I heard that midwives and home birth aren’t covered by insurance. Is this true? I can’t afford a home birth otherwise.

Dear Fiscally Savvy,

The quick answer to whether you can bill for midwifery services is a resounding YES!

We have a phenomenal biller, Jen Vracin of Roots Billing, on staff and insurance filing is offered with pregnancy care. Jen is the magic guru of all things insurance billing and she makes this whole confusing world of health care finance seem like a breeze. She happily guides clients through the process and tackles big insurance companies to make certain you get the best deal for coverage.

The long answer for how insurance billing works, takes a little bit more time to breakdown. So, let’s start with a little Obstetric Billing 101.

Obstetric Billing 101

Global Bill

When billing for pregnancy care, we generally reference Global Billing. A Global Bill is a base fee for services rendered throughout prenatal care, birth, and postpartum care. When midwives discuss what the cost of care is without insurance, they generally reference this base fee. This fee does not include labs, ultrasounds, and occasionally certain medication administration. The Global Bill includes “standard” services offered. 

Deductible

Most insurance plans come with a Deductible. A Deductible is the amount of money you will have to pay prior to your insurance offering any coverage. So, let’s say you have a $2,000 procedure done. If your deductible is $1,000, your insurance will make you pay $1,000, before they will help you cover the rest of the cost of your procedure. Typically you have a deductible with each calendar year, so as soon as you’ve paid off that $1,000, you won’t have to ever do that again in that year. So if your Deductible is met from that first procedure and your next procedure is $500, insurance will go into effect right away for that second procedure. 

In-Network

In-Network refers to a series of providers that your insurance plan has agreed to work with and typically offers the best rate of coverage. These often cover 70-90% of your care. This means you would only need to pay 10-30% of your care cost. 

Out-of-Network

Generally, all other providers are considered Out-of-Network. Most insurance plans offer a lower rate of coverage for Out-of-Network providers. These often cover 50-70% of your care. This means you would need to pay 30-50% of your care cost.

What About Midwifery Care and Home Birth Billing?

Generally most out-of-hospital pregnancy care providers (us included) are considered Out-of-Network. Which as you now know, means they’ll cover care, but not at the best rate. Wop-wop! But before you get too disheartened, let me remind you that we work with a superstar biller who knows all the tricks to getting you the best coverage for you care! Introducing our best friend billing term, the In-Network-Exception.

In-Network-Exception

An In-Network-Exception (sometimes referred to as a GAP Exemption) basically gives you a one-time pass to getting that better coverage rate of an In-Network provider, even if your provider is Out-of-Network. We basically convince your insurance that for this particular instance you should really cover us at a better rate. It’s a bit of phone calls, sitting on hold for those phone calls, and filing of paperwork, but it sure is satisfying when your health insurance actually pays for your care!

So now that you’re an expert in insurance billing for midwifery care and home birth, you know that YES we certainly do work with insurance. Here at SOFT CORNER Midwifery we believe that cost shouldn’t be your deciding factor of whether you get the midwifery care you desire and deserve. We do our best to make insurance work in your favor. And if it doesn’t, or you simply don’t have insurance, we offer a variety of payment plans and financial aid options to make sure you get the midwifery care you know and love. Find out more nitty-gritty information about our fees here.

Curious about care? Schedule a Free Pregnancy Care Consultation Visit and we’ll verify your insurance benefits for free too!