Out of pocket or insurance??

[Amieee]

I am still stressed about where and with whom to have my baby.
I toured a birth center the other day and it was wonderful.
I liked the midwife I met there and I felt comfortable. They had all these neat pictures on the walls with pregnant women, lotuses, moms and babies, babies in utero, etc.
It is far away. Our insurance does not cover use of that facility and only pays a little of the professional fees which would mean thousands of dollars for us.
I told my DH if we and a homebirth, we'd pay it all out of pocket and he said "yeah, that is one reason we are not having a home birth"
I am sure you all think I am crazy to be worried so much about cost when it comes to such an important event. After all, many spend more than that on a wedding or vacations or whatever. But we don't. We have never laid out this much money for anything. (Well that is not true, we paid a few thousand for our car.)
Ironically, the cost there is almost half what it costs to have the baby in the hospital (without an epi) and insurance covers that.
I also sort of think that it is our responsibility to pay for birth. But we do so through our insurance company. We paid enough for our insurance this year that after having the baby it comes out even. So if we have to pay our of pocket, it is like we wasted all that insurance money and we have really paid twice for our birth since that is the only reason we pay for insurance in the first place.
I guess this may seem a bit off topic, but at the same time I don't think it is because I feel like my choices are limited by what I can afford and are being dictated by someone else.
I am just so upset by this.
Has anyone dealt with insurance companies in the past and gotten them to cooperate a little more so you can have the birth you want?
Or am I just being silly and should we just go into debt?
Or should I just have the baby in the hospital and let our insurance pay for it?

[karin]

toh

i would have paid a million dollars for the experience of having dd at home. it was a priceless experience. my insurance paid everything, but had it not, we would have paid out of pocket. we actually paid more for our insurance plan because it covered out of hospital birth.

if you feel in your heart that this birth center is where you should be, i would pay. ask your mw about sliding scale fees or payment plans. lobby your insurance company to pay-call and ask for a supervisor and write an appeal. i believe there was someone here about a year ago who did that and got her homebirth covered.

edited to add that insurance did not pay for my birthing tub, but they should have that at the birth center anyways.

[kbc123]

I'm sorry you're having this insurance problem--it really stinks!! That being said, I'm paying completely out of pocket for my free standing birth center birth. But, I didn't have much choice, as my health insurance excludes maternity coverage, so I would have had to pay somewhere anyways. For us, a birth center birth was much less than it would be at the hospital, but it was what I would have chosen anyways. Oh, and our birth center is far away from where I live too.

I've heard that many insurance companies will pay part or all of a birth center birth when pushed on it. They may not advertise it as an option, but generally it is cheaper for them and they will agree to do it. I would think they could at least pay what they would have paid the hospital if it really is more expensive at the birth center. Check with the birth center itself to see if it has ever worked with your insurance company before for someone else in your situation.

My birth center birth covers all prenatal and postnatal care except labs and ultrasounds. We're paying a total of $3500 plus labs and ultrasound. Its a lot, but hospital births around here start at over $5000 and go up, heaven forbid you "need" anything extra like epidural or a c-section. And of course that doesn't include prenatal care or postnatal follow up exam. That's just the hospital birth.

I'm 15 weeks now and have been in at least 4 times for a consultation/ exam and once for a heartbeat check after they couldn't find it at my 11 week appt. I'm really happy there.

I'd say that if you really want a home birth or birth center birth and can swing the cost, even though it might be more than the other or more than you'd like to pay, it'll be so very worth it.

[huntergirl]

I belong to an HMO, but a really good one. They pay for just about everything, including all prenatal, postnatal and delivery care, with an additional $15 copay for "optional" anesthesia such as epidural. I'd always planned on having a homebirth anyway so figured it would be out-of-pocket. Luck of lucks, my HMO was doing a homebirth study when I was pregnant with Emma, and I qualified since I was low-risk and within their geographic limits. Unfortunately, just MY luck, I did not like any of the midwives in the program. So DH & I opted to hire a midwife we did like, even though she wasn't covered by our insurance. We liked her well enough to hire her again, and again, and again, even though our insurance never paid for it. Believe me, it was money WELL SPENT!

The reason you pay for insurance is not for things you plan on (if you can't afford to have a child, you shouldn't be having it!) but for things you don't plan on, like getting sick or having your appendix burst or breaking your leg in a soccer game. That is what insurance is for. Besides, you won't have "wasted all that insurance money" if your baby needs to be in NICU, or if you have complications and require a c-section. Again, things you don't plan on. Good luck!

[Amieee]

Wow! I can't believe that some of you are lucky enough to have insurance that covers homebirth! It is technically "illegal" here in NC, which means that technically your midwife could have charges placed against her. Of course I don't think that happens, but there is no way it would ever be covered on our insurance.

[ubertulip]

I haven't decided what to do, either. For us, the birth center is pretty much free, which is great, but I know I'll be much more centered at home, which would cost another $1500-$1800. But in the big picture, maybe that isn't too big of a deal. I'm definitely leaning towards home right now.

The other question in my mind is that the birth center is a lot closer to the hospital, in case of a transfer, but I don't want to make a choice based on fear....

Melissa near Seattle

[JulieD]

I also agree with Karin (and I'm typing one-handed as well ;))...

I would have paid for the homebirth in full had it not been covered some.

We ended up transfering to the hospital (and we ended up paying a lot for somewhere we didn't want to be). In my opinion, it would be worth the money hands down to be either at home or the birthing center.

