Midwives & Insurance
Archived Q&A and Reviews
- Insurance for midwives (United Healthcare)
- Searching for In-Network Midwife, Blue Shield PPO
- Which insurance plan for midwife delivery?
- Midwife who bills insurance via Ob-Gyn
- Midwife and HealthNet HMO
- Earlier Discussions
I've just started reaching out to a midwives in the Berkeley/Oakland area that delivers at Alta Bates, and it seems that getting insurance coverage for midwives ends up being quite an expensive proposition. I just exchanged voicemails with Lindy Johnson who said my insurance (United Healthcare) doesn't consider any midwife in this area to be an in-network provider. She also mentioned getting something called a GAP exception...?
Does anyone have advice about how to get insurance coverage for midwives without having to pay huge amounts out of pocket? I had called Pacifica Maternity, and aside from being totally full, I think the out of pocket expense would have been $2.5k+ which is a bit prohibitive for us considering we have so many of the usual expenses of a new baby.
Or perhaps going with an MD is not a bad way to go...? A friend mentioned that they ended up counting more on the nurses anyway due to a long labor and complications. Thank you SO much in advance for your insights. Overwhelmed in Berkeley
I did not deliver with a midwife. It never crossed my mind that I would need one. There was my OB, whom I totally trusted, several great nurses, my husband, I really didn't need another person there. As ''an advocate''? There was no reason I couldn't advocate for myself. So no, you don't ''need'' a midwife, especially if it is cost prohibitive. Best to You and Your Baby!
Give East Bay Perinatal Associates a call. Hsiu-Li Cheng and another midwife there deliver at Alta Bates, and there's a perinatal specialist in case of serious problems. I don't have the same insurance as you, but it's worth checking. Even though my insurance looks like it doesn't cover any midwives, they bill everything through an MD affiliated with their office (who I never met), and it was totally covered with no problem at all. I really liked having a midwife, and delivering at the hospital, well, had its pluses and minuses. I didn't seriously consider Pacifica since I didn't know about it until I'd done all my prenatal stuff with Hsiu-Li, but I would if there's a next time. It's a lot out of pocket, but the hospital bill to my insurance for ONE night and a FAST birth without complications was north of $17k! Of which we had to pay ~~1300, plus with the checkups and various testing, I think was pretty comparable. It is such a racket.
(To the previous respondent: midwives and women who choose to deliver with them (generally instead of, not in addition to an OB) have the outlook that birth is a natural process, not a medical problem requiring a doctor. An OB would only be called in in the case of a serious medical complication.) - Midwife family
As of a year ago Hsiu-Li billed through East Bay Perinatal and accepted my insurance (HealthNet HMO, Hills Physician medical group). I moved to the bay area when I was 7 months pregnant and after reading the BPN posts chose Hsiu-Li in the hopes of having a midwife attend my child's birth at Alta Bates. I ended up with a c-section because my baby flipped to breech at 38 weeks but I did have a chance to interact with her a few times at my appointments. She seemed really great and has a fantastic reputation. The instructor of the childbirth class I attended has worked with her many times as a doula and had nothing but positive things to say about her. She explained on our first visit that there are several other midwives in the practice and one of them will attend the birth if she cannot. She does not attend births in the middle of the night. I met one of the other midwives when she was away at a conference (don't remember her name) and she seemed nice enough.
I am due in a couple months and am seeing Lindy Johnson. It's my understanding that she bills through East Bay Perinatal. She understands the insurance questions and would probably be able to answer all your questions if you ask. I don't know what her rates are as she is fully covered by our insurance (Aetna HMO, Hill Physicians Group).
