Is it possible to get insurance coverage for your home birth?
In Georgia, it’s difficult.
Hospitals are by far the most common location for women in the U.S. to give birth. And for many women, the hospital is the best option. If you feel safest in the hospital, then that’s where you should give birth. But in Atlanta, many hospitals have high intervention rates, little support for natural birth, and high c-section rates. And although Intown Midwifery and See Baby have launched a project to create a birth center in Atlanta–which would provide a wonderful alternative to hospital birth–at the moment the only choice in Atlanta, other than a hospital birth, is a home birth.
Home birth isn’t as countercultural as it used to be, but it’s still pretty unusual. When I tell people that my daughter was born at home, their response is usually either “wow, you’re brave,” or “I didn’t know that was legal!”
Is home birth legal in Georgia? Technically, yes. Practically, no. The license usually obtained by midwives who attended home births, the Certified Professional Midwife license, isn’t recognized by the state of Georgia. Certified Nurse-Midwives are recognized, but they’re required to practice in collaboration with a physician, so a CNM who wants to attend home births has to find an obstetrician who’s willing to work with her. Good luck with that.
And so families who want a home birth in Georgia are usually forced to pay upfront out of pocket. However, many insurance carriers will reimburse you for out-of-network care. As is often the case with insurance, it’s frequently a matter of luck whether they’ll approve your request for reimbursement or not. Generally, you have to wait till after your baby is born, and all of your payments have been made, before you can apply for reimbursement.
After my daughter was born, I didn’t even try to get insurance coverage. My insurance at the time required a $3,000 copay for an in-hospital, in-network, unmedicated birth; the entire cost of my midwifery care (including prenatal and postnatal visits) was only $2,500. Somehow I didn’t think they were going to reimburse me more than my in-network copay would have been.
This December, however, after my second baby is born, I will be attempting to get insurance coverage. Luckily my midwife now partners with a service that requests reimbursement for patients, which should make the process easier.
There are several points to keep in mind if you are trying to get your insurance to cover a home birth:
1. In some states such as New York and Massachusetts, insurance companies are required to cover home birth. Even though Georgia doesn’t technically allow home births, a national insurance company might be more likely to cover your home birth if they cover them in other states.
2. Talk to your insurance about the different plans available to you. It might be that a PPO plan would cover home birth although your current HMO plan won’t–or vice versa. If there’s an open enrollment period between now and when your baby is due, then switch to the plan that will cover the birth you want.
3. If they won’t cover the birth itself, try to get coverage for the pre- and post-natal care. Then ask your midwife to bill the majority of her fee as pre- and post-natal care.
4. Some midwives will accept barter services in exchange for part of the fees. Even if you think you can’t afford a home birth, talk to some midwives. You might have some skills that the midwife is paying for anyway (such as website services) that she’d be willing to barter for.
5. If you really want a home birth and can’t get it covered, then cut back expenses in other ways so you can pay for it out of pocket. Skip on expensive baby items like cribs and strollers; get cheap cloth diapers and hand-me-down clothes. You can also have a “birth shower” instead of a baby shower and ask friends and family to contribute toward the cost of your home birth.
Note: Thanks to CPM Debbie Pulley for correcting my original statement about the legal requirements of the relationship between CNMs and physicians! My original article stated that CNMs are required to be supervised by a physician, which was incorrect; they are only required to have a collaborative relationship.