The insurance carrier might be interested in the info about babies and mothers needing less interventions, etc. at home and the qualifications of the midwives. In comparison, both the Sheetmetal Workers Ins. and Premera Blue Cross cover my midwife who studied at the Midwifery School of Seattle. If you show your carrier that similar schooling is enough to have a midwife covered by other insurances (and believe me, the sheetmetal one is little), they might as well. It's worth the stress and effort, I promise! :D
~Julie

[smileyface]

I just wanted to advise you that if you push the issue with your insurance company, please get their answer in writing. Insurance companies can be very difficult to deal with and often different people will have different answers. I had a hospital birth 12 months ago and I stopped getting bills this month!!! They cover hospital care 100%, but they kept screwing up the billing. Because I also work in health care and I know how insurance works, I kept calling them and finally had everything straigtened out.

Secondly, I'd just like to give a different opinion than most people here. I honestly never thought of having a home birth or a midwife, so I don't "know" the costs.... Is it truely more than a hospital birth???? I was in a hospital, I had absolutely no medication (I did have an IV), I was discharged 24 hours after delivery and my bill was about $3500. I do think this is a lot of money for out of pocket to give birth. Honestly, I love my daughter more than anything on earth and I love that this forum is here for these discussions, but I wouldn't pay out of pocket to get myself into serious debt to give birth. I know this is not the "norm" opinion here, but I do think if you are dedicated to a medication and intervention free birth that you can get it at the hospital. You must research your physician well and you must educate yourself well for labor, but it is possible. I didn't have anything I didn't want, but I honestly would consider myself the most prepared for labor than anyone I know (in real life, I think some of these people here on the internet were as prepared as me) I read and researched everything I could and I stayed home absolutely as long as possible during labor (only my Husband as support). (I delivered Melissa within 3 hours of entering the hospital door). I will admit that I would have liked to give birth in a birth tub, but this was not an option at my hospital. That was a slight dissappointment, but other than that I was extremely happy with my experience and I would have been just as happy if I had had medical intervention such as an epidural because I know I wouldn't have gotton it unless I wanted it. Again, I know this is not the opinion of everyone here, but I really wanted to let you know that it is ok to give birth in the hospital, it can be done the way that you want it, it isn't always an awful experience, but you must educate yourself and prepare yourself for everything. I too also feel that if you can't afford a baby you shouldn't be having one, but paying thousands of dollars or more for a birth is just kind of silly to me. Again, this is just my meager personal opinion.

[smileyface]

I'm now really curious about the cost of care at this facility. Is it truely twice the cost of the hospital?? Is it like $7,000? My hospital birth was entirely medication free and I can't imagine I could have lowered the cost in any way. (I definitely think that I was charged way too much since I really didn't need much care, but insurance did cover it.) Thank you for anyone's response.

[Amieee]

Ooooops! Thanks to smileyface's response, I realize I should have said "half" as much, not "Twice" as much to have the baby at the birth center vs. hospital. That is why I thought it was ironic.
At least I thought it was ironic. The thing I have discovered as I research is that the hospital winds up just eating a lot of the cost. So it really doesn't/didn't/wouldn't cost that much more to the insurance company.
How confusing and warped is this whole system!!!! Argh!!

[smileyface]

Aimee: Now I'm on a different topic, but I wanted to give an additional comment about the irony of insurance. I work in health care, I have medical insurance. I also have a sister who doesn't have any medical coverage so she pays out of pocket for all of her care. Because my insurance company has a "contract" with my physician and my hospital, it only pays the hospital a portion of the bill. Like you said, the hospital eats an amount of the charges to have a relationship with my insurance company. Now my sister, who goes to the same hospital and would be charged the same amount is expected to pay the full bill! She pays more than even my insurance company and she is poor as poor gets. Now is that fair!! She avoids check ups and hospitals like the plague, she'll be in the grave before she'll check herself into the hospital because the hospital bill would put her in a shelter!! Isn't it ironic!! (thanks for letting me rant a bit!!!)

[Andrea_G]

Generally, when a birth center is quoted at such a seemingly high price of $7000 - this includes both the facility AND the midwifery fee. So, it can't exactly be compared to (for example) Kimberly's $3500 hospital birth because that cost does not include the OB's fees.

[Amieee]

Andrea is right.
The cost at the birth center includes everything but a hospital bill is just a hospital bill, then there is a Dr bill.
The birth center is around half the total hospital and Dr with no meds. Sorry I confused everyone!

[ging-ging]

I was in your shoes just a few months ago. We chose to pay out of pocket for a homebirth. I live in NC also.

You can go with a homebirth, and file with your insurance and see what they say. You dont make one attempt with a huge stack of papers anyway... your prenatal care is at an office (even if its your house or her house), so that should get covered. Your aftercare should get covered. Its the actual birth that most often is not covered. My midwife said that the big insurance companies often turn the birth coverage down, but some of the less well known ones have given her full payment.

You also might be able to work out a barter with your midwife... say your husband is a carpeneter and she needs a new porch. that's a great advantage to working with midwives, sometimes you get options like that.

If your husband is dead set on a homebirth, and you go with a hospital, the least he can do is pay for a doula! :) Feel free to email me if you'd like, since we both live in NC.

[djk42]

An idea I have heard of is midwives helping a client get insurance coverage by changing what they charge for. Say she charges $50 for each prenatal visit (15 or them) and $2000 for the delivery. Well, she could bill insurance $100 for each prenatal visit, since insurance covers them, and that way they cover $1500 of the $2750 total. I'm not sure if this is okay to do, I just have heard of midwives doing it to help parents out, especially since they don't blink at a $100 office visit.