My wife and I are first-time parents. In preparing for the delivery, we wanted to find a provider that would guide us through this important and challenging transition in our lives (and that either our insurance would cover or that wouldn't cost us an arm and a leg). We wanted someone that would help us prepare emotionally, physically and mentally. We searched and searched and finally met with Ellie Griffinger and knew she was exactly the provider we were looking for. As far as in the insurance is concerned, we paid a flat amount and then she provides a super-bill that we submit to our insurance (Blue Shield of CA) for reimbursement and then our insurance is billed by Alta Bates directly for the hospital costs. A lot of insurances don't contract with midwives directly, but still cover them as preferred providers. Even IF our insurance doesn't reimburse anything, it has been worth every penny.
Hi BPN! We are expecting our first child in late July and have been searching (and searching) for an in-network CNM willing to deliver at Alta Bates. We met recently with Jeri Zubowski, a lovely Independent CNM working with East Bay Perinatal Group. My only concern is that Blue Shield will not cover any of her bill since she is out-of-network. My in-network deductible plus out of pocket maximum is only $6000 combined, but my out-of-network out-of-pocket maximum plus deductible is a whopping $12,000 combined. Frightening, no? I'd like to avoid any possibility of paying up to $18,000 out of pocket for both in + out of network providers. (We're going to need to save that moola up for the little sprout's school tuition, no?) C'est la vie...
So, all of that being said, I would LOVE to hear your advice regarding:
- CNM recommendations
- Your Blue Shield insurance experiences w/ out of network providers like CNMs
- Cost of Labor & Delivery at a Birthing Center
- Cost of L at Alta Bates (as of 2012)
- General Advice or CNM/ Doula referrals
I'd greatly appreciate your up-to-date information. Thanks so much for your time and consideration! Best, SB new mama at 30
Hi, You don't say whether you would like a homebirth. Most, if not all, homebirth midwives in this area bill insurance. Homebirth midwives are out-of-network providers, but their fee is considerably lower than hospital based midwives, so the total cost may likely be lower regardless of network status or not. Many insurance companies do a 60% out of network/80% in network coverage -- you should check your insurance benefits. If your deductable is high, their fee can be applied to that. Both licensed midwives (LMs) and Certified Nurse Midwives (CNMs) provide homebirth services but the cost is the same. FYI homebirths run around $4000 in this area (some more, some less). Hospital births cost more than $20,000 but can be closer to $30,000. If you're interested, please check out the Bay Area Homebirth Collective (www.bayareahomebirth.org) for more information and links to websites for midwives in our collective. Best of luck to you! Warmly, Laurel Coates
Hi I am due with my first baby in January, and I have Anthem Blue Shield PPO- not sure if that's the same as yours or not? I might not be much help because I don't know what my final costs will be for the birth and I can't speak to actual birth experiences yet, but I would love to recommend my care providers. Hsiu-li Cheng (pronounced show-lee) is my midwife- I found her name here on BPN and she is an in- network provider for me. She's amazing. I cannot recommend her enough. I switched to her from an OB at 30 weeks because I needed someone to spend a bit more time with me and really listen to me, and she does that. She is also out of east pay perinatal, so it seems like someone would have recommended her already. The one thing about her is that she will tell you right off that she doesn't deliver in the middle of the night- but I have doulas so that isn't a big deal to me. I pay my regular co-pay for prenatal visits at her office.
I also am using Dolphin Doulas. They are awesome as well. I have Susan and Cindy, and they make you feel so safe and have given us so many helpful tips and pointers for everything- from sleeping at night, to exercises to get ready for birth, to relaxation tools, etc. They are based in the peninsula but take clients in east bay as well. They are a bit pricey but in my opinion worth it. Obviously insurance doesn't cover them. I wish. Anyway, good luck!! I really hope you find a midwife you like. anon
I have blue cross anthem ppo and am having a home birth with a certified midwife through nova midwifery. They are in Oakland. It is very affordable...much lower than what you quoted. While the service is out of network, I will be reimbursed 70% when I file the claim after birth...he's due in Dec. The claim I submitted for an office visit was quickly reimbursed by blue cross. I started my pregnancy with a standard obgyn and wasnt satisfied with my experience. Nova's care is perfect, and i see them for 45-1hr each vist. They answer all my questions, get to know me and my needs and I wouldnt do it any other way. Hope that helps. Good luck determining your birthing process. G.
