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Oh baby! Health insurance may not cover at-home births

Gina Roberts-Grey

Giving birth to a child at home certainly provides peace and comfort. But it may not be kind to the parents’ pocketbook. Why? Some health insurers don’t pay for at-home deliveries.

For more and more parents, this is an issue. In 2009, nearly 30,000 babies were born at home in the United States, according to the federal Centers for Disease Control and Prevention (CDC). That represented 0.72 percent of all U.S. births in 2009, the highest level since the CDC began collecting data on at-home births in 1989.

The typical hospital birth without complications costs an average of $5,000 to $10,000, according to studies. The same type of birth at home can cost roughly $1,500 to $5,000. A study published in the Journal of Nurse Midwifery speculates that cost of the typical at-home birth — without complications — is smaller, in part, because of the low number of C-sections for at-home deliveries.

OK or ‘inappropriate’?

From state to state and from insurer to insurer, coverage of at-home births varies widely. More than 60 percent of at-home births in 2009 were overseen by midwives; only 5 percent were attended by physicians. Birthing services offered by physicians cost significantly more than those offered by midwives.

Some health insurance companies cover births attended by midwives, whether the delivery is at home or in a hospital or clinic, while others consider at-home births “medically inappropriate.” For those insurers that do cover at-home births, the coverage isn’t the same across the board. For instance:

  • WellPoint covers midwife services, but that coverage varies according to your location and health plan.
  • Aetna contracts with midwives who help with deliveries at hospitals or birthing centers.
  • UnitedHealthcare covers both hospital and at-home births attended by licensed midwives. Benefits generally are the same in both scenarios.

In most states, health insurance does not provide the same coverage — or any coverage at all — for at-home births as it does for those at hospitals and clinics. Only a few states require insurers to cover at-home births, including New Hampshire, New Mexico, New York and Vermont.

Some insurers will cover midwife care only if the midwife is licensed under state law and works at a hospital or approved birthing center, says Rhonda Lipschutz, a spokeswoman for Health Advocate Inc., a company that helps people navigate the health care system. However, not all midwives are certified by state regulators. Health insurance coverage for births overseen by unregulated midwives, referred to as lay midwives, may be reduced or even non-existent.

The nitty-gritty

If an at-home birth is covered, the amount of coverage also depends on who provides the equipment needed. The midwife typically will supply the equipment, like a fetal monitor, and include that in her fees. But many times, smaller items like a rubber sheet for the birthing bed or a special birthing tub won’t be covered for an at-home birth.

Coverage of an at-home birth also depends on reimbursements for midwives with malpractice insurance.

A few states like Vermont require practicing doctors and midwives to carry malpractice insurance to be eligible for reimbursement from health insurance plans. So if you’re considering a home birth, you should talk to your midwife or health care provider to make sure everything’s in order. Malpractice insurance is expensive, so some midwives must align with medical practices to be covered under their insurance.

Hope on the horizon?

Over the next few years, federal health care reform will expand maternity coverage available through Medicaid and part of that coverage includes free-standing birth centers, but it’s unclear whether at-home births will be part of the mix. In 2011, the federal government began requiring midwives to be reimbursed at the same Medicaid rate as physicians. However, state Medicaid programs impose different requirements for reimbursements.

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