INSURANCE COVERAGE

Will insurance cover a licensed midwife and home birth?
While I am encouraged as more and more insurance policies cover home birth midwifery, not all policies will. To
find out, call your insurance company and ask specifically if they cover a licensed midwife. Many policies will cover
at least a large portion of the cost. Follow these guidelines when questioning your insurance company:

  1. Keep a record of the name, phone number, identification, and group number of your insurance plan. You
    should also note who the subscriber is (you or your spouse), his/her date of birth, and social security number.
  2. If you have more than one insurance plan, determine which policy is primary and which is secondary.
  3. Ask specific questions about your benefits. Always take notes about your telephone calls (date/time/name of
    rep./what was said).  Keep copies of e-mail and regular mail correspondence. Remember, having your
    benefits described over the phone does not guarantee coverage.
  4. Ask if your policy offers case management. Case managers either work for the insurance company or are
    contracted by them to monitor and advocate for patients whose costs are high or who have complicated
    needs. They are often helpful in cutting internal “red tape” (problems), gaining access to little-known
    insurance benefits, and reducing your overall out-of-pocket expenses.

Ask about your OUT OF NETWORK benefits. Your deductible and co-pay will most likely be higher than with   
in-network providers.

  1. Do I have a deductible amount?         Yes    No     If yes, how much is it?  _______________________   
  2. How much of my deductible has been met?   ________________________________________________
  3. Am I required to pay a co-payment?   Yes    No     If yes, how much is it?    ______________________
  4. What is the percentage of my coverage?   __________________________________________________
  5. What is the percentage of coverage for a home birth attended by a licensed midwife?   _______________

Pre-Arranging Coverage – to be done at the beginning of your care

  1. Can you provide names of licensed in-network homebirth providers in my area? You can tell them that you
    haven't been able to find anybody near your home who provides the special service that you need.
  2. If they have one - great, give them a call.  If they don't have one:
  • ASK your insurance company how to go about getting in-network coverage of an out-of-network homebirth
    provider.  
  • ASK FOR AN IN-NETWORK BENEFIT REQUEST FORM.  (form may have different name in different
    insurance companies)
  1. If they are not helpful, contact your employer's Human Resources Department if the insurance is through
    their employer. Health insurance coverage is an employee benefit, and if you feel that it's not benefiting you
    in the way you need, your Human Resources staff will want to know about this - after all, they're the ones who
    help to shape the decision about which plan to buy next year!  
  2. Be sure to get a copy of your health insurance company's approval for coverage of homebirth in writing.
  3. If they still refuse, tell them you plan to file a formal appeal with them and, if necessary, a formal appeal
    through your state agency.

Supportive Documents

If the insurance company tries to deny your appeal on the basis that homebirth is experimental, you can point out
that doctors and midwives have been attending homebirths for over 2000 years.  If their medical review board
states that homebirth is unsafe, ask them to cite references supporting this. (They don't have any reputable
references - hospital birth has never been shown to be safer than homebirth or low-risk pregnancy.)