way too low. After several phone calls (asking to speak to a supervisor any time I got an answer I didn't like) they actually sent a check for a reasonable amount. Feel free to contact me if you would like more details. Best of luck with your insurance, and have a wonderful birth! Pamela