Hi, I delivered at Alta Bates with CNM Lindy Johnson. At the times there were only 3 midwives who had priviledges at Alta Bates (it is not a matter of them being 'willing' to deliver there). I believe Jerry is one of the 3. Can't remember the third one's name. I had blue shield HMO and they covered everything but I saw the bill from Altabates. Now mind you, I received no medications, not even an IV, delivered within 10 minutes from my arrival, stayed in L for 3 hours then transferred to post partum were I stayed less than 18 hours. The bill was 22,000. This was 4 years ago. Change your insurance if you can. I wish we had 'socialized medicine'. Sylvie
We are new to Berkeley (and California) and my husband switched jobs in November. We are now eligible for insurance and I have the choice between Kaiser and Blue Shield of CA (both HMO). I have a daughter who is unvaccinated, so I am looking for a pediatrician who is respectful of that choice. We are also thinking of trying to have another baby eventually and I want a midwife and a natural childbirth, if possible. As far as I can tell from the website, blue shield does not have midwives in network, and I can't tell anything about Kaiser covering midwives from their website. Can anyone recommend a pediatrician and or midwife and hospital/ birth center where you had a good experience in network for either of these insurance companies? Thank you in advance. Joy
Hi Joy, I'm a mom, doula, and apprentice midwife with Nova Midwifery Services (www.novamidwifery.com). You don't mention whether you would want to have your baby in hospital or at home. If you will plan on having a homebirth midwife: Kaiser does not pay for homebirth. Blue Cross/Blue Shield (actually, most) PPOs do. Insurance companies do not contract with Licensed Midwives so they are considered ''out of network'' through your PPO. As with any out of network provider, you pay the fee first and then you are reimbursed by the insurance company -- some insurance companies are better at reimbursement than others, but that's how it generally works.
Kaiser Walnut Creek has nurse-midwives on staff; Kaiser Oakland has OB residents. With Kaiser, you have prenatal practitioner (a Nurse Practitioner, mdwife, or OB, depending on the circumstances or where you're planning to deliver) and then you get whomever is on call when you are ready to deliver - - some practitioners do deliveries, some do not.
Alta Bates is the only non-Kaiser hospital in the area where mamas have babies (BS/BC contracts with Alta Bates). Most of the nurses are great and many have had natural childbirths and/or homebirths so they can be really supportive. If you want a midwife to attend a hospital birth, I recommend Hsiu-Li Cheng, CNM.
For our non-Kaiser clients, we usually recommend Janet Perlman and Katya Gerwein at Bayside Pediatrics (www.baysidemedical.com) or Gary Bean (www.glenviewpeds.com). They are usually pretty flexible about vaccination schedules or non-vaccination altogether. Unfortunately I do not know of non- vax friendly Kaiser pediatricians (doesn't mean there aren't any!). Hope this helps! Feel free to contact me if you have more questions. Warmly, Laurel
Hey there, I'm the pregnant half of a gay couple expecting our first, and am having a difficult time finding a midwife and doula rec. (OB-GYN recs would be great too.)
Ideally, I'd like a midwife that bills via an OB-GYN or hospital so that I'm not paying $4000 out of pocket. I have an Aetna PPO, but it doesn't cover independent midwives or doulas (our rockin' healthcare system at work again - sigh). The only Aetna midwife apparently covered by Alta Bates is someone named Jeri Zukowski, who on a search of this board would seem to be... er, experienced with very mixed reviews.
