"How We Got Insurance Reimbursement for our Out Of Network Homebirth"

From the Bring Birth Home Blog, 05 JULY 2011

Guest post by Jeremy

For us, that went from about $4000 out of pocket to about $2000.  And many people have been able to get FULL reimbursement for an “out of network” homebirth.  In a nutshell, here is what we did:

  • We called our insurance provider.
  • We wrote them a letter.
  • We followed up.
  • We followed up again.
  • We followed up again.

Basically, you need to be persistent.

The main point we tried to drive home in our letters is that our homebirth would save our insurance company money.

In other words, they save thousands to tens of thousands of dollars because we avoided all the costs associated with a hospital birth (the cost of any procedures, monitoring, staying in the room, etc).

A vaginal hospital birth with no complications can cost over $6000.  A cesarean birth with complications can cost over $15,000!  Compare that with our safe, comfy homebirth that cost just over $4000.  You’ll want to put these kinds of numbers into your letters.

The other thing we focused on was how thorough and safe our midwives’ care was.  One of the ways we did this was to list all of the care our midwives provided, including:

  • prenatal visits (list how many)
  • labor monitoring
  • immediate postpartum care
  • postnatal visits (list how many), which include postnatal care for both mom and baby.

Homebirth is safe and natural.

You may know this, but the insurance companies either don’t know it, or have been convinced by naysaying doctors and organizations that it is risky.   Doctors and midwives have been attending homebirths for over 2000 years.  Homebirth for low-risk expectant mothers is neither unsafe or uncommon.

To drive home the point that homebirth is safe, you need to provide some proof.  One of the things we made sure to put in our letters were some quotes and studies.  You can find tons of supporting evidence online.

One study we referenced was by Kenneth C Johnson, which looked at outcomes of planned homebirths.  The study concluded that planned homebirth with midwives, for low-risk women, resulted in lower rates of medical intervention, and similar rates of intrapartum and neonatal mortality to low risk women with hospital births. [more on that study here:http://www.bmj.com/content/330/7505/1416.abstract]

Another thing to drive home is that your midwife is a specialist in several roles.

She provides the care of an obstetrician, a pediatrician, a labor and delivery nurse and a maternity and newborn nurse.  Our midwives certainly helped with breastfeeding in those early weeks, when it was quite a challenging transition for Madhavi.

Remember, most OBs will give you the equivalent of about 2 hours of prenatal care, about an hour to an hour and a half during the birth and about an hour of postnatal care.  Compare that with the care our midwives provided.  We had multiple prenatal visits each an hour long, and only with our midwives (not staff or nurses).  They were with us the entire day during Madhavi’s birthing time.  They provided several postnatal visits to our home, a few in their office and they were on call for us 24/7 for 6 weeks!

If your midwife is willing, she can submit the claims.  Alternatively, you can make her life easier by just getting the billing from her for each visit and point of care, and submitting the claims and appeals yourself.  We chose the latter, as we knew our midwives were very busy.Also, it’s best if you submit claims separately.

So, you would submit for each prenatal visit, then submit for the birth, then submit for the first postnatal visit, etc.  It’s not critical that you do it this way, but it helps.  We didn’t do this quite that neatly, although we did submit a few separate claims.  Ultimately, our appeal was all-inclusive of all points of care.

The key is not to let lots of time pass before you submit.  I’ll admit, we started off okay.  But then we let some time pass before we submitted some of the later claims (kind of makes sense as we were adjusting to our new life as parents!).  Perhaps this is why we were only awarded 60% reimbursement…Or perhaps that is because insurance companies just don’t get it!

The last point I want to make is that persistence will reap rewards.

I wrote a draft letter.  Madhavi edited it, and we kept resending it.  Although we were hoping for at least 80% reimbursement, we were proud to have fought the battle to reclaim some of our money.

We were also proud to have brought just a little more awareness about homebirth to insurance providers.  This is a fight worth fighting, even if it’s only to prove a point.

Feel free to email us at jm@dyenfamily.com if you have any questions.

We wanted to share our letters with you as examples, but unfortunately they have been deleted!

However, for a more in-depth discussion on getting reimbursement for homebirth, including sample letters, check out this post from Cafe Mom.

Also check out this super-detailed archive at Gentle Birth.  This is where we got most of info about getting reimbursement.