I'd prefer a birthing center within a hospital (even if I have to travel to Orinda or something), though I am researching home births as well. Recs (and advice) welcome! expectant mom
Hello expectant mom,
I am an apprentice midwife and doula working with a midwifery group. They are licensed midwives (LM) who accept insurance. Typically PPOs cover homebirth midwives as ''out-of-network'' providers, or sometimes even as ''in-network'' providers if the customer can convince the insurance company that because there is no one who provides that service (homebirth) in the PPO network, you (the customer) should be able to get an out of network provider at the in-network rate. This sometimes, but not always, happens.
Many midwives bill differently (sometimes they use a billing service, sometimes they ask the client to submit the claim to their insurance company). It depends on their needs as well as the clients' needs. I can tell you that my group uses a billing service and has had pretty good success with Aetna PPO. I urge you to call her to talk about the possibility of homebirth and to ask her how she handles billing.
Editor note: additional responses to this question are posted on the Midwives page.
Hi, I am 28 weeks pregnant and recently decided I wanted to switch from an OBGYN to a midwife. I have Health Net HMO and need to switch to Hills Physicians for the midwife to be covered. I am wondering if anybody recently switched to Hills Physicians for the same reason and what the procedure was like. HP's Customer Service was not very helpful in explaining all the rules etc.. Thanks! Olga
I did this very same thing 4-5 years ago and it was pretty simple. There are two annoying things about it though. One is that you have to find a new primary doc in Hill Physicians, even if it's temporary. The second is that your baby will have your medical group for the first month of its life, so even though our pediatrician is part of Alta Bates MG, our baby had to go see someone in Hill Physicians for the first month (as well as at the hospital). Annoying, but not necessarily a dealbreaker... anon
I know there are lots of reviews of midwives in the archives, but I need help navigating new insurance waters. I am switching to a BlueShield HMO in January when I will be at 24 weeks, and I need to find a midwife. Blue Shield told me I need to find a primary care doctor first, but I'm hoping I can work backwards and find a midwife first and then find the med group with which she is affiliated. I'm frustrated with the ins and outs of insurance, so if anyone can give me advice on how to find a doctor and midwife, or on which midwives are covered through this insurance, I would be grateful. Emelie
i did the same thing with switching physician groups in my first pregnancy so that i could have a midwife with blue shield HMO. i found that i chose a midwife--jeri zukoski--and then picked a primary care doc--julie nickelsen--who are both affiliated with hill physicians group in the berkeley area. both of them are fantastic and i haven't looked back since! i highly recommend either of them. jeri can also recommend midwives with whom she works or others that also deliver at alta bates and other PCPs that she knows in that MD group. good luck! sv
I had Jeri Zukoski (Certified Nurse Midwife) deliver both my children (2005 and 2007) at Alta Bates. She's great! Call her at 510-530-3374 and see which medical group she's in. I was with PacifiCare and AB Med Group when #2 was born. Good luck! happy Jeri mama
Hi, I've looked on the site for this information, but the latest advice seems to be from 2001. I am wondering if Alta Bates Medical Group still does not cover prenatal and delivery by midwives. I just had my first appointment with Dr. John Girard, and while he was personable, I feel I'd be more comfortable with a midwife. My insurance is Blue Shield. Thanks in advance for any advice! Genevieve
Last fall I switched from AB Medical Group to Hills Physicians so I could be covered by a midwife for my pregnancy. I also have Blue Shield. It seems unlikely that ABMG would have changed their policy in such a short time period, but you can always call them and ask. The problem I have now is that the pediatrician we've chosen isn't covered by HPMG (and newborns are in the same med group as their mothers for the first month) so I've got to find out how to deal with that. Just another aspect to be aware of (a minor one, I'm hoping). anon
I would highly recommend Lindy Johnson as a midwife. I have only heard very positive things about her. I am currently receiving pre-natal care from her and have yet to experience the actual birthing experience. Thus far she has been very warm, caring, supportive and knowledgable. She also has hospital privliges at Alta Bates. I have Bluesheild PPO, which does cover her (not full-coverage, but I think around 70%). I would recommend calling Blueshield to see how your specific plan covers her or other midwives at Altabates. Viviana
When I had a baby 1 year ago, there were no midwives in Alta Bates Medical Group. Hill Physicians, however, had a bunch to choose from. I easily switched medical groups and used a midwife. I have Healthnet, but you may want to see how easy it is to switch groups on your plan. You can always switch back after you have the baby, and many doctors take both (i.e. my primary care physician does) so there may not even be a need to switch back. milli
You asked if Blue Cross or Kaiser cover midwives. Although I use healthnet, this info may yet be of use to you. Under Healthnet I found that I had to switch from the Alta Bates Physicians group to the Hill Physicians group in order to access a midwife. Can you believe that a Berkeley group won't cover midwives!!! I delivered at Alta Bates with midwife Lindy Johnson. You should speak with a midwife as they really know the current status of health care coverage for pregnancies.
I recommend that you speak to some midwives about what insurance companies cover them and what doctors groups are under those insurance companies. Perhaps they will tell you which they find to be the easiest to deal with.
My daughter was delivered in June by Hsui-Li Cheng (highly praised -- and for good reason -- on the website) and there were no problems with PacifiCare billing. I don't remember the details of the PCP/OB referral process, only that it was unproblematic.
As for choosing a pediatrician, we chose someone with Alta Bates Medical group because we wanted both kids to have the same doctor. The process is a little bit more involved, but PacifiCare explained it clearly and then didn't mess up the billing. We filled out a form with all the info beforehand, then notified them as soon as the baby was born so that the baby had its own account immediately rather than remaining on my insurance for the usual 30 days. The only hitch was that Hsui-Li only delivers at Summit, and our pediatrician doesn't have privileges there, so our daughter was seen by the on-call pediatrician in the hospital and then by her regular pedi a few days later. (this wasn't an insurance issue) I can't compare PacifiCare with any of the other plans you mention, but I have no complaints about them. Jennifer
I just had my daughter a few months ago and stayed with UC Care throughout. My midwife, Hsiu-Li (Sho-Lee) Cheng, was fabulous. She delivers at Summit where I had a great experience. Hsiu-Li, referred me to Primary Pediatrics. While I had to change my medical group from Alta Bates to Hills, I was able to keep my PCP because he is in both, as many doctors are. Also, an added bonus, Summit has a free home nurse visit program and so I got 4 home visits postpartum from a nurse through that program plus another visit through UC Care which made all the difference in the world since by baby was a slow-weight gainer. Roxanne
Midwife with PacifiCare insurance?
I am recently pregnant with my second child. I would like to work with a midwife this time, but I have PacifiCare insurance through Alta Bates and it looks like they don't pay for midwives (how crazy!). Does anyone know of a way around this or have any advice. I know I have the option to choose a duola if it turns out I can't get a midwife, but I would prefer to go midwife all the way.
So, my questions to all of you are: is there any way to get a midwife with PacifiCare insurance through Alta Bates Medical Group, if not, I would love OB GYN recommendations (I used Debra Levinsky for my first child who is now 5 years old and have not been thrilled), and finally, any doula suggestions. I know a short time ago there was a wonderful discussion about duolas, but, not knowing I was pregnant at the time, I purged them all from my email! I look forward to hearing from you. Thanks in advance for the help!
I'm fairly sure the only East Bay physician's group which includes independent midwives is Hill Physicians. I saw Lindy Johnson (there's also her partner, Robin Hale) when I had my 2YO, and my friend just had a baby with her. She's very good, I think. I've also heard about some OB who has a midwife in his office who you can use in a similar way -- who is not just part of a big call group -- let me know if you want me to dredge up more details on this.
Have you considered switching phys. groups just for the pregnancy? I've done it several times, for that reason and others. Unfortunately Pacificare won't do it instantly -- if you call before the 15th of the month it'll be effective the 1st of the next month. I don't think there's any limit on how often you switch groups -- you just have to pick a primary care person in the group. I recently wanted to see a specialist at UCSF and picked a primary care person completely blindly, who I've never seen and probably will never see...
Congratulations, and good luck with the pregnancy.
With regards to HMOs, midwives, and Alta Bates, we found that instead of billing you directly, several midwives could bill indirectly through their backup physician's practices and that that would be covered (I am not sure why, I think it may have been because then it was deemed better or prescribed or some such thing (obscurity?).)
We didn't need to go that route, Blue Cross's California Care (and the UC Berkeley Student Health Plan covered midwifery at Alta Bates.) Jerry
Date: Jan 21, 1998
A couple people have asked me for my story on how I got PacifiCare to pay for my Midwife. The full story is somewhat personal, so I'll just send that privately to those who've asked (I haven't forgotton; I just haven't had time!).
For the public record, though, let me say that how I did it was PERSISTANCE. I began investigating midwife care as soon as I knew I was pregant (about 3 weeks). I set my sights on a midwife-attended hospital birth, figuring that should be possible (I didn't think they'd ever consent to paying for a Home Birth). After I found that PacifiCare would not pay for a midwife through ABMG, I went on a campaign to change their minds. I didn't want to use the solution suggested by someone else on this forum--change groups to Hill Physicians--because I also have allergies, and that would require my changing Allergists as well (something I thought was pure stupidity during Pregnancy). It took 5 months, many letters and innumerable phone calls. What finally did it, I think, was a letter my husband wrote, complaining about the treatment we'd been given. We sent it to everyone we could think of: 2 people at PacifiCare, the head honcho at ABMG, all the doctors who'd ever been on this case, my midwife, the person in charge of Health Benefits at UC, and KCBS Call for Action! They caved in, I got my midwife coverage, and I switched at the beginning of my 7th month of pregnancy!
The message, in my opinion, is *never give up*. Everyone told me it couldn't be done, but I did it. I heard later that someone else right after me was approved with no argument whatsoever.
Be bold, ask for what you want, and be persistent. If you annoy them enough, they may give you what you want just to shut you up!
to the mother wanting advice about HMO & midwives
i was in your exact position nearly two years ago: i was pregnant (but w/ my first) and i had Pacificare insurance through UC and i wanted to deliver with a midwife at Alta Bates. and, i did! it was tricky then and i don't know if things have changed, but if you want to know how i did it contact me directly. Fatimah
Thanks to everyone who responded to my request for help finding a midwife and figuring out how to get Pacificare (through Alta Bates) to pay for it. I contacted several midwives and learned that PacifiCare through Hills Physicians will pay for midwives, so I simply switched to the Hills Physician's Group by calling PacifiCare directly. I can always switch back after the baby is born. I also chose Audrey Heffel as my primary care physician. She was recommended highly by many of you and also by a friend of mine. I met with one midwife yesterday and have another meeting scheduled for next week. By the way, both midwives, and a third I plan to contact, all deliver at Alta Bates. I am delighted to have figured this out. My first birth was very difficult, and I am determined to have a positive experience this (my last) time around. After all, this time it has to be positive for all 3 of us... Thanks to all of you who responded!
I would suggest that the person who found a midwife that PacifiCare would pay for check with her OB/Gyn's office to be sure that Hill Physicians will pay for a birth at Alta Bates if that is really where she wants to go. My own OB/Gyn has been grumbling that Hill Physicians makes him do all his surgeries and deliveries on Hill patients at Summit. This is a fairly recent change--when he told me about it last July, it had just gone into effect. When I asked him about Hill Physicians last week, he said it was effective in May. I wasn't sure if he meant last May or this coming May but didn't ask because it wasn't relevant to me.
Note that many doctors belong to more than one IPA (for example, Hill Physicians and Alta Bates Medical Group), and each IPA has its own rules about where its patients can be sent for lab tests, surgery, etc. Fran